Neglected Tropical Diseases: A Case of Buruli Ulcer

January 30 this year marks World Day for Neglected Tropical Diseases (NTDs), which mainly affect the poor in tropical and subtropical latitudes, where access to health services is very limited. With a disease burden similar to that of tuberculosis, of approximately 48 million disability-adjusted life years, NTDs are also a major cause of stigma and social exclusion.

One such NTD is Buruli ulcer, caused by the bacterium Mycobacterium ulcerswhich produces a toxin that destroys the skin, and in advanced cases can even damage the bones.

The mechanism of its transmission is unknown, although it is known to have important environmental determinants and is associated with exposure to stagnant or slowly moving water bodies. The disease has been described in various regions of the world, such as South America and the Western Pacific, but is actually a public health problem in rural communities in sub-Saharan Africa, where it mainly affects boys and girls under the age of 15 . and responsible for preventable suffering:

If not diagnosed and treated in time, Buruli ulcer can lead to disability in up to 25% of cases. Patients generally must be accompanied by family members during hospitalization, which negatively impacts household income by causing patients to be rejected from hospitals or not to complete treatment. Those who suffer from large ulcers or are cured of disfigurement often become socially isolated and eventually drop out of school or work, perpetuating a vicious cycle of poverty and disease.

Buruli ulcer is one of the most neglected NTDs with very little research funding. For this reason, the goals set by the World Health Organization (WHO) for this disease in their new roadmap are rather modest: by 2030, more than 90% of cases must be detected at an early stage to avoid complications (currently 30% of cases are detected too late). Another important goal is that more than 95% of all cases can be confirmed by a laboratory test and complete treatment.

One of the main obstacles to the control of Buruli ulcer is the lack of knowledge about its epidemiology and transmission mechanisms. Its environmental determinants are related to lack of access to clean water and sanitation, and the involvement of insect vectors and reservoir animals is also discussed. While efforts are underway to develop new diagnostic tools that allow early detection in endemic communities and reduce treatment duration (so that it can be received by the most patients and at a lower cost), the control of Buruli ulcer is based on a number of complex actions.

In line with its roadmap for NTDs, WHO is promoting, inter alia, three key actions that make the most of existing tools and strategies to control Buruli ulcer and other NTDs, and improve health services and systems:

1. AND a strategic framework for the integrated management and management of NTDs with cutaneous manifestationssuch as Buruli ulcer, leprosy and scabies, among others: skin screening for early detection of a disease can integrate the processes of diagnosis, treatment and control of these diseases, optimizing resources and infrastructure and enabling more efficient care.

2. AND transdisciplinary and transversal One Health approach: some cutaneous NTDs are transmitted by vectors, such as mosquitoes or flies in the case of lymphatic filariasis or onchocerciasis, or are zoonotic (have an animal reservoir), such as tungiasis or cutaneous leishmaniasis, or have a pronounced environmental effect, such as Buruli ulcer. . Therefore, its control requires an approach OneHealth with intersectoral collaboration between human and animal health professionals, while not forgetting the complexity of the ecosystems in which humans and animals coexist.

3. AND global water, sanitation and hygiene strategy to combat NTDs. This, in the case of Buruli ulcer and other NTDs of the skin, is key to helping care for injuries and preventing infections in open wounds.

Among the targets of Sustainable Development Goal 3 (Health and well-being) is the elimination of NTDs and the achievement of universal health coverage. 12 December was International Universal Health Coverage Day, reminding us that 30% of the world’s population still lacks access to essential health services. In this context, progress against Buruli ulcer and other NTDs will be an indicator of universal health coverage, in addition to contributing to other SDG targets such as fighting poverty and hunger, improving access to education and leading productive working lives.

Alejandro de Arriba Fernandez, Resident Intern, Preventive Medicine and Public Health, CHUIMI; doctoral student in biomedicine ULPGC, University of Las Palmas de Gran Canaria and Israel Cruz Mata, Head of International Health, CIBERINFEC National School of Health, Carlos III Health Institute

This article was originally published on The Conversation. Read the original.