Buruli ulcer disease (WER 7732)

Overview

Buruli ulcer disease (BUD), caused by Mycobacterium ulcerans, is a neglected problem of the poor in remote rural areas that has been increasingly reported from West Africa in recent years. After tuberculosis and leprosy, BUD is the third most common mycobacterial disease among immunocompetent people in some tropical countries. It has been reported or suspected in over 30 countries world-wide. There is a generaly limited awareness of the disease both within the medical community and among the general public, which may result in under-recognition and under-reporting.

BUD is characterized by indolent, necrotizing ulcerations of the skin. The skin lesions progress over weeks to months from typically painless, subcutaneous nodules or plaques, to large, undermined ulcers, usually in the absence of systemic signs of illness. Adverse sequelae are common and include extensive scarring, contractures, osteomyelitis, loss of limb(s) and blindness. In some endemic areas, BUD has replaced tuberculosis and leprosy as the most prevalent mycobacterial disease, affecting up to 22% of the population in some communities. Because the current standard treatment is surgical removal of the affected tissue and possible skin grafting, the economic burden on health care systems is substantial.

Despite the long history of study, the wide geographical distribution, and the severity of BUD, basic questions re-main regarding the route and reservoir of infection, diagnosis, treatment and public health control strategies. Currently, control strategies for BUD are limited to early detection and early treatment to reduce hospitalization, ex-tent of surgery, sequelae, severity of morbidity, mortality and costs. Surgical intervention at the pre-ulcerative (nodule) stage of disease is curative, but few patients present at this stage. Data from a recent study in mice suggest that a combination of rifampicin and amikacin/streptomycin may cure BUD in the early stages, and a pilot study in humans is in progress.