Buruli ulcer is a chronic, progressive skin disease caused by infection with Mycobacterium ulcerans. It is currently considered to be one of the neglected tropical diseases; less common than tuberculosis but more common than leprosy. The initial lesion is a painless subcutaneous nodule, usually less... than 5 cm diameter and adherent to skin. The nodule typically breaks down centrally after days to weeks forming an ulcer with undermined edges. Thus, the external appearance of the ulcer underestimates the true size of the affected area. The patient remains well and there is no pain unless secondary bacterial infection occurs. Other forms of M. ulcerans disease include a firm plaque lesions that behaves in the same way as the nodule or an oedematous lesion that is more aggressive and extends rapidly resulting in a very large ulcer.
Any age group can be affected by Buruli ulcer diseases, but the incidence peaks at 5 to 15 years. Ulcers are most frequently on the limbs but can be on the trunk or head, sometimes with catastrophic consequences such as loss of sight or loss of breast or genital tissue. Healing close to a joint can result in contracture, and sometimes there is so much tissue destruction on a limb that amputation is unavoidable. Occasionally osteomyelitis occurs in bone adjacent to a skin lesion but involvement of other organs is rare. Disseminated disease with HIV has been reported.
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En la presente guía de capacitación se explica cómo reconocer los signos y los síntomas de las enfermedades tropicales desatendidas de la piel a partir de sus características visibles. También contiene información sobre cómo diagnosticar y tratar los problemas frecuentes de la piel que puede... encontrar el personal de salud de primera línea.
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Comment reconnaître les maladies tropicales négligées selon les altérations de la peau : guide de formation à l’usage du
personnel sanitaire de première lignes [Recognizing neglected tropical diseases through changes on the skin: a training
guide for front-line health workers]
The skin of a patient is the first and most visible structure of the body that any health-care worker encounters during the course of an examination. To the patient, it is also highly visible, and any disease that affects it is noticeable and will have an impact on personal and social well-being. Th...e skin is therefore an important entry point for both diagnosis and management. Many diseases of humans are associated with changes to the skin, ranging from symptoms such as itching to changes in colour, feel and appearance.
This training guide explains how to identify the signs and symptoms of neglected tropical diseases of the skin through their visible characteristics. It also contains information on how to diagnose and manage common skin problems that front-line health workers may encounter.
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Buruli ulcer caused by Mycobacterium ulcerans is a neglected tropical disease characterized by extensive ulceration involving predominantly the upper and lower limbs of patients. The disease is common in rural tropical communities in West and Central Africa, where access to proper health care is lim...ited. Pathogenesis of the characteristic painless ulcers is linked to the elaboration by M. ulcerans of a lipid toxin called mycolactone that has potent cytopathic, immunosuppressive, and analgesic effects on a host of cells in cutaneous tissues. Mycolactone is known to profoundly inhibit secretion of a plethora of proteins that are essential for wound healing. Even though a combination antibacterial therapy of streptomycin and rifampicin for 8 weeks is effective for treatment, it relies on good and appropriate wound management to prevent secondary bacterial infections and improve healing. Evidence-based interventions for wound care in Buruli ulcer disease are often lacking and have relied on expert advice and recommendations. Surgical interventions are limited to debridement of necrotic tissue and grafting of extensive ulcers, usually after antibiotic therapy. Patients’ rehabilitation is an important component of care to reduce disabilities associated with the disease and proper integration into the community after treatment.
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Principaux faits
L’ulcère de Buruli est une infection chronique débilitante causée par la bactérie Mycobacterium ulcerans.
L’ulcère de Buruli a été signalé dans au moins 33 pays situés dans des régions au climat tropical, subtropical ou tempéré d’Afrique, d’Amérique ...du Sud et du Pacifique occidental.
Cette infection affecte la peau et parfois les os et peut entraîner des déformations et des incapacités permanentes.
Le mode de transmission de cette maladie est inconnu, on ne peut la prévenir.
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Datos y cifras
La úlcera de Buruli es una enfermedad crónica y debilitante causada por una micobacteria ambiental: Mycobacterium ulcerans.
Al menos 33 países de clima tropical, subtropical o templado han notificado casos de úlcera de Buruli en África, América del Sur y las regiones... del Pacífico Occidental.
Esta enfermedad suele afectar a la piel, y a veces al hueso, y puede causar desfiguraciones permanentes y discapacidad a largo plazo.
No se conoce el modo de transmisión de la enfermedad y no hay forma de prevenirla.
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Key facts
Buruli ulcer is a chronic debilitating disease caused by an environmental Mycobacterium ulcerans.
At least 33 countries with tropical, subtropical and temperate climates have reported Buruli ulcer in Africa, South America and Western Pacific regions.
It often affects the skin an...d sometimes bone and can lead to permanent disfigurement and long-term disability.
The mode of transmission is not known and there is no prevention for the disease.
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Prevencion para proveedores de atención médica
Learn how patients can prevent dengue.
Nat Commun 9, 5370 (2018). https://doi.org/10.1038/s41467-018-07804-8. Mycobacterium ulcerans is the causative agent of Buruli ulcer, a neglected tropical skin disease that is most commonly found in children from West and Central Africa. Despite the severity of the infection, therapeutic options are... limited to antibiotics with severe side effects. Here, we show that M. ulcerans is susceptible to the anti-tubercular drug Q203 and related compounds targeting the respiratory cytochrome bc1:aa3. While the cytochrome bc1:aa3 is the primary terminal oxidase in Mycobacterium tuberculosis, the presence of an alternate bd-type terminal oxidase limits the bactericidal and sterilizing potency of Q203 against this bacterium. M. ulcerans strains found in Buruli ulcer patients from Africa and Australia lost all alternate terminal electron acceptors and rely exclusively on the cytochrome bc1:aa3 to respire. As a result, Q203 is bactericidal at low dose against M. ulcerans replicating in vitro and in mice, making the drug a promising candidate for Buruli ulcer treatment.
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Dengue and severe dengue treatment recommendations for healthcare providers.
Dengue testing guidance according to days of symptom onset.
Cotonou Declaration oBuruli Ulcer
Cotonou, Benin, 30 March 2009
Neglected tropical diseases kill, weaken or incapacitate millions of people every year, causing permanent physical suffering, social stigmatization and reduced productive capacity. Buruli ulcer, one such disease, causes immense suffer...ing and disabilities, especially among children. Delayed schooling and loss of productivity are considerable among the affected populations. These adverse consequences tend to aggravate poverty in affected communities. Globally, the disease has been reported in 30 countries. In WHO’s African Region, Buruli ulcer has been confirmed in 12 countries and is suspected in 10 others.
Significant progress has been made in the past 10 years in knowledge of Buruli
ulcer, investments in related research, control of the disease, and improvement
of tools for case diagnosis and development of treatment protocols. Substantial achievements have been made in diagnosis, treatment, immunology and epidemiology. Despite these achievements, little is known about the exact mode of transmission of the disease, and there is no simple diagnostic test usable in the field.
The use of antibiotics has revolutionized treatment and contributed to reducing the need for surgery by half. However, efforts are still needed to develop simple diagnostic tools usable in the field as well as disability prevention methods. The Global Buruli Ulcer Initiative has adopted the strategy recommended by WHO. The strategy is based on early diagnosis of the disease and the use of antibiotics for treatment upon the onset of the first signs by improving access to screening and case management at the most peripheral level of the health system.
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Buruli ulcer – community information sheet (October 2018)
Buruli ulcer (Mycobacterium ulcerans infection) Resource platform
