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Buruli ulcer: a pocket guidefor community health workers

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Buruli ulcer is a disease caused by a germ whichaffects mainly the skin, but it can also affect the bones.

Buruli ulcer is found in many places around the worldoften near water (in lakes, rivers ...).

The exact mode of transmission of the germ fromthe environment to humans is not known.

Buruli ulcer can affect anyone at any age, but childrenare most often affected.

Buruli ulcer mainly affects the arms and legs; but it canaffect any part of the body.

Buruli ulcer is treated in hospital with specific drugsand by surgery.

Buruli ulcer disability can be prevented throughearly interventions.

Early diagnosis and treatment of Buruli ulcer arevery important in preventing serious complications.

bas

ic i

nfo

rmat

ion

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Buruli ulcer is a disease causedby a germ

Buruli ulcer is not caused by witchcraft

Buruli ulcer is not due to a curse

Buruli ulcer is not a punishment

You cannot get Buruli ulcer through

contact with an affected person

your community should know that…

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Buru

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cer:

glob

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© W

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uli U

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Initi

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: aft

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, WHO

Com

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2005

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distribution

Today, Buruli ulcer has been reported in30 countries but the disease is not well-known and is therefore under-reported.

Within each country, Buruli ulcer occursin some specific places, often in wet areas.

The Ministry of Health in your countrywill provide information on where Buruliulcer occurs and how many cases havebeen reported.

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envi

ron

men

tal

fact

ors

Nyong River, Cameroon – Credit: Dr A. Um Boock

Nyong River, Cameroon – Credit: Dr A. Um Boock

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Buruli ulcer often occurs in places nearwater bodies, for example slow-flowingrivers, ponds, swamps, lakes...

The germ that causes Buruli ulcer livesin a wet environment but the exact placeis not known.

It is suspected that some water insects maytransmit the disease.

environmental factors

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no

du

le

Credit: Dr S. Etuaful

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A nodule is a small painless swellingunder the skin of about 3 centimetresin diameter.

This is often the beginning of the diseasebut only a few affected people go tohospital at this stage.

At the nodular stage, treatment is simpleand prevents deformities.

nodule

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pla

qu

e

Credit: Dr Annick Chauty, Association Française Raoul Follereau, Benin

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A plaque is a large painless swellingof more than 3 centimetres in diameterwith clearly marked borders.

The skin feels hard like cardboard.

Treatment of this form of the diseasecan be difficult.

People affected should be advisedto go to hospital without delay.

plaque

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oed

ema

Credit: National Buruli Ulcer Control Programme, Benin

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Oedema is a large painless swelling;it often involves the arms and the legs.

Treatment of this form of the diseaseis difficult.

People affected should be advised togo to hospital without delay.

oedema

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ulc

er

Credit: Dr S. Etuaful

Credit: National Buruli Ulcer Control Programme, Benin

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Typical ulcers are not very painful; theyhave undermined edges and often havewhitish-yellowish slough in the centre.

With good treatment, small ulcers canheal with no deformity. Unfortunately,most affected people do not go tohospital at this stage.

Large ulcers are very common becausemost affected people wait until it is toolate. These ulcers often lead to seriousdeformities and treatment at this stage isvery difficult and expensive. Any personwho has an ulcer should be advised to goto hospital without delay.

ulcer

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arm

s an

d l

egs

def

orm

itie

s

Credit: Professor H. AsséCredit: Professor H. Assé

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Arms and legs with deformities likethese are common because affectedpeople often go to hospital too late.

It is important to inform the communityabout the serious complications that canresult from Buruli ulcer and advise thoseaffected to go to hospital without delay.

arms and legs deformities

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tru

nk

and

fac

e d

efo

rmit

ies

Credit: Dr R. ZillioxCredit: National Buruli Ulcer Control Programme, Benin

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Trunk and face deformities like theseare common because affected peopleoften go to hospital too late.

Sometimes the eyes are damaged, whichmay lead to blindness.

Complications like these can be avoidedif people affected go to hospital withoutdelay.

trunk and face deformities

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no

def

orm

ity

Credit: Professor H. Assé

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If Buruli ulcer patients are identified andtreated rapidly, simple surgery is needed.They will only have a small scar but nodeformity and no disability.

Today, some specific drugs can be usedto treat Buruli ulcer.

When people with a nodule or smallulcer go to hospital rapidly, surgery maythen be avoided.

no deformity

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can

cer

Credit: Dr S. Etuaful

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If Buruli ulcers are not properly treated,they may turn into cancer after someyears.

Usually, traditional treatments used forBuruli ulcer leave bad scars that can easilydevelop into cancer.

Cancers are painful, have rough surfacesand bleed very easily.

Sometimes, people mistake cancers forBuruli ulcer.

Any person who has an ulcer that looks likethis should go to hospital without delay.

cancer

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amp

uta

tio

n

Credit: Ms L. Lehman

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In some late and severe cases, amputationis necessary.

People who have been amputated or whohave other deformities should receiveappropriate rehabilitation assistance.

The community should also help thesepeople to be part of the society.

amputation

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wh

at c

an y

ou

do

?Example of basic information to be recorded

Family name First name

Address

Age Sex F M Date

Patient classification new recurrent

Location of lesion: leg arm chest

abdomen back face neck

Clinical form:

nodule plaque oedema ulcer

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1. You can be the link between your communityand the health centres or hospitals.

2. You can help to increase awareness aboutBuruli ulcer in your community to encouragethose affected to report rapidly.

3. You can identify people with suspectedBuruli ulcer, register and refer them to thenearest health centre or hospital.

4. You can help to manage simple cases andsupervise those on drug treatment in yourcommunity.

5. You can support and follow up peoplewho have returned to the community aftertreatment at health centres or hospitals.

what can you do?

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Buruli ulcer complications are preventable

Go to hospital without delay!This pocket guide is to help community health workers understand Buruliulcer and to contribute to its control in their communities. It was producedthanks to the financial support from ANESVAD Foundation, Spain.

Credit: National Buruli Ulcer Control Programme, Benin

© World Health Organization 2005. All rights reserved.

http://www.anesvad.org/buruli/pub/ingl/home.htmhttp://www.who.int/buruli/enSPAIN