(formerly IRIN News) Journalism from the heart of crises

Buruli disease still stumps researchers

The first sign of buruli ulcer before skin lesions form

It starts as a painless lump, swelling or a hardened skin patch but if undetected and untreated can turn into a festering lesion and then permanent disability. Researchers are still stumped as to what causes the spread of Buruli ulcer, named for the city where the infection was first described in Uganda more than a century ago. In the face of unanswered questions about the oft-neglected disease, scientists and health officials at a World Health Organization (WHO) conference in one of the endemic countries, Benin, stressed prevention.

“What is most serious about Buruli ulcer is not linked to the mortality rate [estimated two percent, WHO], but the disease’s aftermath, ” said Yves Bargui, the head of a Buruli ulcer testing and treatment in Lalo, 100km west of Benin’s economic capital Cotonou.

In addition to painful disfiguring skin lesions, if the infection reaches the bones, it can cause permanent deformity. “What is important for us is early detection,” said Bargui. “If we can diagnose it early, then there is no need for surgery.”

More on Buruli
 WHO fact page
 Global Buruli Ulcer Initiative
 BENIN: Flesh-eating Buruli ulcer ‘neglected disease’ spreads
 COTE D'IVOIRE: Little known Buruli ulcer disease on the rise

Depending on severity, treatment ranges from eightweeks of antibiotics, which can prevent the infection from becoming an ulcer, to surgery to remove infected tissue.

The head of National Buruli Control Programme in Côte d’Ivoire, one of the most heavily-affected countries, told IRIN more money and government support is needed to improve prevention. “Researchers’ initiatives alone will not be enough. Without a stronger political will than we have now, we will never conquer [this disease],” said Didier Yao Koffi.

More than 60 years after the infection was first identified and analysed in Australia, researchers told IRIN a lack of funds limit research. According to the Australia-based George Institute for International Health, donors and governments invested US$2.4 million for Buruli ulcer research and vaccine development in 2007, which was less than 0.1 percent of spending on neglected disease research worldwide.

Australian scientist Tim Stinear said Buruli ulcer research is sorely lacking. “Sixty years later, we still do not know where the bacterium is found or its mode of transmission.”

''..Sixty years later, we still do not know where the bacterium is found or its mode of transmission..''

Buruli ulcer is caused by the same family of bacteria responsible for tuberculosis and leprosy. The vaccine used for tuberculosis can prevent the most serious Buruli ulcers, according to WHO, but researchers said a more targeted vaccine is needed to prevent a disease that affects fewer people than more well-known diseases in poor countries like HIV or malaria, but can be costly, debilitating and leave severe deformities.

In Côte d'Ivoire approximately 24,000 cases were recorded from 1978 to 2006; in Benin nearly 7,000 cases between 1989 and 2006; and in Ghana more than 11,000 cases since 1993, according to WHO.

But the health agency has written that given scant research, poor diagnostics and lack of information on the disease’s spread, it is most likely underreported.

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