Buruli Ulcers

1
Buruli Ulcers

• A neglected tropical disease
• By Geraldine Ambe
• Walden University
• 10/24/09

2
Disease etiology

• Environment
• Agent host interaction
• Cultural aspects
• Behaviors
• Population

3
Background

• Buruli ulcers known as bairnsdale ulcer, daintree
  ulcer, mossman ulcer, searl ulcer, necrotizing
  disease of soft tissue.
• Cause mycobacterium ulcerans.
• Rapid emergency of disease in most parts of
  Africa.
• WHO tools for better Bu control and surveillance.

4
Prevalence

• Reported in over 30 countries.
• Largest numbers in Zaire, Congo, Cameroon,
  Nigeria, Benin, Ghana, Togo, Liberia, Ivory
  coast, Australia, southeast Asia.

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BARRIER TO DETERMINE EXACT PREVALENCE

• Under reporting
• Under diagnosing
• Lack of access to health care
• Multiple clinical presentation of disease
• Limited knowledge of healthcare workers
• Limited public knowledge about the disease

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Epidemiology

• Occurs near water bodies, rivers, lakes, swams,
  ponds( activities farming)
• Most afflicted children age 15years and under
• 90 of lesions on limbs
• 60 lower limbs.

7

• MORTALITY AND MORBIDITY
• Disease has low mortality rate
• High morbidity and socioeconomic burden
• Prolong debility
• Severely handicapping

8
Numerical Data

• Countries Population 2002
  2003
• Benin 6,097,000 565
  724
• Cameroon 15,481,00 132 230
• Cote divoire 17,109,00 0
  1235
• Ghana 20,212,00 853
  739
• Togo 4,629,00 96
  56
• Guinee 8,185,820 328
  157

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Causes

• M Ulcerans slow growing mycobacteria causative
  agent of BU
• An environmental pathogen, isolated from biofilms
  and small aquatic animals of slow moving, or
  stagnant bodies of water.
• Suggested transmission, mosquitoes bites.

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Signs and Symptoms

• BU starts as a painless, mobile swelling in the
  skin.
• Large area of induration
• Diffuse swelling
• No pain and fever
• Incubation period few weeks to months.

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Retrieved from http//www.who.int/buruli/photos/no
nulcerative/en/index.html

• BU STARTS AS A NODULE

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Buruli ulcer can extend to 15 of a person's skin
surface and may destroy nerves and blood vessels.
Metastatic bone lesions may develop
13
An edematous Buruli ulcer in a 9-year-old
Togolese girl (see Media File 3). Courtesy of
Wayne M. Meyers, MD.
14
Togolese girl in Media File 2 taken 5 years after
the Buruli ulcer had been excised and repaired
with autologous split-skin graft by G.B. Priuli,
MD. Courtesy of Wayne M. Meyers, MD
15
Treatment

• WHO Recommendations
• Rifampin / Streptomycin
• Antimicrobials
• Surgical intervention

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Social and Cultural Aspects

• Sociocultural belief
• Fear
• Stigma
• Loss of productivity
• Cost of treatment

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Control and Surveillance

• Reduce disability
• Early detection
• Training health care professionals
• Case Management
• Laboratory case confirmation
• Advance health facilities
• Monitor, evaluate control activities.

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Goals

• Improve case finding.
• Improve case management
• Improve surveillance
• Improve Channels of communication.
• Increase Research studies on Buruli ulcers.

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Audience

• Members of heavy burden communities
• Medical health care professionals, (Doctors,
  nurses, laboratory workers, other health
  clinicians.
• Village leaders
• community field workers
• University medical student and nursing school
  students.

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Organizations

• Centers for disease control and prevention (CDC)
• UNICEF
• World Health Organization (WHO)
• Doctors without Borders.
• Buruli ulcer control programme Headquaters in
  Harare Zimbabwe.

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ADVOCATES FOR GLOBAL HEALTH
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References

• Benbow, M.,E. Williamson, H., et al (2008). A
  large scale field study on aquatic invertebrates
  associated with buruli ulcer disease Are biting
  water bugs likely vectors? Emerging infectious
  diseases. Retrieved October 20th,2009 from
  website http//www.cdc.gov/EID/content/14/8/1247.h
  tm.
• Wagner, T., Benbow, M.E., et al (2008). A
  landscape based model for predicting
  Mycobacterium ulcerans infections Buruli ulcer
  disease presence in Benin, West Africa.
  EcoHealth.
• Guidelines for controlling buruli ulcers in the
  African Region(2006) World health organization
  Retrieved October 20th, 2009 from website
  www.afro.who.int/buruli/english/AFRO20BU20guidel
  ines.pdf-similar.