Buruli ulcer in West Africa: Aspects of patient management.

Buruli ulcer is a tropical infection caused by Mycobacterium ulcerans. Typically, a large skin ulcer appears which is initially painless, but heals slowly. A common problem is that patients come to the hospital at an advanced stage, increasing the risk of serious scarring and contractures, leading to functional limitations.
Previously, treatment for Buruli ulcer revolved around surgery followed by prolonged hospitalization, but during the last decade, an antibiotic regimen has become available, consisting of 8 weeks of daily rifampicin tablets and streptomycin injections – which is still long and painful. We have now shown that prolonged streptomycin administration also leads to irreversible hearing loss. We have also shown that for a subset of patients with small lesions, a reduction in treatment duration might be feasible.
To ensure that patients come to the hospital with early, small lesions, we show that programs aimed at early detection are feasible. Trained community volunteers from endemic villages appear pivotal, resulting in significant impact on referral at an early stage, with excellent recovery resulting in high, unimpaired quality of life.
We also studied wound care in endemic areas, and show that there is room for improvement, both through cheap and simple measures, and the introduction of modern wound dressings.
Once a neglected condition leaving half of patients with considerable disability and prolonged severe suffering, Buruli ulcer – though still a Neglected Tropical Disease – has changed into a condition for which effective standardized therapy is available, provided that programs are in place to encourage patients to report early.