Buruli Ulcer: Insight into the epidemiology, transmission, prevention and control

Buruli Ulcer is a re-emerging neglected tropical disease of the skin and subcutaneous tissues caused by Mycobacterium ulcerans. Severe forms of the disease are often associated with adverse sequelae such as extensive scarring, gross deformities, amputations, disabilities and social stigmatization. It is most prevalent in the tropical and subtropical countries especially in West Africa, but has been reported in temperate countries such as Australia, China, and Japan. Buruli ulcer is closely associated with proximity and exposure to water bodies and anthropogenic disturbances of such aquatic habitats and the landscape. It is often found in impoverished rural communities. The precise means of transmission of M. ulcerans from its environmental niche to humans has to date not been determined. Various hypotheses have been formulated including skin trauma and the role of aquatic insects as reservoirs or vectors of the bacterium. Presently, prevention and control measures are nonspecific and consist of skin hygiene, wearing of protective clothing, early diagnosis and treatment of the disease. This work focused on 1) global distribution of reported cases of Buruli ulcer from 2002 to 2013, 2) incidence, characteristics, distribution, and seasonal variations of Buruli ulcer in one endemic country Ghana, and 3) distribution of aquatic insects in relation to local and global distribution of Buruli ulcer cases. This research has uncovered that i) global distribution of Buruli ulcer cases overlaps with the distribution of aquatic insects, 2) adults constitute a higher percentage (67.5%) of Buruli ulcer patients than children, and 3) the incidence and risk of transmission of Buruli ulcer are increased during the rainy seasons. We propose health education, mechanization of farming and fishing, provision of potable water, the use of protective clothing and bed nets during the rainy seasons, and increased BCG vaccinations in Buruli ulcer endemic areas