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Tackling “neglected” Buruli Ulcer with Science and Awareness

By Adaobi Rhema Oguejiofor
Facing a serious skin condition caused by bacteria and the support of the environment one lives in can leave a person in a disadvantaged position as in the case of patients living with Buruli ulcer, which mostly affects populations in remote areas with limited access to the formal health sector.
Buruli ulcer, also referred to as Bairnsdale is a chronic debilitating skin disease which is caused by a bacterium called Mycobacterium ulcerans, which produces a toxin that causes skin damage and sometimes affects the bones as well. According to the World Health Organization (WHO), this ulcer belongs to the same family of the bacterium that causes tuberculosis and leprosy. It is characterised by large ulcers, which can lead to long-term and permanent disability without early treatment.
The disease occurs predominantly in West Africa, Central Africa, South America and Western Pacific regions and has been classified as a neglected tropical disease by WHO since most cases occur in tropical, subtropical and temperate climates without much coverage or awareness. It affects communities living along slow-flowing water bodies such as ponds, swamps and lakes. It is, however, still unclear how people get Buruli ulcers from the environment.
WHO highlighted that the mode of transmission of Buruli Ulcer is not known but is being investigated and there is no prevention for the disease as of yet, which is why early diagnosis, detection and treatment is the main strategy to minimize morbidity, costs, as well as prevent long-term disability.
An epidemiologist at Epicentre, Prof. Yap Boum,who is leading a study aimed at simplifying the diagnosis of Buruli ulcer, noted that, it is believed that many cases of Buruli ulcer go unreported as a result of limited knowledge of the disease, limited access to a reliable diagnostic that is available only in few laboratories, its focal distribution and the fact that it affects mainly poor, and rural communities. Although all ages and sexes can be affected by the disease, young children appear to be most at-risk, with most patients being under 15 years of age. A study revealed that there is a higher prevalence of about 66.7 per cent in females compared to males.
For the symptoms, Buruli ulcer at an early stage starts as a painless swelling, lump or nodule. The local immunosuppressive properties of the mycolactone toxin enable the disease to progress with no pain or fever. If it progresses without treatment or sometimes even during antibiotics treatment, the nodule or plaque will ulcerate within four weeks with the classical, undermined borders where the edges appear eaten away and often with a yellow or white base. Occasionally, at the last stage, bone involvement, extensive tissue destruction, severe scarring, and permanent disability or deformity in the limbs can occur.
Although the exact cause or mode of transmission of Buruli ulcer remains unknown, potential scientific theories outline possible causes to include contact with contaminated water sources, such as stagnant swamps, and slow-moving rivers, bites from insects like mosquitoes and aquatic bugs that carry the bacteria, and based on ongoing research, contact with infected animals or environmental sources.
Early diagnosis is very crucial for effective treatment and minimizing scarring. To treat the disease, a combination therapy is usually required like the use of antibiotics, such as rifampicin, streptomycin, and clarithromycin, to kill the bacteria. This prescription dosage can be lengthy lasting for up to 8 weeks.
Also, surgical debridement, which involves the removal of dead and infected tissue to promote healing and prevent further spread is applied, as well as skin grafting, which in severe cases, may be needed to reconstruct damaged areas.
In case of complications, permanent scarring and disfigurement can occur especially if diagnosis and treatment are delayed. Contractures or limited joint mobility, due to scar tissue formation can also take place.
No vaccine for the prevention of the disease exists currently. However, raising awareness about the disease and its symptoms is crucial. Other measures include, avoiding potentially contaminated water sources in endemic areas, wearing protective clothing and insect repellent in high-risk environments, and early diagnosis, as well as prompt treatment, are essential to prevent complications.
The issues of limited awareness of the disease and the fact that it often affects poor populations in remote and rural areas have hampered the detection of new infections, thus, also hindering progress in the control of Buruli ulcers. However, Research is ongoing to understand the exact mode of transmission, develop better diagnostic tools and explore potential vaccine candidates.