Buruli ulcer is an infectious disease, related to the leprosy and tuberculosis virus. The bacteria reaches the tissue under the skin, where it multiplies unnoticed extensively and eats away at the sub-skin tissue without causing pain. When the skin above the infected region finally dies off, a huge ulcer becomes visible.
The precise transmission paths of Buruli ulcer are not yet known. The disease is probably not transmitted from person to person. It is suspected that the proximity and the contact with water as well as insects are somehow related to the disease.
The Buruli virus destroys the sub-skin tissue and, finally, also the skin and causes extensive ulcers. Mostly, the extremities are affected by it. If left unattended, the disease sooner or later burns out and leaves behind severest disabilities, comparable with the condition of untreated burns with severe scars and adhesion. The affected persons, mostly children, must live lifelong with the deformities.
Buruli ulcer is a disease, which – if recognized early enough – can be treated successfully without difficulty. The early recognition is the big challenge. Often, the affected children and adults, however, come too late for the correct treatment, by which time irreversible disabilities have already set in and the diseased range of skin can only be removed through an extensive surgical operation.
Equally problematic is the high remission rate of Buruli patients, which is up to 30% depending upon the treatment.
It is difficult to determine the extent of the disease worldwide, since in many countries the affected persons are still not treated adequately and also not registered. It is estimated today that annually around 20,000 persons are afflicted by Buruli ulcer and treated for it. The estimated number of unreported cases is high. Over half of the registered cases are children below 15 years.
Buruli ulcer was detected in Africa, in West-Pacific as well as Latin America. The affected countries in Africa are Angola, Benin, Burkina Faso, Congo, Democratic Republic of Congo, Ivory Coast, Gabon, Ghana, Guinea, Cameroon, Liberia, Nigeria, Sierra Leone, Sudan, Togo, Uganda and possibly also the Central African Republic. In West Pacific, the affected countries are Australia, China, India, Indonesia, Japan, Malaysia and Papua New Guinea. In Latin America, Buruli ulcer has been detected in Bolivia, French Guyana, Mexico, Peru and Surinam.
If Buruli ulcer is diagnosed early enough, the virus can be excised through a small surgical operation of treated by antibiotics (streptomycin and rifampicin). The treatment with antibiotics is at an early stage is usually successful. Treated at a later stage (big ulcers and distroyed tissue) the only recourse is often extensive surgical treatment with subsequent skin transplantation or even the amputation of the affected limbs. Antibiotics are no longer effective at the later stages but they support the healing process.
Recently reserchers have started to work on an alternative method of treatment, thermo therapy. The affected limbs are heated up by thermal dressings. The Buruli bacilli tolerates heat badly and is - at least - partly killed. This therapy can replace the use of antibiotics but not the surgical treatments in severe cases.
In order to regain mobility after an extensive operation with skin transplantation, the affected persons must spend a lot of time with a specialised physiotherapist. With reconstruction surgery and technical auxiliary means, a functioning everyday life can often be made possible for the severely affected persons once again.
An infection from person-to-person is largely excluded up to now. An infection is possible while staying in regions where Buruli ulcer prevails, especially if one shares the living habits of the people in the infested areas (living and working in swampy zones close to the banks of sub-tropical infested regions).
The disease exists probably ever since primeval times, but was never widespread. Through the increase of the affliction in Africa in the 80s and 90s, relief organisations (like our) and also the responsible authorities in the countries became alert to it. WHO has made the call for the fight against this disease since 1998 and has declared it a threat to world health in 2004.
The reason for the dramatic increase in the past centuries can probably be ascribed to different environmental influences, like the extension of watered surfaces or the disappearance of natural cover along river banks.
