What you call boil may be Buruli ulcer

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.

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.