Survey on the Prevalence of Buruli Ulcer among Patients with Persistent Wounds in Imo State, Nigeria

Background Buruli ulcer (BU), caused by Mycobacterium ulcerans , is a neglected tropical disease presenting with chronic necrotizing skin lesions. In Nigeria, its role in the burden of persistent wounds is poorly understood due to diagnostic challenges and overlapping clinical presentations. Methods We conducted a multisite cross-sectional study among patients with wounds persisting ≥ 4 weeks across healthcare facilities in Imo State, Nigeria. Socio-demographic, clinical, and exposure data were collected using standardized questionnaires. Wound specimens were tested with IS2404 real-time PCR (reference standard), smear microscopy, and histopathology (subset). Logistic regression identified independent predictors of BU. Results Of 300 participants, 75 (25.0%) had PCR-confirmed BU. Most were adults aged 30–59 years (53.4%), farmers (40.0%), and individuals reporting freshwater exposure (70.0%). Lesions were mainly on the lower limbs (53.3%), large (≥ 5 cm, 66.7%), and chronic (≥ 12 weeks, 60.0%). Seventy percent initially sought care outside the formal health system. Predictors of BU included freshwater contact (aOR = 3.25, 95% CI: 1.45–7.28), lower limb lesions (aOR = 2.80, 95% CI: 1.20–6.55), and symptom duration > 12 weeks (aOR = 4.10, 95% CI: 1.85–9.08). Smear microscopy showed low sensitivity (48%) but high specificity (90%); histopathology demonstrated sensitivity of 65% and specificity of 95%. PCR achieved 100% accuracy with a median turnaround of 3 days. Conclusions BU is a substantial but under-recognized cause of persistent wounds in southeastern Nigeria. Early recognition, risk-based screening, and deployment of rapid molecular tests at peripheral facilities are essential to improving detection and outcomes.