INTRODUCTION OF BURULI

ULCER Buruli Ulcer is said to be a neglected tropical disease when traced

dated back to the nineteenth century when a british missionary
physician Albert Cook recorded his observations in the mengo
hospital in Uganda. . In 1948, characteristics of similar skin ulcers
were described by McCallum and his colleagues in six patients from
the Bairns Dale district in southeast Australia and due to that, this
was referred as Bairns Dale Ulcer. The causative organism isolated
from these ulcers were found to be acid fast mycobacterium, now
Mycobacterium ulcerans. In 1950s and 1960s a larger case series of
patients with similar ulcers were detected in today's Nakasongola
district in Uganda formerly known as Buruli County. From then the
diseases became generally known as Buruli Ulcer (BU). Sporadic
Mycobacterium ulcerans infection occurred in a number of additiona
countries with tropical and subtropical regions except Australia and
Japan.
ALBERT COOK
 Dr. T. Paul van de Ven worked as a physician at the
Agogo Presbyterian Hospital in Asante Akyem from
1995 to 2000. He made important observations about
the disease and its epidemiology, including its
association with stagnant water bodies. He also
developed effective treatment protocols for the
disease. His work was instrumental in raising
awareness of Buruli ulcer and securing funding for
further research and treatment. He was a true
pioneer in the fight against this neglected tropical
disease.

DR. T. PAUL VAN DE

VEN
 DEFINITION OF BURULI
Buruli ulcer also known as Bairnsdale or Daintree ulcer is a debilitating skin disease and affect the bone as well. It
ULCER
is caused by the bacterium Mycobacterium Ulcerans. This chronic condition can lead to significant skin and soft
tissue damage if left untreated. Cases are generally seen in the tropics, primarily in WEST Africa and Australia.
Infections often leads to ulcer on the arms and legs which can destroy soft tissues and skin. Symptoms usually
begins with a painless nodule and swelling, usually around the arms and legs and sometimes on the parts of the
body. These areas can develop into large ulcers with a white and yellow base. Mycobacterium Ulcerans produces
the toxin Mycolctone. How it is transmitted is unknown but one possibility is that the disease is passed to humans
from some insects that are found in water.
 CLASSIFICATION OF BURULI
ULCER
Category I ulcers: Superficial ulcers
with no bone involvement. In category I
Buruli ulcer, the ulcers are usually painless
and may present as a single papule,
nodule, plaque, or ulcer. They typically
have welldefined margins and can range in
size from 1 to 5 cm in diameter. The ulcers
may be indurated or indurated with some
central necrosis. The overlying skin may
be hyperpigmented, hypopigmented, or
normal in colour. The surrounding skin
may be edematous or erythematous. There
may be regional lymphadenopathy, but
this is not always present.
 CLASSIFICATION OF BURULI
ULCER
Category II ulcers: Deeper ulcers
with bone involvement. In category II
Buruli ulcer, there are usually multiple
skin ulcers present, with at least one
ulcer measuring greater than 5 cm in
diameter. The ulcers may be indurated
or necrotic, with irregular margins.
The surrounding skin may be
erythematous, edematous, or fibrotic.
Lymphadenopathy is often present,
and the regional lymph nodes may be
enlarged and tender. In addition, there
may be signs of systemic involvement,
such as fever, malaise, and weight loss.
 CLASSIFICATION OF BURULI
ULCER
Category III ulcers: Extensive ulcers with
significant tissue destruction. In category III
Buruli ulcer, there is extensive tissue
destruction, resulting in severe disability. There
may be multiple skin ulcers present, with
significant scarring and contractures. The ulcers
may be indurated or necrotic, and there may be
significant edema and erythema of the
surrounding skin. In addition, there may be
extensive regional lymphadenopathy and
systemic involvement, including fever, malaise,
and weight loss. In some cases, patients with
category III Buruli ulcer may develop chronic
ulcers that are resistant to treatment.
FACTORS CONTRIBUTING TO THE
CONDITION
ExpLiving in an endemic area.

osure to infected water.

Poor sanitation and hygiene practices.

Wounds or cuts on the skin.

Contact with an infected animal or insect.

Weakened immune system.

Climate change.
 MODE OF
TRANSMISION
Buruli ulcer is thought to be transmitted
through direct contact with contaminated
water, soil, or infected animals or insects.
The disease-causing bacterium,
Mycobacterium ulcerans, is found in
aquatic environments, such as stagnant
water bodies, and can be spread through
contaminated water or soil. In addition, the
bacterium can be transmitted through the
bites of infected insects, such as flies or
mosquitoes. In some cases, the bacterium
may also be transmitted through contact
with an infected animal, such as a rodent.
 PREVENTION
MODELS
Increase access to clean water.

- Improve sanitation and hygiene practices.

- Control of insect vectors. –

Control of animal reservoirs. –

Early detection and treatment. –

Public education and awareness campaigns.

- Collaboration with community leaders and healthcare workers.

CONTROL
MODELS
Empirical treatment of early lesions.

Enhanced surveillance.

Active case finding.

Early treatment of cases.

Enhanced case management.

Contact tracing.

Public health education.

Vector control.

Animal reservoir control.

Environmental management.
IMPACT OF THE CONDITION ON
SOCIAL
Buruli ulcer can have a significant impact on individuals, families,
and communities socially. The visible nature of the disease can lead to
stigma, discrimination, and social isolation for affected individuals.
This can result in feelings of shame, low self-esteem, and
psychological distress. The economic burden of the disease can also
lead to increased poverty and financial strain on families. Physical
disabilities resulting from advanced cases of Buruli ulcer can affect an
individual's ability to perform daily activities, attend school, or work,
leading to social exclusion and decreased quality of life. Social
isolation, fear of contagion, and lack of awareness about the disease
can further contribute to the social impact of Buruli ulcer on
individuals and communities. Addressing these social challenges is
crucial to supporting affected individuals and promoting social
inclusion and well-being.
 IMPACT OF THE CONDITION ON
HEALTH
Buruli ulcer can have a significant impact on health, particularly if
left untreated or not diagnosed early. The disease is caused by the
bacteria Mycobacterium ulcerans and primarily affects the skin and
soft tissues, leading to the formation of large, painless ulcers. If not
treated promptly, Buruli ulcer can progress and cause extensive
tissue damage, leading to deformities, functional limitations, and
long-term disabilities. In severe cases, the infection can affect bones
and joints, potentially resulting in permanent disability or
amputation. Additionally, the disease can be associated with
secondary infections, delayed wound healing, and chronic pain.
Early detection, proper treatment with antibiotics, and surgical
intervention when necessary are crucial in preventing these serious
health consequences associated with Buruli ulcer.
 IMPACT OF THE
CONDITION ON
Buruli ulcer canECONOMICS
have a significant economic impact by
causing financial burden on affected individuals and
families due to medical expenses, prolonged hospital
stays, and loss of income. Additionally, the disease can
lead to long-term disabilities that affect individuals'
ability to work and contribute to the economy.

At the community level, Buruli ulcer can reduce

workforce participation, agricultural productivity, and
tourism, impacting local economies. Stigma and
discrimination associated with the disease can further
exacerbate economic challenges. Early detection,
timely treatment, and comprehensive care are crucial
to mitigate the economic impact of Buruli ulcer.
 CONCLUSION
ON BURULI
ULCER
In conclusion, Buruli ulcer is a neglected tropical
disease that can have significant economic
consequences for affected individuals, families, and
communities. The financial burden of medical expenses,
loss of income, and long-term disabilities can impact
livelihoods and local economies.

Early detection, prompt treatment, and

comprehensive care are essential to mitigate the
economic impact of Buruli ulcer and prevent
further social and economic challenges associated
with the disease. Efforts to raise awareness,
improve access to healthcare services, and reduce
stigma are crucial in addressing the economic
implications of Buruli ulcer.