What is Buruli ulcer?
Habu Bash Buruli ulcer often starts as painless nodules, usually on the arms or legs. These then develop into large ulcers, with a whitish-yellowish base. Although most ulcers eventually heal, poorly managed patients may develop severe scars and local deformities, including disabling contractures. The disease occurs most frequently in children living in rural tropical environments, […]
Habu Bash
Buruli ulcer often starts as painless nodules, usually on the arms or legs. These then develop into large ulcers, with a whitish-yellowish base. Although most ulcers eventually heal, poorly managed patients may develop severe scars and local deformities, including disabling contractures. The disease occurs most frequently in children living in rural tropical environments, near wetlands. It can be treated with antibiotics and surgery.
Mycobacterium ulcerans is a bacterium, which causes an ulcerative skin disease, known as Buruli ulcer. The mode of transmission of the infection to humans is unknown, although there is some evidence that it may be transmitted through the bites of infected aquatic insects. Buruli ulcer is one of the 17 neglected tropical diseases. It is caused by infection with Mycobacterium ulcerans, an organism which belongs to the family of bacteria that causes tuberculosis and leprosy.
In Africa, about 48% of those affected are children under 15 years, whereas in Australia, 10% are children under 15 years and in Japan, 19% are children under 15 years. Gender distribution of the disease also varies: Africa – 52% males and 48% females; and Japan – 34% males and 66% females.
In general, about 35% of lesions occur on the upper limbs, 55% on the lower limbs and 10% on the other parts of the body. In Africa, most cases are still diagnosed late: Category I (32%), Category II (35%) and Category III (33%). In North Africa about 26% of cases are diagnosed before ulceration while in Australia and Japan, less than 10% are diagnosed before ulceration.
The exact mode of transmission of M. ulcerans is still unknown. However, it appears that different modes of transmission occur in different geographic areas and epidemiological settings. There may be some role for living agents as reservoirs and as vectors of M. ulcerans, in particular aquatic insects, adult mosquitoes or other biting arthropods.
Signs and symptoms
Buruli ulcer often starts as a painless swelling (nodule). It can initially also present as a large painless area of induration (plaque) or a diffuse painless swelling of the legs, arms or face (oedema). Local immunosuppressive properties of the mycolactone toxin enable the disease to progress with no pain and fever. Without treatment or sometimes during antibiotics treatment, the nodule, plaque or oedema will ulcerate within four weeks with the classical, undermined borders. Occasionally, bone is affected causing gross deformities.
Depending on the patient’s age, location of lesions, pain, and geographic area, other conditions should be excluded from the diagnosis. These include tropical phagedenic ulcers, chronic lower leg ulcers due to arterial and venous insufficiency (often in the older and elderly populations) and diabetic ulcer.
HIV infection is not a risk factor but it weakens the immune system, making the progress of Buruli ulcer more aggressive. Coinfected patients often present multifocal lesions and bone inflammation (osteomyelitis).
The aim of Buruli ulcer control is to minimize the suffering, disabilities and socioeconomic burden.
The strategy is based on early detection and antibiotic treatment. The following activities are essential for implementing this strategy:
1. Health education at the community level to enhance early reporting;
2. Training of health workers and village volunteers;
3. Laboratory confirmation of cases;
4. Standardized recording and reporting system and mapping;
5. Strengthening of health facilities;
6. Monitoring and evaluation of control activities.