Buruli ulcer, caused by Mycobacterium ulcerans66顺彩票app is a chronic debilitating disease that affects mainly affects the skin and sometime bone. First described by Sir Albert Cook in 1897 in Uganda. It was not until the 1930’s that Australian scientists led by Peter MacCallum first succeeded in culturing the organism from lesions of patients from the Bairnsdale region. They referred to their discovery as “A new mycobacterial infection in man”. The name Buruli however comes from a country in Uganda where a lot of cases were reported in the 1960s. In Africa, the about half of the patients are children under 15 years. In Australia, the average age is around 60 years. In 1998, WHO established the Global Buruli Ulcer Initiative in response to the growing spread of the disease particularly in West Africa.
M. ulcerans belongs to the family of bacteria that causes tuberculosis and leprosy. However, the causative organism of Buruli ulcer is an environmental bacterium but the mode of transmission to humans remains unknown. The organism produces a unique toxin – mycolactone – that causes the damage to the skin. Early diagnosis and treatment are crucial to minimizing morbidity, costs and prevent long-term disability.
66顺彩票appTreatment consists of a combination of antibiotics and complementary treatments (under morbidity management and disability prevention/rehabilitation).
Current WHO recommendations are rifampicin 10 mg/kg per body weight daily and clarithromycin 7.5 mg/kg per body weight twice daily. Treatment guidance for health workers can be found in the WHO publication "Treatment of mycobacterium ulcerans disease (Buruli ulcer)."
In addition to the antibiotics and depending on the stage of the disease, other interventions such as wound care, lymphoedema management, surgery (mainly debridement and skin grafting to speed up healing) and physiotherapy are needed. Psychological support may also be needed for those with severe disease.
These same interventions are applicable to other neglected tropical diseases, such as leprosy and lymphatic filariasis so it is important to integrate a long-term care approach into the health system to benefit all patients. The integrated approach to the control of skin-related NTDs provides an opportunity to integrate Buruli ulcer detection and its management with these diseases.
66顺彩票appBuruli ulcer has been reported in 33 countries in Africa, the Americas, Asia and the Western Pacific. Most cases occur in tropical and subtropical regions except in Australia, China and Japan. Out of the 33 countries 14 regularly report data to WHO.
Between 2002 and 2018, a total of 63,000 cases have been reported. The annual number of suspected Buruli ulcer cases reported globally was around 5000 cases up until 2010 when it started to decrease until 2016, reaching its minimum by 1961 cases reported. Since then, then number of cases has started to rise again every year up to 2713 cases in 2018. The reasons for the decline and for the recent increase in not clear.
In Africa, the majority of cases are reported from West and Central Africa, including Benin, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Nigeria and Ghana. Liberia has recently started to report large number of suspected cases, while Côte d’Ivoire which used to report the highest number of cases in the world (2242 cases in 2008) reported only 261 cases in 2018. Outside Africa, the Australia remains a major endemic country where cases have been reported since 1930s.