Epidemiology and disease burden of Buruli ulcer: a review

Abstract

Buruli ulcer (BU) is a neglected tropical skin disease caused by Mycobacterium ulcerans. Infection foci occur mainly in remote, rural areas of Central and West Africa, but also in Australia and Papua New Guinea. In addition, infections caused by M. ulcerans strains of a different lineage are sporadically reported from scattered foci in Asia and the Americas. While in the past decade more than 42,000 BU cases have been reported worldwide, an assessment of the actual global disease burden is complicated by the remoteness of affected populations and a lack of data on the incidence of BU in a number of countries, from which cases have been historically reported. Moreover, as BU patients present with diverse clinical manifestations ranging from relatively unspecific nodules, plaques, or edema to necrotic, ulcerative lesions, differential diagnosis is manifold and thus clinical misclassification may occur. Since to date reservoirs and transmission pathways of M. ulcerans remain equivocal, early diagnosis and treatment of patients are key determinants to control the disease. Particularly in view of the apparent decline in BU incidence in regions of West Africa, awareness and knowledge of BU in endemic regions must be retained to ensure a continuous monitoring and control. An integrated approach for the control of tropical skin diseases should be considered to cope with this difficult task. This review article aims at providing an overview of the current global burden of BU and summarizes the state of knowledge on the various epidemiological aspects of this enigmatic disease.

Transdisciplinary Research and Action to Stop Buruli Ulcer: A case Study from Philanthropy

“…Findings from epidemiological studies indicated that the BU burden in Africa was underestimated [3] and solid world-wide prevalence data were not available. BU was reported in 33 countries, but not all endemic countries regularly reported case numbers to the WHO and in some countries, endemic regions still have to be mapped.…”

The chemistry and biology of mycolactones

“…In certain highly endemic regions like the Zou department in southern Benin, the prevalence of Buruli ulcer can even exceed that of tuberculosis or leprosy [ 10 ]. Since 2010, the number of reported Buruli ulcer infections worldwide has declined from almost 5000 annual cases to approximately 2000 in 2015 [ 11 – 12 ], but the reasons for this decrease are unknown [ 3 ]. However, these numbers have to be treated with care and numerous cases have to be assumed to remain unreported, since only 15 countries regularly report data to the WHO [ 3 ].…”

Structural Basis and Designing of Peptide Vaccine using PE-PGRS Family Protein of Mycobacterium ulcerans – An Integrated Vaccinomics Approach

“…Buruli ulcer is a neglected tropical disease of the skin characterized by chronic skin lesions and tissue necrosis leading to permanent cosmetic deformity and functional disability affecting thousands of people worldwide (Pluschke and Röltgen 2015;Simpson et al 2019;Barksby 2019). Despite being endemic to West and Central Africa (Johnson 2019), Buruli ulcer has been reported from more than 34 countries worldwide including countries from South America and Western Pacific regions (Pluschke and Röltgen 2015;Singh et al 2019;Simpson et al 2019). About 80% of cases were from West African countries i.e., Côte d'Ivoire, Ghana, Benin and Cameroon (Mitra AK 2017).…”

“…The pathogen M. ulcerans has evolved from the fish pathogen M. marinum which rarely causes skin lesions in humans (Yip et al 2007;Petrini 2006). The emergence of M. ulcerans has been associated by the acquisition of pMUM plasmid that encodes the gene for the production of mycolactone (Johnson 2019;George et al 1999), a polyketide-derived diffusible exotoxin, that has cytotoxic and immunosuppressive properties responsible for chronic skin lesions (Adusumilli et al 2005;Walsh et al 2005;Hong et al 2008) and destroying the immune cells before reaching the infection site (Pluschke and Röltgen 2015). This exotoxin (mycolactone) is the main virulence factor of M. ulcerans (George et al 1999;Barksby 2019).…”