Buruli ulcer

20 February 2018

Buruli ulcer: early detection and antibiotic treatment cures this debilitating skin condition

Buruli ulcer is an ulcerative skin disease caused by the bacterium Mycobacterium ulcerans.

It often starts as painless nodules, usually on the arms and legs. These then develop into large ulcers with a whitish-yellow base. Buruli ulcer can be cured with early detection and a combination of antibiotics. But, if diagnosed late, the condition can lead to permanent disfigurement and disability.

This fact file features important aspects of Buruli ulcer.

WHO

Buruli ulcer can lead to permanent disfigurement and disability

Buruli ulcer is caused by the bacterium Mycobacterium ulcerans. The infection mainly affects skin, soft tissue and bone, and leads to the formation of large ulcers found usually on legs and arms. Although most ulcers eventually heal, poorly managed patients may develop severe scars and deformities.

K Abass

25% disability risk if cases are reported late

Patients who are not treated early enough suffer long-term functional disability. Infection of bone can lead to gross deformities and amputation of limbs. The key approaches to minimize suffering are based upon early detection and antibiotic treatment.

WHO

Over 30 countries have reported Buruli ulcer

Regular and accurate reporting helps keep track of the disease and treatment progress. To date, Buruli ulcer has been reported in 33 countries across Africa, the Americas, Asia and the Western Pacific. Most cases occur in tropical and subtropical regions, except in Australia, China and Japan.

J Buntine

Data from 14 countries show 2713 suspected Buruli ulcer cases reported in 2018

Countries in West and Central Africa - Benin, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo and Ghana – account for 85% of reported cases. Australia remains a major foci outside Africa. But, overall, the disease is considerably under reported. Across Africa, most cases are still diagnosed too late. While most Category I lesions (~90%) are diagnosed in Australia and Japan, only 32% are identified in African patients.

WHO

Many patients are under the age of 15 living in rural, tropical environments

The clinical and epidemiological aspects of the Buruli ulcer vary considerably within and across different countries and settings. In Africa, about 48% of those affected are children under 15 years. This figure for children under 15 years is much less in Japan (19%) and Australia (10%).

J Buntine

Mycobacterium ulcerans is in the same family of bacteria that cause tuberculosis and leprosy

Under the microscope, M. ulcerans and M. tuberculosis look the same. But M. ulcerans grows in lower temperatures (29–33 °C) than M. tuberculosis (36–37 °C). Unlike TB, the mycolactone produced by M. ulcerans is responsible for the tissue damage in Buruli ulcer.

ANESVAD

55% of lesions occur on lower limbs

M. ulcerans infection leads to the destruction of skin and soft tissue with large ulcers usually found on the legs and arms. While the majority of lesions are found on the lower limbs, about 35% of lesions occur on the upper limbs and 10% on other parts of the body.

WHO

80% of cases detected early can be cured

Prompt diagnosis and treatments involving a combination of specific antibiotics have vastly improved outcomes for patients since the introduction of antibiotics treatment in 2005. Recurrences have almost disappeard with antibiotics treatment. A late diagnosis can lead to long and costly hospitalizations.

WHO

Mycobacterium ulcerans produces a unique toxin called mycolactone

Buruli ulcer often starts as a painless swelling without fever, which makes early detection difficult. M. ulcerans produces a unique toxin – mycolactone – which causes tissue damage and inhibits the local immune response. The toxin’s local immunosuppressive properties enable the disease to progress rapidly with no pain and fever. An innovative method using a fluorescent thin-layer chromatography to detect mycolactone in infected tissue is being used as a rapid diagnostic test.

WHO

Health education is key in Buruli ulcer control

Early detection and antibiotic treatment are the cornerstone of the control and management of Buruli ulcer. Disease awareness, community health education, screening, training of health workers and active involvement of village volunteers are crucial to ensure early diagnosis and treatment of the disease.