Buruli Ulcer: A Dangerous Yet Neglected Disease

Buruli Ulcer: A Dangerous Yet Neglected Diseas

By Halima Ishaku Unbuwa

Buruli Ulcer (BU) is a neglected, debilitating skin disease caused by infection with Mycobacterium ulcerans. After the first definite description in 1948, M. ulcerans infections have been reported from 34 countries, mainly with tropical and subtropical climates. Following a peak of 5,954 reported BU cases globally in 2004, the number of new recorded cases has been decreasing in recent years. In 2016, a total of 1,952 BU cases were reported to the World Health Organisation (WHO) from twelve different countries.

Underreporting is considered likely, as BU mostly affects populations in remote areas with limited access to the formal health sector. Although transmission pathways of M. ulcerans are still unclear, infection foci are closely associated with wetlands. This is the third most common disease after tuberculosis and leprosy.

Although, it is not known how people get Buruli ulcer.One possibility is that the disease is passed to humans from some insects that are found in water. While no proven link exists between human and animal infection, some animals can get the disease.For example, laboratory tests from Victoria, Australia, confirmed the disease in several animals including horses, dogs, Alpacas, Koalas, Possum, etc.

The symptoms of Buruli ulcer include: swelling of the skin, destroyed skin and soft tissue, and one or more slow growing, generally painless ulcers. People who are sick should see a doctor and get antibiotics (medicine that can help stop the disease). If these antibiotics are not given soon after getting sick, the disease can sometimes lead to:Deformity, Functional disability (such as limited joint movement), Bone infection, Secondary bacterial infection of skin ulcer lesions.

Buruli ulcer is found in at least 33 countries with tropical, subtropical, and temperate climates.In 15 of these 33 countries, between 5,000 and 6,000 cases are reported every year. Overall, most cases occur in rural communities in sub-Saharan Africa. Nearly half of those affected in Africa are children under 15 years of age.

Prior to 2004, excision was the treatment of choice for Buruli ulcers. Most patients required multiple staged surgeries and extensive skin grafts, which resulted in prolonged hospitalizations, averaging around three months. Recurrence rates after surgery alone were 16-28 per cent. With the use of antibiotics, 40 per cent of patients do not require surgery.

In conjunction with antibiotics, surgery is used to remove devitalised tissue, cover open wounds with skin grafts, and correct or minimise deformities.While traditionally Buruli ulcers are thought to be painless as a result of the neurotoxic effects of mycolactone, many patients experience pain during wound care, which must be addressed.

Currently, the only dressing used for wound care is gauze, which results in pain and bleeding when removed. More research needs to be performed to determine the best dressings to be used for these patients. Additionally, the availability of clean water and good hygiene are important for the management of Buruli ulcers and prevention of secondary infections.

Suggestions to reduce the risk of infection include: Reduce mosquito breeding sites around houses and other accommodation by reducing areas where water can pool (including pot plant containers, buckets, open tins or cans, discarded tyres, and other untreated, freshwater pools).

Mosquito proof your home by securing insect screens on accommodation.

Avoid mosquito bites by using personal insect repellents containing diethyltoluamide (DEET) or picaridin

Covering up by wearing long, loose-fitting, light-coloured clothing

Avoiding mosquito-prone areas and vector biting times, especially at dusk and dawn.

When gardening, working or spending time outdoors: Wear gardening gloves, long sleeved shirts and trousers;

Wear insect repellent on any exposed skin Protect cuts and abrasions with a dressing.

Promptly wash any new scratches or cuts you receive with soap and apply a topical antiseptic and dressing.

Exposed skin contaminated by soil or water should be washed following outdoor activities.

– Unbuwa is a Mass Communication student in ABU, Zaria.