Buruli ulcer (BU) is a disease caused by a toxin-producing bacteria,Mycobacterium ulcerans, which is endemic in 30 countries. The disease occurs largely in rural, swampy subtropical locations amongst children 5 – 15 years old. Central and West Africa have the largest number of cases, followed by Australia and Southeast Asia.
Infections normally begin with a painless growth under the skin on the arms or legs. This growth breaks down over weeks or months, forming an ulcer that destroys the skin, soft tissues, and sometimes bone. Early detection and treatment can prevent permanent disfigurement and disability. In the later stages, treatment is extremely difficult, costly and has poor outcomes.
Each year, more than 6000 cases of BU are reported. Approximately 25% of those are reported or treated too late to prevent disability. The epidemiology of BU is very poorly understood and there are no primary preventative measures for control of the disease. The current control strategy emphasizes early detection and prompt treatment.
The diagnostic landscape
Diagnosis is a major challenge in BU control. Outside of specialized facilities, clinical diagnosis and microscopy are the only available methods of detecting BU. Clinical diagnosis is often inaccurate because early stage BU symptoms are similar to many other conditions. Microscopy has an unacceptably low sensitivity (40-60%).
In specialized laboratories, it is possible to detect BU with high sensitivity and specificity using culture and PCR. However, access to testing at these facilities is generally not available for the rural, poor populations that are predominantly affected by the disease.
A confirmatory test with higher sensitivity and wider availability would enable more rapid initiation of treatment. Given infrastructure constraints, a primary or community-level test for screening symptomatic individuals is also needed. Likewise, gaps in information and awareness about BU have to be filled, both at the community level and amongst healthcare workers.
FIND’s strategic approach
FIND is prioritizing accelerated screening, surveillance, and control of BU through early and near-patient detection of cases.
The primary areas of focus are: i) supporting the use of improved case finding strategies; ii) establishing diagnostic solutions for early detection of BU close to where people live, and; iii) enabling the development of faster, less burdensome confirmation of BU through improved tools.
Currently, FIND is supporting the development of two technologies for case confirmation and plans to coordinate research on promising biomarkers and test development.
FIND also supports interventions to facilitate improved access to diagnostics that are linked to treatment. This includes advocacy, convening stakeholders, and helping set joint goals and priorities.