Buruli ulcer (BU), or Mycobacterium ulcerans disease, is a severe bacterial infection that affects the skin, soft tissues and the bones. The infection causes permanent disfigurement and disability and belongs to the same family of organisms that cause tuberculosis and leprosy.
Buruli ulcer often starts as a painless swelling or nodule on the arms or legs. The nodules then develop into large ulcers, or skin erosions, that have a whitish-yellowish base. Poorly managed patients may develop severe scars and progress to severe bone deformities and joint contractures.
The mode of transmission to humans is unknown, although there is some evidence that it may be transmitted through the bites of infected aquatic insects, adult mosquitoes or other biting arthropods.
Most cases occur in rural communities in sub-Saharan Africa. Nearly half of people affected in Africa are children under the age of 15. HIV infection is not a risk factor but it weakens the immune system, making the progress of BU more aggressive.
West Africa (Benin, Côte d’Ivoire and Ghana) report most cases with Côte d’Ivoire reporting almost half of the global cases. Africa with more than 80 000 cumulative cases has around 99% of the global burden of BU. Approximately 80% of cases that are detected early can be cured with a combination of two antibiotics, recommended by the AHO (rifampicin with streptomycin or clarithromycin).