For those of us who live in the western world, there’s a lot of diseases that we don’t hear about or bother to learn about. But, there are people who have to face such diseases every day. One of these diseases is Buruli ulcer.
Buruli ulcer is a chronic, debilitating skin infection caused by mycobacterium ulcerans. It begins as localized skin lesions that worsen into ulceration and even bone disease, causing functional disability, loss of economic productivity, and social stigma (Up to Date). The bacteria produces a unique toxin–mycolactone–which causes this tissue damage and inhibits immune response.
M. ulcerans is the third most common mycobacterial infection worldwide in immunocompetent hosts after tuberculosis and leprosy (Up to Date). Buruli ulcer mainly occurs in West Africa, but cases are also seen in Australia, Mexico, South America, and Papua New Guinea. The peak age group of infected people in West Africa is 5-15 years old whereas it’s 50-66 years in Australia. Most cases occur in humid, tropical areas except for Australia, China, and Japan (WHO).
Until 2010, 5,000 cases of Buruli ulcer were reported worldwide. This number started to decrease until 2016, reaching its minimum with 1,961 cases reported. Since then, the number of cases has started to rise again every year, up to 2,713 cases in 2018. In 2020, 1,258 cases were reported compared with 2,271 cases in 2019. However, this could be linked to the greater focus on COVID-19 detection.
The mode of transmission for Buruli ulcer is unknown. Areas affected by Buruli ulcer are often near still water, so perhaps it is spread via contaminated water. However, more research is required in order to confirm or deny that. There are also no prevention initiatives; the BCG vaccine seems to provide very limited protection.
In 1998, the WHO established the Global Buruli Ulcer Initiative in response to the growing spread of the disease, particularly in West Africa. The primary initiative of this program is to minimize the suffering associated with this disease, particularly when it comes to socioeconomic struggles produced as a result, and accelerate research on this disease. Early detection, antibiotic treatment, and research on its transmission are the keys to successfully controlling Buruli ulcer, a disease that can have chronic, stigmatizing effects on its victims.