Buruli ulcer is a Neglected Tropical Disease (NTD) affecting the skin caused by an environmental mycobacterium known as Mycobacterium ulcerans, which is part of the same family of bacteria causing tuberculosis or leprosy. Its prevention and mode of transmission are still unknown, and therefore early diagnosis and treatment are crucial.
Buruli ulcer is a disease of unknown origin. It is normally linked to the presence of stagnant and unhealthy water, and it has a disproportionate effect on people from rural and impoverished backgrounds in sub-Saharan Africa. Its treatment with antibiotics is cheap and effective, but as it is a neglected disease not enough resources are deployed to detect it or treat it.
Buruli ulcer: a nodule that ulcerates and leads to disability
Buruli ulcer manifests as a painless swelling or nodule on the legs, arms, or face. If not treated in time, these nodules become ulcers after a few weeks, affecting the soft tissues and bones of the patient. This can give rise to a permanent disability with psycho-social and socio-economic implications. The need for hospitalization in order to receive treatment and heal the wounds has a great impact on households, especially when most cases are detected in an advanced stage of the disease, requiring a longer period of hospitalization.
To accelerate healing and reduce time spent in hospital, treatment with antibiotics is combined with curing the wounds, surgery, and in serious cases, physiotherapy to prevent disability.
More than 30 countries have reported cases of Buruli ulcer, being the most affected in western and central Africa. Efforts to control the disease in the past decade have focussed on these two WHO regions. At Fundación Anesvad we combat Buruli ulcer in four countries of the Gulf of Guinea: Ivory Coast, Ghana, Togo and Benin.
Buruli Ulcer and Mycobacterium ulcerans infection
Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans, a bacterium related to those responsible for tuberculosis and leprosy. It leads to large, disfiguring skin ulcers, often in the limbs, that can cause lasting disability if not treated. Most common in rural, low-income areas of West and Central Africa, the disease thrives near wetlands and rivers. Though rarely fatal, its social and economic toll is immense. Increasing awareness has become essential to controlling its spread and impact.
Symptoms and diagnosis
The disease often starts with a small, painless swelling or nodule under the skin, which gradually turns into a large ulcer with characteristic undermined edges. Without treatment, Buruli ulcer can destroy skin, tissue and bone, leaving permanent scars or deformities. Diagnosis is usually clinical but can be confirmed with specialized tests like PCR. Early detection dramatically improves outcomes, reducing the need for surgery. Timely diagnosis remains a cornerstone of disease control.
Transmission and risk factors in Africa
Although the precise route of transmission is still not fully understood, Buruli ulcer is believed to be linked to contact with contaminated environments, especially wetlands, swamps and slow-moving rivers. Children under 15 are most often affected, likely due to frequent outdoor activity and exposure. Poor wound hygiene, lack of protective clothing and environmental disruptions may heighten risk. Understanding these patterns is crucial for designing effective prevention strategies.
Prevention and control in African communities
Prevention focuses on promoting awareness, protective behaviors, and improved access to early treatment. Community education campaigns teach families to recognize early signs and practice good wound care, particularly when living near high-risk areas. Simple measures like wearing protective clothing can help reduce exposure. Strengthening local health services ensures patients receive prompt antibiotics, preventing complications. Empowering communities is key to long-term disease control.
Early detection and the role of health workers
Having said that, frontline health workers are essential in the fight against Buruli ulcer (and other NTD), often serving as the first point of contact for early cases. Through active case-finding and school screenings, they help identify patients before ulcers progress. Training health workers to recognize subtle early signs improves referral and treatment rates. Community trust in health teams also encourages people to seek help early. Their role is vital in bridging the gap between isolated communities and health systems.
WHO strategies and community engagement
The World Health Organization’s (WHO) global strategy for Buruli ulcer emphasizes early case detection, free antibiotic treatment and access to surgical care when needed. Collaborating closely with national programs, NGOs, and local leaders, WHO supports health system strengthening. Community engagement is key, as local involvement ensures awareness, trust and uptake of services. By integrating public health campaigns with local customs and leadership, these efforts become more sustainable and effective.
Impact on African communities
Buruli ulcer leaves a deep mark on individuals, families, and communities. Beyond the physical pain, it can bring school dropout, job loss, stigma and social isolation. The disease disproportionately strikes the most vulnerable, deepening poverty and limiting future opportunities. For affected children, the emotional burden can be as heavy as the physical one. Combating Buruli ulcer is ultimately about restoring health, dignity and hope to those whose lives it touches. That’s one of our most serious struggles in our work. That’s one of our greatest beliefs: a continent —a world— without Buruli ulcer.
