Paediatric Buruli ulcer in Australia.

Area of Science:

• Infectious Diseases
• Paediatric Medicine
• Dermatology

Background:

• Buruli ulcer (BU) is a chronic mycobacterial infection primarily affecting tropical and subtropical regions.
• While predominantly seen in adults, paediatric cases of BU are increasingly reported globally and in Australia.

Purpose of the Study:

• To describe the characteristics of paediatric Buruli ulcer (BU) patients in an Australian cohort.
• To compare the clinical presentation, treatment, and outcomes of paediatric BU cases with adult BU patients.

Main Methods:

• Prospective cohort analysis of all BU cases managed at Barwon Health, Victoria, Australia, from January 1998 to May 2018.
• Patients were categorized into children (≤15 years) and adults (16-64 years and ≥65 years).
• Comparison of lesion types, severity, symptom duration, treatment complications, and cure rates between paediatric and adult cohorts.

Main Results:

• The cohort included 52 paediatric BU patients (9.2%) and 513 adult patients.
• Children exhibited a higher proportion of non-ulcerative (32.7%) and severe lesions (26.9%) compared to adults.
• Paediatric patients had shorter symptom duration before diagnosis and lower rates of antibiotic complications but higher rates of paradoxical reactions.
• High cure rates were observed in both children and adults treated with antibiotics alone or with antibiotics and surgery.

Conclusions:

• Paediatric BU cases are increasing in Australia, forming a significant proportion of the overall BU burden.
• Distinct differences in clinical presentation and treatment outcomes exist between paediatric and adult BU patients in Australia.
• This highlights the need for tailored management strategies for children with Buruli ulcer.