Buruli Ulcer: A misunderstood mycobacterial disease

Buruli ulcer is caused by a germ that mainly affects the skin but which can also affect the bone. Left untreated, the disease leads to functional disability, loss of economic productivity, and social stigma.

Monday May 19 2014

Martin Tako (inset) shows his scarred left leg which is healing after

Martin Tako (inset) shows his scarred left leg which is healing after a buruli ulcer operation. His biggest complaint is that the leg still swells. Dr Dominic Drametu (R) says the disease is very common during the rainy season. photos by PAUL MENYA 


May 2012 evokes sad memories for Martin Tako. It was the month when something pricked the lower limb of his left leg, resulting in buruli ulcer.

At the time, he did not know what was ailing him even when the affected spot got swollen and developed blisters which eventually turned into a wound.

The father of eight says, “I then sought medical attention. I first used local herbs and therapeutic cuts were done with no change.” He was referred to Adjumani Hospital. “I would feel pain right to my bones in the affected leg. My left leg would swell even after a short walk. The swelling would only reduce when I raised the leg.”

Moment of truth
On June 17, 2012, he was admitted to Adjumani Hospital where he was told he had buruli ulcer.

This diagnosis was then followed with surgery and then skin grafting was done. He was discharged on July 30, 2012. That gave him a new lease of life because the pain disappeared and he was able to wear closed shoes again.

Although he does not know what causes buruli ulcer, his advice to victims is to seek medical attention.
Tako says he did not react to drugs but he complains of the swelling of his left leg. “I can’t say I have completely healed because my left leg occasionally swells. I hope for complete recovery,” he says. As a result, Tako’s farming activities have retarded yet this is his only source of income.

He owns 11 acres of land, five in Pakele Sub-county and six in Adjumani Municipality where he used to grow ground nuts, rice, cassava and maize.

“I can’t do anything on my farm for fear of harming my leg. A stone or any other object could hit the leg and cause another wound,” Tako says.

According to the World Health Organisation (WHO), buruli ulcer is caused by infection with mycobacterium ulcerans, an organism which belongs to the family of bacteria that causes tuberculosis and leprosy.

It is a chronic debilitating skin and soft tissue infection that can lead to permanent disfigurement and disability.
Infection leads to destruction of skin and soft tissue with large ulcers usually on the legs or arms. Patients who are not treated early suffer long-term functional disability. Early diagnosis and treatment are the only ways to minimise morbidity and prevent disability.

Buruli ulcer has been reported in 33 countries in Africa, America, Asia and the Western Pacific. Most cases occur in tropical and subtropical regions except in Australia, China and Japan. Between 5,000 and 6,000 cases are reported annually from 15 of the 33 countries.

Most cases occur in rural communities in sub-Saharan Africa and nearly half of the people affected are children under 15. West Africa, Benin, Côte d’Ivoire and Ghana report most cases, with Côte d’Ivoire reporting almost half of the global cases.

According to statistics from Ministry of Health, the disease is the third most common mycobacterial infection after tuberculosis and leprosy.

It is also the most misunderstood of the three human mycobacterial diseases. The disease affects men and women equally.
About 75 per cent of those affected are children under 15 years of age and 90 per cent of the lesions are on the limbs; mostly lower limbs. There is little seasonal variation in the incidence of the disease.

The ministry adds that buruli ulcer imposes a serious economic burden on the affected household and on health systems that are involved in the diagnosis of the disease and treatment.

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