Buruli - a puzzling disease

Buruli ulcer is almost unknown in Europe. In West Africa, the “little sister” of leprosy is very widespread - and has hardly been researched.

Buruli ulcer is an insidious disease: it is caused by a bacterium that excretes a poison. This suppresses the immune defense. The pain is often only felt when the bacterium has already destroyed the skin and tissue down to the bone. Immediate antibiotic treatments are crucial in these stages of the disease. This kills the pathogen.

What is Buruli Ulcer?

Buruli ulcer is caused by the leprosy bacterium related "Mycobacterium ulcerans". This secretes a toxin (mycolactone), which destroys the skin and tissue down to the bone. At the same time, the immune defense and the sensation of pain are suppressed. Because of the painlessness, but also because the disease is afflicted with a strong stigma in many places, the wounds are often hidden at first or are often only noticed by those affected when larger ulcers (open wounds) have already formed. Medical help is sought too late.

How is Buruli ulcer transmitted?

Although it was described over 100 years ago, the path of the infection is still unknown and accordingly there are no concrete measures to protect against infection. Buruli is unlikely to be transmitted from person to person. Since people often get sick near bodies of water, it is believed that an insect that needs water to live can transmit the disease. Why contact with standing water, e.g. during agricultural work, poses a risk of infection.

What does the clinical picture look like?

The first symptoms of Buruli are small, non-painful lumps or lumps under the skin. Once inside the body, the bacteria often eat their way through skin, bones and other tissues on the arms and legs, creating large, flat, painless ulcers. When the disease is finally recognized, it has usually already caused great damage, similar to leprosy.

How is Buruli Ulcer diagnosed?

Both the primary detection and treatment of Buruli ulcer require a very experienced team; an ulcer can often be diagnosed as a Buruli ulcer based on its appearance. In any case, however, the diagnostic evidence must be provided. This is done in specific laboratory tests, for which some tissue has to be removed.

Today, these methods are so refined that antibiotic therapy can already determine whether the causative bacteria have been killed and healing can be expected.

Is Buruli Ulcer Curable?

In principle, the disease is curable and is rarely fatal. Unfortunately, there is still no good and simple therapy. In the early stages of the disease, one can try to treat Buruli ulcer with a combination of antibiotics for eight weeks. Unfortunately, this treatment is often associated with serious side effects such as numbness.

If left untreated, serious complications can also occur, for example in the form of a stiffening of joints and severe contractures, if large ulcers extend over joints for a long time without treatment and thereby lead to the shrinking of the underlying tissue. Alternatively, one can try to surgically remove the Buruli ulcer over a large area. The resulting wounds heal very slowly and can become infected with other bacteria. If the Buruli ulcer heals, large scars remain, which often lead to restricted mobility and deformities on the arms and legs. These patients must undergo intensive physical therapy to restore joint function.

How is Buruli ulcer treated?

The treatment of ulcers, in particular, is complicated and tedious. The following treatment measures are used:

  • An elaborate wound care
  • the administration of a combination of antibiotics against the pathogens
  • surgical interventions

Today, treatment begins with a combination of two antibiotics over a period of 8 weeks. Due to many studies, this therapy is considered mandatory and has been established as a guideline by the WHO.

The initial drug treatment (antibiosis) ensures that either smaller ulcers heal completely or larger ulcers become significantly smaller; however, if tissue excision is necessary, this can be done to a much more limited extent. In this case, however, the smaller remaining wound - after often longer wound care - still has to be covered with a skin graft.

Until a few years ago, surgical therapy was the main focus of treatment: the ulcer was cut out, removing the visibly damaged tissue, and the wound was then covered with a skin graft.

The battle with Buruli ulcer can hardly be won with current resources. There is an urgent need for more research to develop better diagnosis and therapy and to discover suitable preventive measures.

Who does Buruli ulcer affect?

Buruli ulcer mainly affects children (around 50% of those affected are younger than 15 years). The “Buruli” region in Uganda gave the disease its name.

Where exactly is Buruli ulcer common?

Buruli occurs in 30 countries worldwide. Especially common in swampy, humid areas of West and Central Africa.

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