Buruli Ulcer (BU) is a devastating skin disease caused by a germ from the same family as the bacteria that cause tuberculosis and leprosy. However, it receives much less attention and is one of the most neglected but treatable tropical diseases.
Also known as the Bairnsdale or Daintree ulcer, BU is caused by Mycobacterium ulcerans, which is found in dust and slow-moving water and produces a toxin that damages the skin. It usually starts as a painless lump or wound that can be mistaken for an insect bite. If untreated, painful skin ulcers develop that fail to heal, and the lesion can spread over many months, leading to severe skin and limb damage. This is where it gets its “flesh-eating” name. By contrast, leprosy is not flesh-eating but destroys the nerves, especially in the hands and feet.
Buruli Ulcer is found in at least 33 countries, predominantly in poor subsistence farming families in tropical riverland regions in West and Central Africa, where most patients are children under 15.
Once rare in Australia, BU cases now occur in North Queensland, the Northern Territory, and Victoria. There has been an exponential rise in cases in Victoria despite its temperate climate. Until recently, the disease was confined to the Douglas Shire in far north Queensland between Mossman and just beyond the Daintree River, Victoria’s Bellarine, and Mornington peninsulas. However, over the past decade, cases have spread beyond the affluent coastal regions to Greater Geelong and the inner north and west of Melbourne, in a trend that has concerned infectious disease experts.
In Nigeria, where BU is endemic, The Leprosy Mission Nigeria is partnering with a government strategic plan to control BU and eliminate leprosy by 2030.
The Australian government is supporting the Enhanced Care for Integrated Skin NTDs project in Zamfara, Benue and Nasawara, in Nigeria. Thanks to the joint support of Australian supporters and the Australian NGO Cooperation Program (ANCP), this project works towards the elimination of Leprosy, Buruli Ulcers and Lymphatic Filariasis as a public health problem in 3 states in Nigeria.
Whether in Africa or Australia, BU is similar in the suffering it causes and the complexity of treatment of severe forms. The ulcers can create significant skin damage, including painful lumps, limb swelling and occasionally severe pain and limb damage.
In Victoria, there is increasing evidence that mosquitoes and possums transmit the infection. The infection is not spread from person to person. Most cases can be treated with oral antibiotics but the Victorian Department of Health says early diagnosis is vital because the ulcers grow over time. With a record 363 Buruli ulcer cases tracked in Victoria in 2023, state health authorities warn people to cover up in warmer months to prevent mosquito bites.
A ‘Beating Buruli in Victoria’ research project began in 2018 to identify when and where Buruli ulcer transmission occurs, including the mosquito and possum species involved, and to test mosquito control methods in places and times of highest risk. The project aims to disrupt Buruli ulcer transmission for the first time and lead to evidence-based policies to reduce and prevent cases of Buruli ulcer in Victoria and perhaps globally.
Pius Ogbu Sunday, TLM Nigeria’s Head of Programs and Operations, says the incubation period can be up to nine months, which leads many sufferers to delay treatment until large ulcers appear, usually on the arms and legs, causing extensive destruction of skin and soft tissue.
“Patients who are not treated early often suffer from long-term functional disabilities such as joint restriction. Early detection and treatment are critical in the prevention of such disabilities,” he says.
“In 2022, Nigeria notified 216 cases of Buruli. The Federal Ministry of Health, with the support of partners such as The Leprosy Mission Nigeria, has developed a new strategic plan for Buruli,” he says.
“This roadmap covering from 2023 to 2030 lays out an ambitious agenda toward the goal of further reducing the burden of BU in Nigeria.
“We are positioned to promote and provide integrated interventions with our funding from The Leprosy Mission Australia and the Australian Government Department of Foreign Affairs and Trade.”
PHOTO CREDITS: photos of Rukkaiya by James Montgomery
PHOTOS of Buruli Ulcer (close-ups of legs) provided by The Leprosy Mission Nigeria
The Enhance Care for Integrated Skin NTDs in Nigeria project is supported by the Australian Government through the Australian NGO Cooperation Program (ANCP). Thanks to Leprosy Mission Australia supporters and ANCP, these projects can help improve the well-being of people affected by Neglected Tropical Diseases (NTDs), like Leprosy and Buruli Ulcer, in Nigeria.
