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Buruli Ulcer Disease Essay

1069 words - 5 pages

Buruli Ulcer Disease
Buruli ulcer is an emerging disease that has been found in over 30 countries worldwide, predominately in humid tropical areas of Asia, Latin America and Africa. (Infection, 2003) The disease may also occur in temperate climates like those found in the coastal regions of southeastern Australia. It is the third most common mycobacterial infection in immunocompetent people in the endemic regions. There are an increasing number of cases in West Africa, where the disease has surpassed leprosy and tuberculosis in some regions. Buruli ulcer is caused by an infection with Mycobacterium ulcerans that involves the skin and subcutaneous adipose tissue that mainly affects children ...view middle of the document...

Although PCR is currently considered the “gold standard” it is not widely used due to the remoteness of the endemic areas and cost of the testing. PCR has proven to be 98% sensitive with swabs obtained from ulcers or tissue biopsies. A culture of Mycobacterium ulcerans is approximately 40-43% sensitive when using Lowenstein –Jenson slopes when incubated at 32oC for 6-8 weeks or more. Histopathology requires tissue biopsies and has a 90% sensitivity and can be used for a differential diagnosis when the other methods are negative. The simplest way to differentiate Mycobacterium ulcerans is by a direct smear examination for acid-fast bacilli from a swab using Ziehl-Neelsen stain. The direct smear examination is currently the most widely used method for identification of Mycobacterium ulcerans because it is easy to perform at a local level, does not require expensive materials or equipment and gives you rapid results. (Van Der Werf, et al., 2005)
It has been known for some time that Buruli ulcer transmission is associated with tropical, humid areas in Africa usually where there are areas of stagnant ground water or slow moving rivers. The bacterium has been found in the environment, wild animals, water bugs and fish. Although it has been found in these areas the exact mode of transmission is not known. It is thought that it is spread through the bite of an infected water bug, such as Naucoris flavicollis or Belostoma cordofna or by some other type of penetrating injury with contaminated vegetation.
Mycobacterium ulcerans Is similar to M. marinum strains but produces a polyketide toxin mycolactone. (Nienhuis, et al., 2010) Microlactones are secreted and diffuse into the infected tissues and surrounding areas inducing apoptosis and necrosis. For several years the primary treatment was surgical excision of the lesion with primary closure or skin grafting following excision. In the last few years the World Health Organization has recommended the use of oral antibiotic therapy. The use of rifampicin and intramuscular streptomycin is currently being used along with or without surgical intervention. The drug therapy is recommended for 8 weeks. Because of poor access to healthcare in endemic regions and the belief of traditional ways of healing treatment is usually delayed. Delay of treatment usually leads to extensive destruction of skin and tissue and long-term functional disabilities from scarring and joint immobility.
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