Buruli ulcer

Monday 4 February 2019 - Updated on Monday 29 April 2019
Improving access to diagnosis.
Buruli ulcer
Légende
Buruli ulcer.

Buruli ulcer (BU) is an infectious disease due to Mycobacterium ulcerans and the third most common mycobacterial disease after tuberculosis and leprosy1. BU is characterized by large ulcers and often results in permanent disability2.

BU has been reported worldwide with the majority of cases in West and central Africa. It has been classified by the World Health Organization as a neglected tropical disease. Although 42,000 cases have been reported in the last decade, it is difficult to obtain a sense of the importance of the disease due to remoteness of patients, lack of data, and challenges for obtaining an accurate diagnosis2. The current treatment consists of a combination of rifampicin and clarithromycin for 56 days. Because the mode of transmission of M. ulcerans is still unknown, there is no primary prevention method that can be suggested3

BU is a rural disease with a costly diagnosis requiring sophisticated laboratory technologies. 
 

Research in Cameroon

Developing and validating a clinical score

Buruli ulcer can be treated with antibiotics when diagnosed sufficiently early. Otherwise the infected tissue may need to be removed surgically.
Légende
Buruli ulcer can be treated with antibiotics when diagnosed sufficiently early. Otherwise the infected tissue may need to be removed surgically.

After assessing the burden of BU in Centre Region of Cameroon 4, Epicentre developed a clinical score to facilitate the detection of the disease and shorten the delays in start of treatment. The score relies on the grading of demographic (e.g. age and gender) and clinical parameters, such as the size and color of the wound. This score is now being validated by Epicentre in Cameroon in partnership with the National Program in the fight against Buruli ulcer the Centre Pasteur du Cameroun, and FAIRMED 5,6.

We want to estimate the performance of this score compared to molecular diagnostic (polymerase chain reaction), which is the reference diagnostic method. Early and accurate diagnosis is critical to start adequate treatment and reduce the morbidity of BU  thereby avoid the disability that would be likely to occur in the absence of a cure.

Improving access to treatment

Validation of this clinical score will enable early diagnosis and thereby can shorten the delay in start of treatment in the most remote places. We are currently evaluating this score in 3 endemic zones of Cameroon: Akonolinga, Ayos, and Bankim7
 

Adapting national recommendations in West and Central Africa

A BU score can improve the management of the disease in all affected countries. Epicentre partners with the National Program in the fight against Buruli Ulcer (PNLUB) which will use the study results to adapt national policies on BU management. We also partner with the World Health Organization to support control and research activities on BU.
 

Selected publications

The "Buruli Score": Development of a Multivariable Prediction Model for Diagnosis of Mycobacterium ulcerans Infection in Individuals with Ulcerative Skin Lesions, Akonolinga, Cameroon.

Journal Reference: PLoS neglected tropical diseases 2016 Apr ; 10(4); e0004593. doi: 10.1371/journal.pntd.0004593. Epub 2016 04 05

Prevalence of Buruli ulcer in Akonolinga health district, Cameroon: results of a cross sectional survey.

Journal Reference: PLoS neglected tropical diseases 2009 Jun 23; 3(6); e466. doi: 10.1371/journal.pntd.0000466. Epub 2009 06 23
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Recent activity

Buruli ulcer meeting in Yaoundé, Cameroon, 3-4 April 2019

As part of the project to validate the clinical score for Buruli ulcer a meeting took place in Yaoundé, Cameroon, on 3-4 April 201...

References

1  van der Werf TS, van der Graaf WT, Tappero JW, Asiedu K. Mycobacterium ulcerans infection.Lancet. 1999 Sep 18;354(9183):1013-8.
2  http://www.who.int/buruli/disease/en/
3  http://www.who.int/news-room/fact-sheets/detail/buruli-ulcer-(mycobacterium-ulcerans-infection)
4 Porten K, Sailor K, Comte E, Njikap A, Sobry A, Sihom F, Meva'a A, Eyangoh S, Myatt M, Nackers F, Grais RF.Prevalence of Buruli ulcer in Akonolinga health district, Cameroon: results of a cross sectional survey.PLoS Negl Trop Dis. 2009 Jun 23;3(6):e466. doi: 10.1371/journal.pntd.0000466
5 Mueller YK, Bastard M, Nkemenang P, Comte E, Ehounou G, Eyangoh S, Rusch B, Tabah EN, Trellu LT, Etard JF.The "Buruli Score": Development of a Multivariable Prediction Model for Diagnosis of Mycobacterium ulcerans Infection in Individuals with Ulcerative Skin Lesions, Akonolinga, Cameroon.PLoS Negl Trop Dis. 2016 Apr 5;10(4):e0004593. doi: 10.1371/journal.pntd.0004593. eCollection 2016 Apr.
6 Toutous Trellu L, Nkemenang P, Comte E, Ehounou G, Atangana P, Mboua DJ, Rusch B, Njih Tabah E, Etard JF, Mueller YK. Differential Diagnosis of Skin Ulcers in a Mycobacterium ulcerans Endemic Area: Data from a Prospective Study in Cameroon.PLoS Negl Trop Dis. 2016 Apr 13;10(4):e0004385. doi: 10.1371/journal.pntd.0004385. eCollection 2016 Apr.
7 Tabah EN, Nsagha DS, Bissek AC, Njamnshi AK, Bratschi MW, Pluschke G, Um Boock A.Buruli Ulcer in Cameroon: The Development and Impact of the National Control Programme.PLoS Negl Trop Dis. 2016 Jan 13;10(1):e0004224. doi: 10.1371/journal.pntd.0004224. eCollection 2016 Jan.