Buruli ulcer Disease
Buruli ulcer Disease: Bruli ulcer is a disease that impacts the skin and subcutaneous tissues. It is caused by an environmental pathogen, Mycobacterium ulcerans, that produces a toxin, mycolactone, now known to be accountable for the considerable devastating late lesions. Early lesions include nodules, papules or raised plagues distributed mainly on the limbs and trunk. These lesions subsequently develop into ulcers which if left untreated may cause amputation, contracture deformities, significant disability and sepsis. About a quarter of patients develop long lasting disability. The cost of clinical management is quite high.
The disease is associated with marshes and wetlands and is found in many African countries. It is also popular in Australia. The main burden of the illness is in children in sub-Saharan The African continent although adults buy afflicted. In Ghana the disease has been reported out of all 10 regions of the country. The disease has also been fairly studied in conditions of epidemiology, clinical management and pathogenesis but there remains major unraveled factors in the control of the disease. Two of these major factors include the availability of easy to use classification tools for disease diagnosis in the early period of the disease, when antibiotic treatment produces very good responses and the elucidation of the function of transmission (of the disease).
- Buruli ulcer is a chronic debilitating skin and soft tissue infection which can lead to permanent disfigurement and disability.
- Buruli Ulcer is caused by the Mycobacterium ulcerans bacterium.
- 33 countries with tropical, subtropical and temperate climates have reported Buruli ulcer in Africa, South America and Western Pacific regions.
- In 2014, 2200 new cases were reported by 12 of the 33 countries.
- Majority of patients are children aged under 15 years.
- 80% of cases detected early can be cured with a combination of antibiotics.
Buruli ulcer Disease
In this concern of the journal Adu E, publish their findings on the clinical epidemiology of M. ulcerans disease in an endemic region of Bekwai, ghana. The paper presents data on the various treatment options including the effect of antibiotic treatment of early and late lesions in combo with surgery. It highlights the value of early recognition and appropriate treatment of M. ulcerans disease and the role of antibiotic treatment.
Wilson MD dispute in this issue of the journal4 that Acanthamoeba species are the natural hosts of M. ulcerans and in charge of its tranny. Because of the relationship of M. ulcerans with marshy areas and esturine habitat it has been discovered in aquatic insects, snail, small fish and biofilms of aquatic plants using polymerase chain reactions. Different mechanisms have been postulated for the transmission routine including passage through the salivary glands of aquatic insects.
Buruli ulcer disease
While searching for early diagnostic tools and effective treatment chemotherapy it is important that the seek out the agents accountable for the transmission of M. ulcerans disease be intensified. It is merely when the transmission cycle is known with certainty that appropriate public health interventions can be designed and implemented to reduce the burden of the disease.
Different combination of antibiotics given for 8 weeks are used to treat the Buruli ulcer irrespective of the stage. One of the following combinations may be used depending on the patient:
- a combination of rifampicin (10 mg/kg once daily) and streptomycin (15 mg/kg once daily); or
- also combination of rifampicin (10 mg/kg once daily) and clarithromycin (7.5 mg/kg twice daily) has been used, though its effectiveness has not been proven by a randomized trial.
Since streptomycin is contraindicated in pregnancy, the combination of rifampicin and clarithromycin is considered the safer option for pregnant patients. A combination of rifampicin (10 mg/kg once daily) and moxifloxacin (400 mg once daily) has also been used though its effectiveness has not been proven by randomized trial.
Morbidity management, disability prevention and rehabilitation
Interventions such as wound management and surgery (mainly debridement and skin grafting) are used to speed up the healing of wounds, thereby working to prevent and rehabilitate disability.
It is important to strengthen the capacity of the health system at all levels in affected areas to ensure access to quality care.
As there is no knowledge of how Buruli ulcer is transmitted, preventive measures cannot be applied.
The objective of Buruli ulcer control is to minimize the suffering, disabilities and socioeconomic burden. Early detection and antibiotic treatment is the cornerstone of the WHO Buruli ulcer control strategy.
There are 2 ongoing research activities aimed to improve the management of the disease.
1. Development of oral antibiotic treatment
A randomized clinical trial coordinated by WHO started in Benin and Ghana in 2013 with the objective of developing an oral-based treatment for Buruli ulcer. The recruitment is expected to be completed by the end of 2016, with a one-year follow-up till the end of 2017.
2. Validation of fluorescent thin layer chromatography as point of care test
Preliminary results from the initial analysis of patients’ samples, using the fluorescent thin layer chromatography method to detect mycolactone, has shown great potential for a rapid diagnosis at district-level health facilities1. With the support of the Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland, and Harvard University, field evaluation of the method will start this year in Benin, Democratic Republic of the Congo, and Ghana.
WHO and global response
WHO provides technical guidance, develops policies, and coordinates control and research efforts. WHO brings together all major actors involved in Buruli ulcer on a regular basis to share information, coordinate disease control and research efforts, and monitor progress.
These efforts have also helped to raise the visibility of Buruli ulcer, and mobilized resources to fight it. Under WHO’s leadership and with support of nongovernmental organizations, research institutions and governments of affected countries, steady and impressive progress has been made.