Addressing the public health concerns associated with Buruli ulcer on a global scale

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Addressing the public health concerns associated with Buruli ulcer on a global scale. Ann Trop Med Public Health 2016;9:441-2


How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Addressing the public health concerns associated with Buruli ulcer on a global scale. Ann Trop Med Public Health [serial online] 2016 [cited 2020 Nov 23];9:441-2. Available from:

Dear Sir,

Buruli ulcer is a chronic condition due to the mycolactone toxin released by the Mycobacterium ulcerans organism which causes tissue damage, and eventually precipitates permanent disfigurement and disability, in the absence of prompt medical attention.[1] This neglected tropical disease has been identified as a public health concern across more than 30 nations from both developing (Benin, Cameroon, Congo, etc.) and developed nations (Australia, Japan).[1],[2] In fact, the current global estimates revealed that close to 2250 new cases were reported in the year 2014, with the maximum share from the nations in the African region.[1]

The current trends reflect that the number of reported cases has reduced since 2010, and it is predominantly due to the targeted public health interventions for the control of the disease.[1] However, often the available estimates do not represent the real picture as large number of cases goes unreported.[1],[2],[3] This could be because of inadequate surveillance, lack of sensitization among the health professionals about the different aspects of the disease, and the tendency of the disease to predominantly affect poor rural communities, who have a poor health seeking behavoiour.[1],[2],[3]

The epidemiological distribution suggests that the majority of the cases have been reported in the tropical and subtropical regions, with the disease being more common in children <15 years of age in most of the affected nation, and no predilection for any specific sex.[2],[4] Further, the disease is more prevalent among individuals/farmers who come in contact with unprotected surface water without being compliant to protective tools.[1],[4] The lesions associated with disease are more common in the lower extremities, followed by upper extremities, and present in three categories of severity, namely, single small lesion, nonulcerative or ulcerative lesions, and disseminated lesions with bony involvement.[1],[2] Although most of the cases in developed nations are detected in the early stage, close to 70% of the overall cases are detected in the ulceration stage, which indirectly reflects the failure of the health sector to detect and manage the disease at an earlier stage.[1]

Furthermore, it has been realized that by ensuring an early diagnosis (through either clinical or laboratory methods such as polymerase chain reaction) and offering appropriate treatment with antibiotics (rifampicin + streptomycin or rifampicin + clarithromycin) are the key interventions to minimize the associated morbidity and prevent long-term disability.[1],[5] In fact, it has been estimated that almost four-fifth of cases detected early can be completely cured with a combination of antibiotics.[1] In addition, measures should be taken to strengthen the capacity of the health system at all levels in the affected regions to ensure access to quality care, and extend services such as wound management, surgical debridement, and skin grafting to facilitate the healing of wounds, and thereby prevent disability.[1],[2],[5]

Moreover, measures to sensitize the health professionals about the clinical presentation of the disease, improve the level of compliance with protective equipment during agricultural activities, avoidance of contact with surface water through awareness campaigns, and to inculcate self-care behavior among the general population, can also deliver long-term results.[1],[3],[4] However, the biggest challenge in the control of the disease is no knowledge about the modes of transmission of the disease; hence, no targeted preventive measures can be applied.[1] At the same time, there is a great need to promote research in the field of development of an oral antibiotic treatment, validate the use of fluorescent thin-layer chromatography to enable rapid diagnosis, and epidemiological studies to understand the modes of transmission of the disease.[1],[3]

To conclude, as Buruli ulcer is associated with extensive morbidities, disability, and social and financial burden on the community and the health sector, all measures should be taken to ensure its early detection and promptly offer antibiotic treatment to effectively control the disease.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.



World Health Organization. Buruli Ulcer (Mycobacterium ulcerans Infection) – Fact Sheet; 2016. Available from: [Last accessed on 2016 Mar 05].
Yotsu RR, Murase C, Sugawara M, Suzuki K, Nakanaga K, Ishii N, et al. Revisiting Buruli ulcer. J Dermatol 2015;42:1033-41.
Ndongo PY, Fond-Harmant L, Deccache A. Community-based approaches in the fight against Buruli ulcer: Review of the literature. Sante Publique 2014;26 1 Suppl: S41-50.
N’krumah RT, Koné B, Tiembre I, Cissé G, Pluschke G, Tanner M, Utzinger J, et al. Socio-environmental factors associated with the risk of contracting Buruli ulcer in tiassalé, South Côte d’Ivoire: A Case-Control Study. PLoS Negl Trop Dis 2016;10:e0004327.
World Health Organization. Treatment of Mycobacterium ulcerans disease (Buruli ulcer): Guidance for health workers. Geneva: WHO press; 2012. p. 1-13.

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.193978

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