Where is it found
Mycobacterium ulcerans or Buruli ulcer infections have been reported in over 30 countries including Africa, the Americas, the Eastern Mediterranean, Southeast Asia, and the Western Pacific, with most cases occurring in rural communities in sub-Saharan Africa.
Typically these infections are found in communities that are close to rivers, swamps and wetlands and in areas where the water is slow-flowing or stagnant. Areas that have undergone or are undergoing deforestation, construction of dams and irrigation systems, sand mining, surface mining of minerals, and agriculture have also been noted to have higher incidences or exacerbations of the disease.
It is very likely that this disease occurs more frequently and in more countries than reported due to under-reporting. This is due to various factors that may include:
- Lack of knowledge about the disease by both healthcare providers and community members. In some rural and isolated communities, Buruli ulcer infections are not thought of as a disease but as black magic, a spell or a curse. These socio-cultural beliefs and practices strongly influence the health-seeking behaviours of the community who tend to rely on traditional treatments with the local healers. In most cases, the delay of care leads to extensive disease and therefore a strong possibility of lifelong disability.
- Lack of access to medical attention or health care center. Many infections occur in remote, rural areas where travel to a local hospital or clinic could take a full day or more. There is also the financial expense, both in terms of income lost due to medical treatment and income not obtained due to the time commitment needed to care for the infected individual.
- Fear of social isolation and stigma due to disfigurement from surgery, scarring and possible amputations.
- Variability in the clinical presentation of the disease which may lead to misdiagnosis and wrong treatment as one may think it is a different tropical skin diseases or ulcer.
- In many countries, Buruli ulcer is not a reportable disease, unlike Dengue, Ebola, Malaria or Cholera.
Countries impacted by disease:
The Americas
Brazil, French Guiana, Mexico, Peru, Suriname
Africa and the Eastern Mediterranean
Angola, Benin, Burkina Faso, Cameroon, Congo, Côte d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Ghana, Guinea, Kenya, Liberia, Malawi, Nigeria, Sierra Leone, Sudan, Togo and Uganda
South-East Asia and Western Pacific
Australia, China, Indonesia, Japan, Kiribati, Malaysia, Papua New Guinea, Sri Lanka
* There have been a few reported cases in the United Stated but these were determined to have been acquired in an endemic country and later diagnosed in the US.
 |
How many people are infected
There are 5000–6000 cases reported annually.
Côte d’Ivoire, in West Africa, is the most affected country reporting over 2500 cases per year.
* Again, it should be noted that these numbers are from countries that are reporting cases. The total number of cases and countries affected may actually be far greater.
Who is affected
All races appear to be affected equally.
There is no difference in the rates of infection among males and females.
Children between the ages 5 - 15 years appear to be most at risk, however, any age group may be affected. That said, nearly half of people affected in Africa are children under 15.
Per the World Health Organization (WHO), the majority of those infected in Africa are children compared to Australia and Japan where most are adults (Table I).
The sex distribution in Africa and Australia is the same, however, more females appear to be affected in Japan (Table II).
In general, most lesions occur on exposed parts of the body, particularly the arms and legs (Table III). The lesions are more frequent on the lower limbs in Africa and Australia compared to Japan.
Table I. Age distribution in years
<15 years
|
Mean
|
Median
|
Range
| |
Africa
|
48%
|
24
|
15
|
0.5–90
|
Australia
|
10%
|
50
|
62
|
1–96
|
Japan
|
19%
|
41
|
48
|
2–81
|
Table II. Sex distribution
Males
|
Females
| |
Africa
|
52%
|
48%
|
Australia
|
55%
|
45%
|
Japan
|
34%
|
66%
|
Table III. Location of lesions
Upper limb
|
Lower limb
|
Other parts of the body
| |
Africa
|
25%
|
63%
|
11%
|
Australia
|
31%
|
64%
|
5%
|
Japan
|
50%
|
38%
|
13%
|
* Above information and table obtained from http://www.who.int/mediacentre/factsheets/fs199/en/
Additional information and articles regarding endemic countries:
Videos:
1. Buruli ulcer: from a difficult past to a hopeful future: http://youtu.be/W0Gu3kNE_9c
2. Buruli ulcer - Togo - Handicap International: http://youtu.be/mDVN8m5d3LU
References:
1. World Health Organization - Media Centre - Factsheet: http://www.who.int/mediacentre/factsheets/fs199/en/
5. CDC - Buruli ulcer - Technical Information: http://www.cdc.gov/nczved/divisions/dfbmd/diseases/buruli_ulcer/technical.html
6. What Role Do Traditional Beliefs Play in Treatment Seeking and Delay for Buruli Ulcer Disease?–Insights from a Mixed Methods Study in Cameroon: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036954
-----------------------------------------------------------------------------------------
There are no easy answers' but there are simple answers. We must have the courage to do what we know is morally right.
- Ronald Reagan
No comments:
Post a Comment