Understanding Buruli Ulcer: A Neglected Tropical Disease
Buruli ulcer is a debilitating and often under-recognized bacterial infection that affects the skin and soft tissue. It is caused by Mycobacterium ulcerans, a close relative of the bacteria responsible for tuberculosis and leprosy, makicng it a serious yet neglected global health issue. This neglected tropical disease disproportionately affects people in rural and impoverished communities, particularly in parts of West and Central Africa, Australia, and South America. Despite its devastating impact, Buruli ulcer remains relatively unknown to the global public, which often leads to delayed diagnoses and preventable disability in affected individuals.
Anna Wickenden, Vice-President of Advocacy & Strategic Partnerships at Effect Hope, highlights the impact of this disease’s lack of awareness:
“Before we began working with the government in Liberia, in reviewing data on Buruli Ulcer (BU) prevalence in West Africa, you could see that every country around Liberia was endemic. And yet, Liberia was reporting 0 cases. But, there were indications that there might be BU in Liberia. In the local dialect, it was referred to as ‘the everlasting sore.’ The implication being if you get it, you have it forever. When we first started working with the WHO in 2012 to map BU in Liberia, the people we found with it had been living with it for sometimes 20, 30, 40 years! Until Effect Hope started working with the Ministry of Health in Liberia, there was no access to the antibiotics to treat it, no capacity within the health system to diagnose it, and no access to any kind of rehabilitation or treatment.”
In Liberia, the disease was once thought to be nonexistent—despite evidence of its presence in neighboring countries. Without proper diagnosis and access to treatment, many individuals suffered from Buruli ulcer for decades, enduring severe disability and stigma. Until Effect Hope partnered with the Ministry of Health, Liberia lacked the healthcare infrastructure to address Buruli ulcer, leaving countless people untreated and vulnerable to long-term suffering.
According to the World Health Organization (WHO), over 33 countries have reported cases of Buruli ulcer, with most infections occurring in tropical and subtropical regions. Early detection and proper treatment are critical in preventing long-term disabilities and can significantly improve recovery outcomes.
Symptoms and Progression
The disease typically starts as a small, painless lump or swelling on the skin, often mistaken for an insect bite or minor injury. Over time, this lesion grows and deteriorates, forming large ulcers with deep, undermined edges. If left untreated, the infection can rapidly spread, causing severe tissue damage, deformities, and life-altering disability.
How is Buruli Ulcer Transmitted?
While, the exact mode of transmission remains unclear, research points to a potential link between Mycobacterium ulcerans and aquatic environments, including stagnant water. Some studies indicate that insects, such as mosquitoes, may play a role in spreading the bacteria, but further research is needed to confirm these findings. Buruli ulcer is not considered highly contagious from person to person. Learn more about how mosquitoes may contribute to spreading the bacteria in this CDC article.
Diagnosis and Treatment
Early diagnosis is crucial for preventing the disease from advancing to disabling stages. Confirming the diagnosis usually involves clinical assessment, laboratory tests, including PCR (Polymerase Chain Reaction) analysis of a skin sample.
The recommended treatment involves a combination of antibiotics—usually rifampicin and clarithromycin—for at least eight weeks. In advanced cases, surgical intervention may be required to remove dead tissue and facilitate wound healing. Physiotherapy and skin grafting may also be necessary to restore mobility and function in severe cases.
The Impact of Buruli Ulcer
Because Buruli ulcer primarily affects marginalized communities with limited healthcare access, many cases go untreated until life-changing disabilities have occurred. The disease can lead to social stigma, economic hardship, and emotional distress for those affected. Children, who make up a significant portion of cases, often face interruptions in their education and future opportunities, further compounding the long-term impact.
A Story of Hope: John Sean’s Journey
John Sean, born April 1993, knows the pain and suffering of Buruli ulcer, which left him with a swollen, painful ulcer on his foot that eventually burst. Despite trying ointments, his condition worsened, and he had to rely on crutches to move. Through proper treatment and the support of a peer support group, John not only began his recovery but was also empowered to connect with others facing similar struggles. His story is one of strength, hope, and the transformative power of community support.
Watch John’s story here.
Breaking the Cycle
Neglected tropical diseases like Buruli ulcer thrive in conditions of poverty and insufficient healthcare infrastructure. By advocating for better healthcare access, supporting research into disease transmission, and equipping local health workers with the tools to diagnose and treat the disease effectively, we can help break the cycle of disability and suffering caused by Buruli ulcer.
John’s story is a testament to the importance of early diagnosis and treatment. His journey reminds us that by improving awareness and access to medical care, lives can be transformed.
Take Action
Buruli ulcer is preventable and treatable – yet many still suffer because awareness, diagnosis, and care remain out of reach.
Stigma and neglect are still a thing, but action can change that.
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