Forgotten Flesh-Eating Disease Spreading in Africa

By Fid Thompson

Dakar
01 April 2009

A high-level conference in Benin this week is bringing together African heads of state and health officials to discuss efforts to contain the little-known Buruli ulcer.

The Buruli bacteria eats away at human flesh, leaving large ulcers before devouring muscle tissue to the bone. If untreated it can lead to severe disability and, in some cases, amputation.

The mycobacterium ulcerans was first identified in Australia in 1948. In Africa, it surfaced in Uganda in the 1950's and has since spread rapidly, particularly in West Africa, where thousands of cases have been reported in Ivory Coast, Benin and Ghana.

Dr. Alexander Tiendrebeogo is an expert on the Buruli Ulcer for the World Health Organization.

"We do not exactly know why most of the cases are coming from West Africa," Dr. Tiendrebeogo said. "But we think that the actual burden of disease is unknown and underestimated. So Cote d'Ivoire was the first country reporting up to more than 25 cumulative cases since the 1990s, but we think that other countries like Ghana, Togo, Benin, even Nigeria, could have as many or more cases as Cote d'Ivoire."

Tiendrebeogo says the disease is caused by bacteria living in water, but that little is known about where the disease comes from.

"We know the disease occurs in places where we have swampy areas with hot and humid climates, especially in lowlands where we have slow-flowing rivers or lakes," Dr. Tiendrebeogo said. "For example in Cote d'Ivoire we found it around the lakes and dams. In Gabon we find it in the province of Moyen Ogooue where you have the river Ogooue which is a slow-flowing river in this province."

Experts are not sure how the disease is transmitted, but they believe that the bacteria must come into contact with an opening on the skin. Dr. Tiendrebeogo says people in areas where there is the highest risk for infection must be made more aware of the disease.

"We need to increase awareness of the disease among affected communities in suspected endemic areas, so patients will come earlier to health facilities and be treated with the combined antibiotic treatment," Dr. Tiendrebeogo said.  

Tiendrebeogo says the disease has a low profile for several reasons.  

"The disease occurs in particular environment and those areas are quite often difficult to access areas because it is swampy or forest," Dr. Tiendrebeogo said. "Also when people are affected they do not present first to the health services. They used to think it is linked to sorcery so they go first to traditional healers. Also at the beginning there is no pain and so the patients do not take it seriously."

Until experts better understand how human beings become infected with the Buruli ulcer, he says the only prevention measures are common hygiene.

Since the first international conference on the Buruli ulcer in Ivory Coast 10 years ago, scientists have discovered a combination of antibiotics that easily treat the disease.

Previously, there was no treatment, which often meant amputating limbs or leaving the person with severe lack of movement.

This week's conference in Benin brings together health officials from 30 countries, including Australia, France, Canada, Norway, Germany and the United States. Several West African nations are reporting on progress in containing the disease, including Benin where incidents of the disease have declined during the past year.

Experts also hope to develop a fully oral treatment for the disease, with no need for injections. This would allow more people to be treated in their own communities without having to travel to a health center.

With concerns the disease is becoming more common, Dr. Tiendrebeogo and others are calling for a renewed commitment from governments and development partners to support Buruli ulcer control programs.