A Buruli ulcer is a debilitating infection of the skin and soft tissue that, when left untreated, can progress to ulcers, bone infections, and even deformities. A huge cause for concern in tropical and sub-tropical countries, a Buruli ulcer is tricky to identify – it appears as a painless nodule on the surface, doing its damage beneath the surface until the local tissue is completely necrotized. Over 5000–6000 cases are reported every year in a good majority of the countries Buruli ulcers have ravaged.1
Buruli Ulcers Are Caused By Mycobaterium Ulcerans
People living in countries with tropical, subtropical, or temperate climates are at risk of contracting buruli ulcers. This is especially true for rural communities in sub-Saharan Africa where half of those affected are children under 15 years of age. Parts of South America and Australia are also infection-prone.2
Buruli ulcers get transmitted via water or skin-to-skin contact, with mycobacterium ulcerans being responsible for the infection. It develops rapidly in a sub-tropical or tropical, humid environment. Bacteria of the Mycobacterium family are also responsible for other illnesses such as tuberculosis and leprosy. One common thread through these three diseases is that they can drastically impact a person’s quality of life and functional ability if not caught and treated in time.
A toxic chemical called mycolactone released by the Mycobacterium ulcerans is responsible for the tissue death associated with a Buruli ulcer. Mycolactone causes the tissue in the area to lose immune function, making it prone to secondary infection and tissue death.3
Aquatic bugs of the Naucobris and Diplonychus family are thought to act as hosts for the bacterium that causes the ulcers. The bacteria live and multiply in the salivary glands of these insects without harming them in any way. Even a small cut or wound can become a window for these insects to inject the human body with the bacterium, where it grows and causes ulcers.4 Animals such as horses, dogs, alpacas, and koalas have been found to be infected in Australia, but it’s not clear whether these animals actually transmit the infection to humans.5
The Symptoms Of Buruli Ulcer Include Swelling And Tissue Damage
A Buruli ulcer starts out as a painless nodule that is often mistaken for a boil or a swelling of a lymph node. This nodule, usually seen in the limbs, then proceeds to grow in size, destroying the tissue in its path. Due to the release of mycolactone in the infected area, there is no pain or fever, typical immune-system reactions to an infection.6 This perhaps explains why people don’t approach a doctor until the nodule turns into an ulcer and secondary infections set in. However, if caught in time and treated with antibiotics, the condition can be cured completely.
Diagnosis Of Buruli Ulcers Involves Clinical And Laboratory Tests
In order to diagnose buruli ulcers, professionals perform the following tests:7
- Clinical checkup: This includes looking into whether the patient lives in, or has traveled to, an endemic area. The doctor will also check for lesions. 85% of these lesions are found on the limbs with lower limbs being twice as likely to have them as opposed to the lowers.
- Laboratory tests: These include microscopy, culture, PCR, and histopathology. Of these, microscopy and PCR are used routinely for diagnosis.
Buruli Ulcers Are Treated With The Help Of Antibiotics Or Surgery
Earlier, most patients and doctors working in disease-prone places often cut out the tissue or amputated the bone in the infected area. More recently, antibiotics such as streptomycin have been used to treat milder cases.8 Surgery, mainly to debride the wound, remove dead skin, and graft skin, is necessary in some cases.9 In severe cases where infection has spread to the bone and may cause sepsis, amputation is necessary to save the patient’s life.
Considering the cost of medication which many can’t afford, locals often use a variety of herbal medicines to treat Buruli ulcers. In 2015, studies were able to prove the efficacy of some of these plant products. For example, aloe vera was found to be an effective ally in managing the condition thanks to its antibacterial, anti-inflammatory, and wound-healing properties. It also helped the repair of infected tissue. Extracts from the trees of the Alstonia family and the medicinal plant forest burr (Pupalia lappacea) have been shown to help heal the wounds and inhibit the infection. Even compounds derived from guava trees and garlic plants, when consumed orally, have antimicrobial properties that can help mend the wounds.10 If proven to be 100% effective, these alternative therapies can go a long way in treating this endemic disease, apart from providing relief to people who can’t always afford mainstream medicine.
Delayed Treatment Of Buruli Ulcers Can Have Lifelong Implications
If adequate medical care is not provided in time, a Buruli ulcer can soon become more than just a cosmetic issue. Back in the late 90s in Ghana, about 25% of all people who reported a Buruli ulcer faced life-long deformities and even death.11 Even today, delays in treatment can cause
- Functional disability (such as limited joint movement)
- Bone infection
- Secondary bacterial infection of skin ulcer lesions
In Africa, the condition has improved only slightly since. This has huge socioeconomic implications, with people who’re already fighting poverty and food scarcity often losing working family members to the illness.
Only a handful of cases have been reported in the United States, mainly among people returning from Africa or Australia.12
|↑1||Buruli Ulcer: Risk of Exposure, CDC.|
|↑2||Risk of Exposure. Centers For Disease Control And Prevention.|
|↑3||Buruli Ulcer Fact Sheet, World Health Organization.|
|↑4||Marsollier, Laurent, Raymond Robert, Jacques Aubry, Jean-Paul Saint André, Henri Kouakou, Pierre Legras, Anne-Lise Manceau, Chetaou Mahaza, and Bernard Carbonnelle. “Aquatic insects as a vector for Mycobacterium ulcerans.” Applied and environmental microbiology 68, no. 9 (2002): 4623-4628.|
|↑5, ↑9||How do people get Buruli ulcer? CDC.|
|↑6||Buruli Ulcer Fact Sheet. World Health Organization.|
|↑7||Sakyi, Samuel A., Samuel Y. Aboagye, Isaac Darko Otchere, and Dorothy Yeboah-Manu. “Clinical and laboratory diagnosis of Buruli ulcer disease: a systematic review.” Canadian Journal of Infectious Diseases and Medical Microbiology 2016 (2016).|
|↑8||Etuaful, S., B. Carbonnelle, J. Grosset, S. Lucas, C. Horsfield, R. Phillips, M. Evans et al. “Efficacy of the combination rifampin-streptomycin in preventing growth of Mycobacterium ulcerans in early lesions of Buruli ulcer in humans.” Antimicrobial agents and chemotherapy 49, no. 8 (2005): 3182-3186.|
|↑10||Tsouh Fokou, Patrick Valere, Alexander Kwadwo Nyarko, Regina Appiah-Opong, Lauve Rachel Tchokouaha Yamthe, Mark Ofosuhene, and Fabrice Fekam Boyom. “Update on Medicinal Plants with Potency on Mycobacterium ulcerans.” BioMed research international 2015 (2015).|
|↑11||Asiedu, Kingsley, and Samuel Etuaful. “Socioeconomic implications of Buruli ulcer in Ghana: a three-year review.” The American Journal of Tropical Medicine and Hygiene 59, no. 6 (1998): 1015-1022.|
|↑12||Berger, Stephen. Infectious Diseases of the United States. GIDEON Informatics Inc, 2014.|