Buruli ulcer is a chronic debilitating disease that mainly affects the skin and sometimes bones. First described by Sir Albert Cook in 1897 in Uganda, it was not until the 1930s that Australian scientists led by Peter MacCallum first succeeded in culturing the organism from lesions of patients from the Bairnsdale region. The name Buruli comes from an area of Uganda where many cases were reported in the 1960s. In Africa, about half of the patients are children under 15 years. In Australia, the average age is around 60 years. In 1998, WHO established the Global Buruli Ulcer Initiative in response to the growing spread of the disease, particularly in West Africa.
Buruli ulcer is caused by Mycobacterium and belongs to the family of bacteria that causes tuberculosis and leprosy. Although the causative organism of Buruli ulcer is an environmental bacterium, the mode of transmission to humans remains unknown. The organism produces a unique toxin – mycolactone – that causes the damage to the skin. Early diagnosis and treatment are crucial to minimizing morbidity, costs and prevent long-term disability.
Symptoms
The initial signs of Buruli ulcer involve painless lumps and swelling, typically on the arms and legs but can also appear on other body parts, which can progress into large ulcers with a white and yellow base due to the toxin mycolactone produced by M. ulcerans. This toxin has the ability to suppress the immune system locally, causing rapid progression of the disease without pain or fever, making it challenging to detect early. However, prompt treatment of the ulcers can result in complete healing. Failure to diagnose or treat the condition can lead to scarring, permanent disfigurement, and disability.
Buruli ulcer has been documented in 33 countries across Africa, the Americas, Asia, and the Western Pacific, with the majority of cases occurring in tropical and subtropical regions except for Australia, China, and Japan. Among the 33 countries, 14 regularly provide data to WHO. Until 2010, there were approximately 5,000 suspected cases of Buruli ulcer reported globally each year, but the number gradually declined until it reached its lowest point of 1,961 reported cases in 2016. However, the number of cases has been increasing every year since then, reaching 2,713 cases in 2018. It is unclear why there was a decline in reported cases and why there has been a recent increase.
Treatment
The treatment for Buruli ulcer involves a combination of antibiotics and complementary therapies to manage morbidity and prevent disability. The World Health Organization recommends using rifampicin and clarithromycin as antibiotics for daily use. Health workers can refer to the WHO publication “Treatment of Mycobacterium Ulcerans Disease” for guidance. Other interventions, such as wound care, lymphoedema management, surgery, and physiotherapy, may also be necessary depending on the stage of the disease. Patients with severe disease may require psychological support. The same interventions can be used for other neglected tropical diseases, so it is important to integrate long-term care into the health system. This integrated approach can help detect and manage Buruli ulcer along with other skin-related NTDs.
