The History of Buruli Ulcer

Sir Alfred Cook first recorded cases of skin ulcers similar to those caused by Mycobacterium ulcerans in 1897 while in the Buruli region of Uganda, hence today Mycobacterium ulcerans infection is commonly referred to as Buruli Ulcer (BU). In other countries the disease is known as Bairnsdale ulcer or Searle's ulcer. However, the name Buruli Ulcer generally has priority by precedence of publication and by virtue of the geographic site in Uganda; where the first large number of patients were reported. Although the first documented case study of Buruli Ulcer was published in Australia in 1948. Buruli ulcer remained fairly obscure until WHO recognized it as a major public health problem in 1997.

Buruli ulcer is the third most common form of mycobacterial infections in humans, after tuberculosis and leprosy. Of the three, Buruli ulcer is the least understood. The mode of transmission for Buruli ulcer remains unclear. The most widely accepted theory is that the mycobacteria enter the body through the skin at the site of a penetrating or blunt trauma but may be as slight as a hypodermic needle puncture. The first indications of Buruli ulcer begin with a firm painless nodule just below the surface of the skin and may be mistaken for a common boil. However, cytotoxins released by the mycobacteria eventually destroy subcutaneous tissues, leading to aggressive damage of soft tissue and bone. As the nodules are not painful until the disease progresses, early detection is rare.

There is no preventive treatment and no effective cure for Buruli ulcer. Currently, the preferred form of treatment is surgical excision of the infected tissue followed by the application of skin grafts. The surgical treatment is expensive and leaves patients prone to infection. In Ghana, the average cost of treatment has recently been estimated at US$780 per patient. By comparison, treatment in the early stages of the disease average US$20-30. It is estimated that less than 1% of all cases receive treatment at the early stages.

Buruli ulcer is found nearly equally in both men and women who live in rural areas near rivers of wetlands however, the highest frequencies of infection are in children under 15 years of age. It is most prevalent in West Africa, but has been found in areas of Asia, Latin America and the Western Pacific.

HART teams have two objectives when they travel to Ghana. The surgical teams treat patients and train local doctors in the proper treatment methods. HART social development teams perform surveillance and social research activities and work to educate people about Buruli ulcer, specifically its signs and symptoms, for early detection.