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1 Buruli Ulcers Buruli Ulcers A neglected tropical disease A neglected tropical disease By Geraldine Ambe By Geraldine Ambe Walden University Walden University 10/24/09 10/24/09

Buruli Ulcers

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Buruli Ulcers. A neglected tropical disease By Geraldine Ambe Walden University 10/24/09. Disease etiology. Environment Agent host interaction Cultural aspects Behaviors Population. Background. - PowerPoint PPT Presentation

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Buruli UlcersBuruli UlcersA neglected tropical diseaseA neglected tropical disease

By Geraldine AmbeBy Geraldine AmbeWalden UniversityWalden University

10/24/0910/24/09

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Disease etiologyDisease etiology EnvironmentEnvironment Agent host interactionAgent host interaction Cultural aspectsCultural aspects BehaviorsBehaviors PopulationPopulation

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BackgroundBackground Buruli ulcers known as bairnsdale Buruli ulcers known as bairnsdale

ulcer, daintree ulcer, mossman ulcer, ulcer, daintree ulcer, mossman ulcer, searl ulcer, necrotizing disease of soft searl ulcer, necrotizing disease of soft tissue.tissue.

Cause mycobacterium ulcerans.Cause mycobacterium ulcerans. Rapid emergency of disease in most Rapid emergency of disease in most

parts of Africa.parts of Africa. WHO tools for better Bu control and WHO tools for better Bu control and

surveillance.surveillance.

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PrevalencePrevalence Reported in over 30 countries.Reported in over 30 countries. Largest numbers in Zaire, Congo, Largest numbers in Zaire, Congo,

Cameroon, Nigeria, Benin, Ghana, Cameroon, Nigeria, Benin, Ghana, Togo, Liberia, Ivory coast, Australia, Togo, Liberia, Ivory coast, Australia, southeast Asia.southeast Asia.

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BARRIERBARRIER TOTO DETERMINEDETERMINE EXACT PREVALENCEEXACT PREVALENCE

Under reportingUnder reporting Under diagnosingUnder diagnosing Lack of access to health careLack of access to health care Multiple clinical presentation of diseaseMultiple clinical presentation of disease Limited knowledge of healthcare Limited knowledge of healthcare

workersworkers Limited public knowledge about the Limited public knowledge about the

diseasedisease

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EpidemiologyEpidemiology Occurs near water bodies, rivers, lakes, Occurs near water bodies, rivers, lakes,

swams, ponds( activities farming)swams, ponds( activities farming) Most afflicted children age 15years and Most afflicted children age 15years and

underunder 90% of lesions on limbs90% of lesions on limbs 60% lower limbs.60% lower limbs.

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MORTALITY AND MORBIDITYMORTALITY AND MORBIDITY Disease has low mortality rateDisease has low mortality rate High morbidity and socioeconomic High morbidity and socioeconomic

burden burden Prolong debilityProlong debility Severely handicappingSeverely handicapping

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Numerical DataNumerical Data

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

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CausesCauses

M Ulcerans slow growing M Ulcerans slow growing mycobacteria causative agent of BUmycobacteria causative agent of BU

An environmental pathogen, isolated An environmental pathogen, isolated from biofilms and small aquatic from biofilms and small aquatic animals of slow moving, or stagnant animals of slow moving, or stagnant bodies of water.bodies of water.

Suggested transmission, mosquitoes Suggested transmission, mosquitoes bites.bites.

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Signs and SymptomsSigns and Symptoms BU starts as a painless, mobile BU starts as a painless, mobile

swelling in the skin.swelling in the skin. Large area of indurationLarge area of induration Diffuse swellingDiffuse swelling No pain and feverNo pain and fever Incubation period few weeks to Incubation period few weeks to

months.months.

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Retrieved from Retrieved from http://www.who.int/buruli/photos/nonulcerative/en/index.htmlhttp://www.who.int/buruli/photos/nonulcerative/en/index.html

BU STARTS AS A NODULEBU STARTS AS A NODULE

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Buruli ulcer can extend to 15% of a person's Buruli ulcer can extend to 15% of a person's skin surface and may destroy nerves and blood skin surface and may destroy nerves and blood vessels. Metastatic bone lesions may developvessels. Metastatic bone lesions may develop

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An edematous Buruli ulcer in a 9-year-old An edematous Buruli ulcer in a 9-year-old Togolese girl (see Media File 3). Courtesy of Togolese girl (see Media File 3). Courtesy of

Wayne M. Meyers, MD. Wayne M. Meyers, MD.

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Togolese girl in Media File 2 taken 5 years Togolese girl in Media File 2 taken 5 years after the Buruli ulcer had been excised and after the Buruli ulcer had been excised and repaired with autologous split-skin graft by repaired with autologous split-skin graft by

G.B. Priuli, MD. Courtesy of Wayne M. Meyers, G.B. Priuli, MD. Courtesy of Wayne M. Meyers, MDMD

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TreatmentTreatment WHO RecommendationsWHO Recommendations Rifampin / StreptomycinRifampin / Streptomycin AntimicrobialsAntimicrobials Surgical interventionSurgical intervention

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Social and Cultural AspectsSocial and Cultural Aspects

Sociocultural beliefSociocultural belief FearFear StigmaStigma Loss of productivityLoss of productivity Cost of treatmentCost of treatment

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Control and SurveillanceControl and Surveillance Reduce disabilityReduce disability Early detectionEarly detection Training health care professionalsTraining health care professionals Case ManagementCase Management Laboratory case confirmationLaboratory case confirmation Advance health facilitiesAdvance health facilities Monitor, evaluate control activities.Monitor, evaluate control activities.

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GoalsGoals

Improve case finding.Improve case finding. Improve case managementImprove case management Improve surveillanceImprove surveillance Improve Channels of Improve Channels of

communication.communication. Increase Research studies on Buruli Increase Research studies on Buruli

ulcers.ulcers.

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AudienceAudience

Members of heavy burden communitiesMembers of heavy burden communities Medical health care professionals, Medical health care professionals,

(Doctors, nurses, laboratory workers, (Doctors, nurses, laboratory workers, other health clinicians.other health clinicians.

Village leadersVillage leaders community field workerscommunity field workers University medical student and nursing University medical student and nursing

school students.school students.

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OrganizationsOrganizations

Centers for disease control and Centers for disease control and prevention (CDC)prevention (CDC)

UNICEFUNICEF World Health Organization (WHO)World Health Organization (WHO) Doctors without Borders.Doctors without Borders. Buruli ulcer control programme Buruli ulcer control programme

Headquaters in Harare Zimbabwe.Headquaters in Harare Zimbabwe.

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ADVOCATES FOR GLOBAL ADVOCATES FOR GLOBAL HEALTHHEALTH

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ReferencesReferences

Benbow, M.,E. Williamson, H., et al (2008). A large –scale field Benbow, M.,E. Williamson, H., et al (2008). A large –scale field study on aquatic invertebrates associated with buruli ulcer study on aquatic invertebrates associated with buruli ulcer disease: Are biting water bugs likely vectors? Emerging disease: Are biting water bugs likely vectors? Emerging infectious diseases. Retrieved October 20infectious diseases. Retrieved October 20thth,2009 from website ,2009 from website http://www.cdc.gov/EID/content/14/8/1247.htmhttp://www.cdc.gov/EID/content/14/8/1247.htm ..

Wagner, T., Benbow, M.E., et al (2008). A landscape based Wagner, T., Benbow, M.E., et al (2008). A landscape based model for predicting Mycobacterium ulcerans infections: Buruli model for predicting Mycobacterium ulcerans infections: Buruli ulcer disease presence in Benin, West Africa. EcoHealth.ulcer disease presence in Benin, West Africa. EcoHealth.

Guidelines for controlling buruli ulcers in the African Guidelines for controlling buruli ulcers in the African Region(2006) World health organization Retrieved October 20Region(2006) World health organization Retrieved October 20 thth, , 2009 from website www.afro.who.int/buruli/english/AFRO2009 from website www.afro.who.int/buruli/english/AFRO

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