Buruli Ulcer: A Neglected Tropical Disease

Abstract

Buruli ulcer is a neglected trophical disease. It is characterized by the development of painless open wounds. It causes large skin ulcers mainly in children aged 5 to 15 years. Buruli ulcer is a skin infection caused by a bacterium called Mycobacterium ulcerans. The disease is concentrated in West Africa and coastal Australia, with occasional cases in Japan, Papua, New Guinea and the Americas. In West Africa, the disease is predominantly reported from remote, rural communities, Côte d'Ivoire, Cameroon, Ghana, and Nigeria.  In endemic areas, the disease occurs near stagnant bodies of water. This is in agreement with the long-standing hypothesis that M. ulcerans is somehow transmitted to humans from aquatic environments. The first sign of Buruli ulcer is a painless swollen bump on the arm or leg, often similar in appearance to an insect bite. Over the course of a few weeks, the original swollen area expands to form an irregularly shaped patch of raised skin. Buruli ulcer can be diagnosed using microscopy, culture, and polymerase chain reaction.  For microscopy, fluid is typically taken from the ulcer's edge by fine-needle aspiration or by swabbing the edge of the ulcer. The fluid is then stained with the Ziehl–Neelsen stain which makes Mycobacterium visible. Buruli ulcer is treated with a combination of antibiotics such as streptomycin, azithromycin to kill the bacteria, wound care and surgery to support the healing of the ulcer. Buruli ulcer can be prevented by avoiding contact with aquatic environments in endemic areas. The risk of acquiring it can be reduced by wearing long sleeves and gardening gloves, and using suitable repellents to avoid the contamination of this disease. Buruli ulcer is a public health challenge especially in rural areas of developing countries that should be given more attention by the government and policy makers.