Cases and Conditions / Buruli Ulcer

What is Buruli ulcer?

Buruli ulcer, a disease caused by a bacterium related to those that cause tuberculosis and leprosy, has emerged as a major cause of human suffering over the past 20 years. It most commonly affects impoverished inhabitants in remote and isolated rural areas with limited access to health care, frequently occurring in close proximity to stagnant water. All age groups but particularly children under 15 years are affected. Transmission is not fully understood but the organism probably enters the body through small breaks in the skin from contaminated soil, water or vegetation carried by aquatic bugs. Entry may be through a wound as slight as a hypodermic needle puncture.

Where does it occur?

In recent years increasing numbers of cases have been reported from West African countries with the incidence in some areas now exceeding those of tuberculosis and leprosy. In one community in Ghana 22% of the people have the disease and in one of the endemic districts in Ghana an estimated 3.19 per 1000 suffer from this devastating condition. In addition to an increase in actual numbers of cases, there is also increasing geographical spread of the disease within West Africa.

What are its effects?

Buruli ulcer starts as a painless often itchy swelling on the skin which is often ignored at first and there is usually a long delay before the patient seeks care. A nodule develops teeming with mycobacteria that produce a toxin that destroys tissue and suppresses the immune system. If left untreated the nodule may lead to massive skin ulceration (lesions) followed by debilitating complications that may include contractual deformities, amputation of limbs, loss of organs such as the eyes, breast and genitalia. The Buruli factsheet photos show that no part of the body is safe from its devastating effects.

Unfortunately antibiotics have proved ineffective and surgery is the current treatment of choice. However, adequate surgical facilities are rarely available in most endemic areas of the developing world. With its spread and associated complications, the long-term economic and social impact of Buruli ulcer on rural populations could be substantial.

Prevention, Surveillance and Control

The management of Buruli ulcer is frustrating and often unrewarding. Its chronic and often recurrent nature makes it expensive to manage both for the patient and the health service provider. The World Health Organisation has recognised Buruli ulcer as an emerging public health threat and is working with endemic countries world-wide to co-ordinate control, research and awareness-raising efforts. Very little is known about various aspects of the disease, notably its mode of transmission to human beings and its causative organism. Its geographical distribution is far from established. Improving local awareness of the importance of early treatment is vital. There is much work to be done.

For further information see the World Health Organisation website