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What Causes Buruli Ulcers?

A Buruli ulcer is a debilitating infection of the skin and soft tissue that, when left untreated, can progress to ulcers, bone infections, and even deformities. A huge cause for concern in tropical and sub-tropical countries, a Buruli ulcer is tricky to identify – it appears as a painless nodule on the surface, doing its damage beneath the surface until the local tissue is completely necrotized. Over 5000–6000 cases are reported every year in a good majority of the countries Buruli ulcers have ravaged.1

What Causes A Buruli Ulcer?

The Mycobacterium ulcerans is responsible for the infection, spreading through water or skin-to-skin contact. It develops rapidly in a sub-tropical or tropical, humid environment. Bacteria of the Mycobacterium family are also responsible for other illnesses such as tuberculosis and leprosy. One common thread through these three diseases is that they can drastically impact a person’s quality of life and functional ability if not caught and treated in time.

A toxic chemical called mycolactone released by the Mycobacterium ulcerans is responsible for the tissue death associated with a Buruli ulcer. Mycolactone causes the tissue in the area to lose immune function, making it prone to secondary infection and tissue death.2

Although it isn’t clear how exactly this infection spreads, aquatic bugs of the Naucobris and Diplonychus family are thought to act as hosts for the bacterium that causes the ulcers. The bacteria live and multiply in the salivary glands of these insects without harming them in any way. Even a small cut or wound can become a window for these insects to inject the human body with the bacterium, where it grows and causes ulcers.3 Animals such as horses, dogs, alpacas, and koalas have been found to be infected in Australia, but it’s not clear whether these animals actually transmit the infection to humans.4

Initial Signs And Symptoms

A Buruli ulcer starts out as a painless nodule that is often mistaken for a boil or a swelling of a lymph node. This nodule, usually seen in the limbs, then proceeds to grow in size, destroying the tissue in its path. Due to the release of mycolactone in the infected area, there is no pain or fever, typical immune-system reactions to an infection.5 This perhaps explains why people don’t approach a doctor until the nodule turns into an ulcer and secondary infections set in. However, if caught in time and treated with antibiotics, the condition can be cured completely.

The Implications Of Buruli Ulcers

Buruli ulcers are endemic in Africa, some parts of South America, and Australia. Children and adults alike can develop this infection though a good majority of cases are reported among children under the age of 15 years.6 If adequate medical care is not provided in time, a Buruli ulcer can soon become more than just a cosmetic issue. Back in the late 90s in Ghana, about 25% of all people who reported a Buruli ulcer faced life-long deformities, amputations, disabilities, and even death.7 In Africa, the condition has improved only slightly since. This has huge socioeconomic implications, with people who’re already fighting poverty and food scarcity often losing working family members to the illness.

Only a handful of cases have been reported in the United States, mainly among people returning from Africa or Australia.8

Treating Buruli Ulcers

Earlier, most patients and doctors working in disease-prone places often proceeded to cut out the tissue or amputate the bone in the infected area. More recently, antibiotics such as streptomycin have been used to treat milder cases.9 Surgery, mainly to debride the wound, remove dead skin, and graft skin, is necessary in some cases.11 In severe cases where infection has spread to the bone and may cause sepsis, amputation is necessary to save the patient’s life.

Considering the cost of medication which many can’t afford, locals often use a variety of herbal medicines to treat Buruli ulcers. In 2015, studies were able to prove the efficacy of some of these plant products. For example, aloe vera was found to be an effective ally in managing the condition thanks to its antibacterial, anti-inflammatory, and wound-healing properties. It also helped the repair of infected tissue. Extracts from the trees of the Alstonia family and the medicinal plant forest burr (Pupalia lappacea) have been shown to help heal the wounds and inhibit the infection. Even compounds derived from guava trees and garlic plants, when consumed orally, have antimicrobial properties that can help mend the wounds.10 If proven to be 100% effective, these alternative therapies can go a long way in treating this endemic disease, apart from providing relief to people who can’t always afford mainstream medicine.

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