Buruli Ulcer: A Mystifying Disease

"I was shocked. It was a terrible blow to my family, my coach and me. After two years of being treated by traditional medicine and the local nurse, and after another nodule appeared on my left elbow, I found out about MSF and decided to go visit them at the Buruli department of the Akonolinga hospital. I had to have an operation and the nurses looked after me day after day, cleaning and changing the dressing.

"Today, more than five years later, I am smiling again. I know I will be able to have a normal life and I'm so thankful to those who helped me. But I want to tell those affected by the ulcer: please do not wait, go and visit the Buruli ward at Akonolinga as early as possible."

Lack of awareness of Buruli by health workers and affected communities means that the disease is usually detected at a late stage. Other factors for not seeking medical advice are financial constraints, beliefs that the treatment does not work, fear of surgery and anaesthesia or superstition and stigma.

"The delayed recourse to surgery - the main treatment for the ulcer - is much more traumatic than if carried out early, when it is highly effective. At a later stage, wide excisions or removal of the affected skin area, including healthy tissues, are recommended to stop the infection and prevent recurrence or relapse at the same site.

It requires skin grafting and means a long stay in hospital," explains a former coordinator of the Akonolinga project.

Patients suffering from Buruli Ulcer currently receive eight weeks of antibiotics as well as wound dressing and surgery.

Although initial results of the antibiotic treatment seem to reduce the need for surgery, more evidence is needed before concluding its effectiveness.

Named after a county in Uganda, Buruli is caused by mycobacterium ulcerans, a bacteria related to tuberculosis and leprosy.

Scientists do not yet know how the disease is transmitted, but it does not appear to be contagious. Currently diagnosed primarily by clinical symptoms, Buruli needs more research for rapid and accurate diagnosis and effective treatment.

The World Health Organization estimates that 100,000 people are suffering from this tropical disease, which has been reported in over 30 countries worldwide, particularly in West Africa, Central and South America, Southeast Asia and parts of Australia.