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| Buruli ulcer |
Among the villagers, his wife was the
witch who struck her husband with a wound that refused to heal. In
reality, the wound actually started as a boil, but it soon proceeded to
becoming a long-lasting sore that defied explanation.
But because of the witchcraft theory
that went with the painful condition, the patient did not see the need
to seek medical help. Rather, he took many painful incisions around the
wound, to no avail.
It wasn’t until some doctors on medical
mission diagnosed his condition as Buruli ulcer — an infectious disease
caused by Mycobacterium ulcerans — that he got a relief from a disease
that had come to define his old age.
Continue after the cut...
An official of the Federal Ministry of
Health, Dr. Okechukwu Chukwuekezie, reveals that Mycobacterium ulcerans
(M. ulcerans) is a slow-growing mycobacterium that infects the skin and
subcutaneous tissues, giving rise to indolent non-ulcerated (nodules,
plaques) and ulcerated lesions.
He notes that this bacterium is so
deadly that it also causes serious diseases that include tuberculosis
and leprosy in human beings.
Family doctor, Greg Obiajunwa, says
generally, the human body is equipped with disease-fighting agents
called immunity. However, when M. ulcerans infects, it first suppresses
the immune system, and this enables the infection to wreak havoc on the
cells, leading to what is medically known as apoptosis or programmed
cell death and eventual tissue damage.
“That is why you see shocking, gaping wounds on its victims,” Obiajunwa says.
Experts say when it affects the leg, for
instance, the disease might present as a grossly swollen and stiff leg,
and later progress to a stage where you start having a copious
discharge.
Obiajunwa describes Buruli ulcer as a
chronic debilitating skin and soft tissue infection that can lead to
permanent disfigurement and disability.
He notes, “Infection usually leads to destruction of skin and soft tissue, with large ulcers usually on the legs or arms.”
He warns that patients who are not
treated early will suffer long-term functional disability that may
severely reduce their ability to perform necessary physical activities.
He notes that early diagnosis and treatment are the only ways to
minimise morbidity and prevent disability.
Physicians say Buruli ulcer can affect
any part of the body, including the upper limbs (arms and hands), lower
limbs (legs) and sometimes, other parts of the body such as the face;
and larger skin portions such as the back and abdomen.
“The ravaging capacity of the causative bacteria is indescribable,” Obiajunwa laments.
Symptoms
According to the World Health
Organisation, “Buruli ulcer often starts as a painless swelling
(nodule). It can initially also present as a large painless area of
induration (hardening of a normally soft tissue or organ, especially the
skin, because of inflammation or an accumulation of blood) or a diffuse
painless swelling of the legs, arms or face (oedema).
“Local immunosuppressive properties of
the mycolactone toxin enable the disease to progress with no pain and
fever. Without treatment or, sometimes during antibiotics treatment, the
nodule, plaque or oedema will ulcerate within four weeks with the
classical, undermined borders. Occasionally, bone is affected, causing
gross deformities.”
Diagnosis
Experts warn that because research is
still ongoing about how to correctly diagnose this painful disease,
early nodular lesions are occasionally confused with boils, lipomas (a
benign tumor composed of body fat), ganglions (lumps that shows up next
to a joint or a tendon), lymph node tuberculosis, onchocerciasis nodules
or other subcutaneous infections such as fungal infection.
“In some cases, papular lesions may
initially be confused with an insect bite. Worse still, it may be
confused with cellulitis — another potentially serious skin infection,”
physicians warn.
Those at risk
While the route of transmission remains
unclear, authorities at Centres for Disease Control and Prevention say
one hypothesis is that M. ulcerans enters the body through a break in
the skin, via insect bite, cut or wound.
Experts say those who risk having Buruli
ulcer include children, aged people and those who live in rural areas
where strict hygiene is not adhered to.
The WHO experts also report that domestic animals such cat, horse, and dog have been diagnosed as having this disease.
“Also at risk are those whose immune
system has been weakened as a result of infectious diseases such as
HIV/AIDS, making the progress of Buruli ulcer more aggressive in such
persons,” Obiajunwa says.
Indeed, physicians warn that patients
who have a combination of Buruli ulcer and HIV often present lesions
(damage) in multiple areas of the body, as well as bone infection
(osteomyelitis). Consequently, patients infected with a combo of Buruli
ulcer and HIV are advised to also undergo screening for tuberculosis.
Control & treatment
Experts say at present, there’s no
vaccine for the primary prevention of Buruli ulcer, but that once
diagnosed, patients could be treated with different combinations of
antibiotics over an eight-week period.
The WHO also recommends complementary
treatment such as wound care, surgery (mainly debridement and skin
grafting) and interventions to minimise or prevent disabilities,
depending on the stage of the disease.
Experts also stress the need for health
education at the community level to enhance early reporting; training of
health workers and village volunteers; laboratory confirmation of
cases; strengthening of health facilities; and monitoring and evaluation
of control activities in order to wipe out Buruli ulcer.
-Punch
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