buruli ulcer

buruli ulcer

• 1. GPSA Health Committee Buruli Ulcer What do you know about Buruli ulcer? October, 2014 History and Epidemiology Be informed…. pg. 3 Maecenus quis lacus? Buruli ulcer is a disease of skin and soft tissue with the potential to leave sufferers scarred and disabled. It is caused by an environmental pathogen, Mycobacterium ulcerans, which produces a destructive toxin. The exact mode of transmission is unclear. The main burden of disease falls on children living in sub-Saharan Africa, but healthy people of all ages, races, and socioeconomic classes are susceptible. M. ulcerans is the third most common mycobacterial pathogen of humans, after M. tuberculosis and M. leprae (which cause tuberculosis and leprosy, respectively). The definitive description of M. ulcerans was published in 1948, when MacCallum and others in Australia reported six cases of an unusual skin infection caused by a mycobacterium that could only be cultured when the incubation temperature was set lower than for M. tuberculosis. In Africa, large ulcers almost certainly caused by M. ulcerans had been described by Sir Albert Cook in 1897 and by Kleinschmidt in northeast Congo during the 1920s. The main burden of disease falls on children living in sub- Saharan Africa. Prior to the 1980s, foci of M. ulcerans infection were reported in several countries in sub-Saharan Africa including Congo, Uganda, Gabon, Nigeria, Cameroon, and Ghana. The Uganda Buruli Group coined the name “Buruli ulcer” because the cases they described were first detected in Buruli County, near Lake Kyoga.
• 2. lorem ipsum dolor issue, date 2 Causative Organism and Pathology Clinical Features Mycobacteriumulcerans is a slow-growing environmental mycobacterium that can be cultured from human lesions on mycobacterial medium at 30–32 °C. Histological specimens typically show large clumps of extracellular acid-fast organisms surrounded by areas of necrosis and a poor or absent inflammatory response. Subcutaneous fat is particularly affected, but underlying bone may also become involved in advanced cases. A recently identified diffusible lipid toxin, mycolactone, explains the pathogenesis and histological appearance. Later in the natural history of the disease, the host somehow overcomes the immunosuppressive effect of the toxin, immunity develops, and healing commences. The classic lesion is a necrotic skin ulcer with deeply undermined edges. Any part of the body can be affected, but most lesions occur on limbs. The ulcers are slowly progressive and usually painless, and the patient is usually systemically well, which may explain why sufferers often delay seeking medical assistance. Early Buruli lesions may initially appear as a mobile subcutaneous nodule, a papule, or a raised plaque.
• 3. lorem ipsum dolor issue, date 3 Future Directions and the End of Obscurity Since 2005, three (3) Buruli Ulcer training workshops have been held in the hospital at which surgical teams in various endemic regions in Ghana are trained Buruli Ulcer Disease has been prevalent in the Asante Akim North District of Ghana since the early 1970s, long before the disease became endemic in the country and the West African Sub Region in the early 1990s. Initially the disease was limited Villages in the Afram Plains sector of the district but it gradually spread to other towns in the district. The Agogo Presbyterian Hospital has been in the forefront of Buruli Ulcer management since the early 1970s. Since 2005, 3 Buruli Ulcer training workshops have been held in the hospital at which surgical teams in various endemic regions in Ghana are trained. In May, 2006, the WHO and the Ministry of Health of Ghana organized an International training workshop on Buruli Ulcer in Agogo Hospital. Participants were drown from all over Africa while the facilitators came from Australia, Switzerland, France, USA, Ghana and Cote D'Ivoire. Due to the efforts of the Buruli Ulcer Volunteers and the Public Health Unit of the hospital an increasing number of nodules and other clinical forms are being identified and brought to the hospital. Buruli Ulcer accounts for about 0.6% of total admissions per year and the average length of stay in hospital is about 90 days. A lot of research into Buruli Ulcer has been carried out in the Agogo Presbyterian Hospital, the latest being a drug trial using Streptomycin and Rifampicin as well as Clarithromycin and Rifampicin. Buruli ulcer is now emerging from long years of neglect: interest and momentum are growing. However, there is much to do if we are to understand why the disease is becoming more common and how this relates to human activity. The current control strategy of early detection and treatment should be scaled up in the affected countries. Our ultimate goal is the development of an effectiveand safe vaccine able to provide long-lasting protection for those who live in endemic areas. The Research and Information Team (Health Committee)
• 4. lorem ipsum dolor issue, date 4 Continued Why Has Buruli Ulcer Been Neglected Until Now? A subgroup of patients present with rapidly progressive oedema of a whole limb, abdominal wall, or side of the face without an obvious focal lesion. Part or all of the affected area will subsequently ulcerate, although anecdotal reports suggest that timely antibiotic therapy may greatly reduce the resulting necrosis. "They call it the mysterious disease because nobody knows how it's transmitted," said Fogarty grantee Dr. Richard W. Merritt, of Michigan State University. "If you ask, what do you think causes it, you get a variety of answers. It's a tough one." Case control studies have suggested that farming activities close to rivers in endemic areas are a risk factor for Buruli ulcer, but for farmers involved in subsistence agriculture, avoidance of riverine areas is difficult. A recent study from Ghana has suggested that swimming in rivers may also be an independent risk factor. To date, the main focus of public health efforts has been on early detection and treatment, which greatly reduce morbidity and cost. Despite its long history, Buruli ulcer has gone largely unnoticed until recently. Buruli ulcer typically occurs in poor rural communities with little economic or political influence. Rural isolation may mean that national surveillance systems do not immediately detect the appearance of new outbreaks. Affected populations may believe that there is no effective medical treatment for the disease, which discourages them from seeking assistance. In the developed world, Buruli ulcer is frequently omitted from standard medical texts and undergraduate medical courses. The absence of a potentially profitable market has meant that there has been little private investment to date in drug and vaccine development or in research to improve prospects for better control.