Buruli ulcer disease: prospects for a vaccine

Abstract

Buruli ulcer disease (BUD), caused by Mycobacterium ulcerans, is a neglected bacterial infection of the poor in remote rural areas, mostly affecting children. BUD is a mutilating disease leading to severe disability; it is the third most common mycobacterial infection in immunocompetent people after tuberculosis and leprosy. It is most endemic in West Africa, but cases have been reported from more than 30 countries. Treatment with antibiotics is possible, long-lasting and requires injections; there are cases of treatment failures, and the disease is prone to resistance. A vaccine against M. ulcerans would protect persons at risk in highly endemic areas, and could be used as a therapeutic vaccine to shorten the duration of treatment and prevent relapses. There is considerable evidence supporting the notion that generation of a vaccine is feasible. This article reviews the present state of the art with special emphasis on the immunology of the infection and the prospects for development of a vaccine.

Mycolactone Suppresses T Cell Responsiveness by Altering Both Early Signaling and Posttranslational Events

“…Despite these progresses, surgical excision of the lesions with skin grafting remains the only alternative for advanced ulcers. To minimize the morbidity and disability associated with BUD and to propose preventive approaches against M. ulcerans, it is essential to progress in our understanding of the pathogenesis of this disease (4). Several lines of evidence suggest that mycolactone, a macrolide toxin uniquely produced by M. ulcerans and essential for bacterial virulence, may contribute to the establishment of long-term infections by suppressing host immune defenses (5,6).…”

Help-Seeking for Pre-Ulcer and Ulcer Conditions of Mycobacterium ulcerans Disease (Buruli Ulcer) in Ghana

“…7,17 Buruli ulcer is known to affect poor, rural communities. 9,11,[19][20][21][22] Only 19% of our respondents received a regular income, 26.0% were unskilled workers, mainly subsistence farmers or petty traders, and most (55.3%) were in school.…”

Buruli ulcer

“…The ML toxin is poorly immunogenic in both mice and humans 25 and ML-specific antibodies have not been found. Antibody and T-cell responses have, however, been detected against a number of M. ulcerans proteins.…”