Buruli ulcer is third most common mycobacterial disease in Nigeria- NTBLCP

The National Tuberculosis, Buruli Ulcer, and Leprosy Control Program (NTBLCP) in Nigeria says Buruli Ulcer (BU), is the third most common mycobacterial disease of the immunocompetent host, after tuberculosis and leprosy in the country.

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The Deputy Director and Head of Leprosy And Buruli Ucler, NTBLCP, Mr. Peter Adebayo disclosed this , in Abuja, at a two-day Media Engagement and Sensitisation meeting, organized by NTBLCP.

He said that mycobacterium ulcerans infection, also known as Buruli Ucler, is a re-emerging neglected tropical disease characterized by extensive destruction of the skin and soft tissue resulting in the formation of ulcers.

He said that without proper treatment, BU results in severe and permanent disability in more than a quarter of patients.

Dr Adebayo also noted that despite the increase in prevalence, BU was one of the least studied tropical diseases particularly in Nigeria where the disease was first described in 1967.

“Buruli ulcer generally begins as a painless dermal papule or subcutaneous edematous nodule, which, over a period of weeks to months, breaks down to form an extensive necrotic ulcer with undermined edges,” he noted.

According to him, treatment includes a prolonged course of antibiotics and surgical debridement.

He pointed out that early identification and treatment was key, as lesions heal with scarring that can be a significant source of morbidity.

Other names for the entity, he said include Bairnsdale ulcer, Daintree ulcer, Mossman ulcer, and Searl ulcer

Adebayo also disclosed that BU cases have been found in the southern and southeastern regions and other parts of the country.

He noted that transmission grows at temperatures between 29–33 °C (Mycobacterium tuberculosis grows at 37 °C) and needs a low (2.5%) oxygen concentration.

He added that the organism produces a unique toxin – mycolactone – which causes tissue damage and inhibits the immune response.

“Buruli ulcer often starts as a painless swelling (nodule), a large painless area of induration (plaque) or a diffuse painless swelling of the legs, arms or face (oedema).

“The disease may progress with no pain and fever. Without treatment or sometimes during antibiotics treatment, the nodule, plaque or oedema will ulcerate within four weeks. Bone is occasionally affected, causing deformities,” he explained.

He said that the disease had been classified into three categories of severity: Category I single small lesion (32%), Category II non-ulcerative and ulcerative plaque and oedematous forms (35%) and Category III disseminated and mixed forms such as osteitis, osteomyelitis and joint involvement (33%).

“Lesions frequently occur in the limbs: 35% on the upper limbs, 55% on the lower limbs, and 10% on the other parts of the body,” he said.

Adebayo, however, advised health workers to be careful in the diagnosis of BU in patients with lower leg lesions to avoid confusion with other causes of ulceration such as diabetes, arterial and venous insufficiency.

“In most cases, experienced health professionals in endemic areas can make a reliable clinical diagnosis but training is essential,” he advised.