Buruli Ulcer Disease

Not as well known as other tropical diseases, the Buruli ulcer is still an infection to be reckoned with. Caused by Mycobacterium ulcerans, this bacterium is in the same family as the bacteria that cause leprosy and even tuberculosis, two infections more known worldwide.

Infection from this Buruli bacteria causes quite a bit of damage to the soft tissues and the skin with the formation of ulcers. These ulcerated areas usually occur on the arms or legs. If these Buruli ulcers are not treated in the early stages of the disease, sufferers not only have to live with ugly deformed skin but also considerable pain in the joints as well as partial immobility.

Up to 50 countries worldwide with sub-tropical and tropical environments have incidences of Buruli ulcer disease with even more not readily identified. Africa, the Western Pacific areas, Central and South America, parts of Australia and even China have reported cases of Buruli. The World Health Organization (WHO) calls this disease one of the neglected tropical diseases as not much is known about it.

Likely Causes of Buruli Ulcer Disease

Many researchers believe that the bacterium which causes Buruli is environmentally based in specific niche areas. As of right now, they believe that aquatic areas are the likely breeding grounds but there is still no idea of exactly how the bacteria is transmitted to humans. The theory is that somehow the bacteria enter the human body through a previous wound or trauma to the skin.

A recent study [1] has shown that wading in swamps and wearing short clothing during farming activities are risk factors for BU. In addition, some aquatic insects do harbor the bacteria in their saliva but are not always known to bite.

There are various strains of these bacteria depending on where the disease occurs.It is not the bacteria themselves that cause the ulcerated areas that are identified as Buruli ulcer disease but the toxin they produce. This toxin called mycolactone is what causes the damage to the soft tissues and skin and hinders the body’s immunological response.

Buruli ulcer disease is often diagnosed in people who live near bodies of water like lakes, swamp areas, sluggish flowing water and ponds. Risk factors are those people who wade and play in these water ways as well as farmers in the region who use the water sources for irrigation. Seasons do not affect the rate or timing of infection and there is no predisposition as to which sex the disease occurs in more.

Symptoms and Treatment of Buruli

A nodule usually forms first just under the skin, with some swelling and no accompanying pain. The swelling can extend beyond the nodule area too. Sometimes, instead of a nodule, a pimple-like formation occurs. Eventually the bacterium affects the tissue and become necrotic which leads to the ugly, potentially disfiguring ulcers. Fever and secondary infections typically occur around the site as well.

Diagnosis is usually made definitively through cultures taken from the ulcer itself. Treatment is usually a combination of several things. First, there are strong antibiotics that are given for several months and do not have to be administered at a hospital unless the Buruli ulcer disease is advanced.

Surgery is also an option to remove dead tissue as well as cosmetically correct any disfigurements. There are other medical interventions that may be employed to minimize disability and mobility.

The average traveler is not likely to contract Buruli ulcer disease. However it is a possibility if you are working in one of the target countries for peace or medical missions. These capacities often come in close contact to the aquatic areas which could be affected by the bacteria.

1. Pouillot R, Matias G, Wondje CM, Portaels F, Valin N, et al. (2007) Risk Factors for Buruli Ulcer: A Case Control Study in Cameroon. PLoS Negl Trop Dis 1(3): e101. doi:10.1371/journal.pntd.0000101

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