Chapter 6 : The Mycobacterial Infections: Buruli Ulcer and Leprosy

Abstract:

This chapter considers two serious and important mycobacterial infections of the poor--Buruli ulcer and leprosy, which have not benefited from the same level of advocacy as tuberculosis (TB). Buruli ulcer and leprosy are two highly disfiguring and stigmatizing NTDs occurring almost exclusively among the impoverished living in developing countries. Buruli ulcer is a highly disfiguring skin infection caused by Mycobacterium ulcerans. Although it is typically painless and rarely results in death, the ulcer of Buruli disease has a number of catastrophic consequences for the patient, including a profound socioeconomic impact and the widespread belief that witchcraft and curses play an important role in transmitting the disease. Leprosy (also known as Hansen’s disease) is caused by M. leprae. Due to its profoundly disfiguring clinical features, there are numerous accounts of leprosy in ancient texts. Lepraphobia was extant throughout medieval Europe. Today, as a result of widespread availability and use of MDT, the global registered prevalence of leprosy has been reduced to 224,000 cases with an estimated 259,000 new cases detected annually. Leprosy proceeds along either one of two clinical courses. The majority of patients develop the so-called tuberculoid form. Such patients have the ability to mount strong immunological responses against M. leprae and, as a result, develop only localized disease. These patients experience widely disseminated disease in the skin and nerves and even the eyes, nose, mouth, and bones. The most widely used MDT drug regimen calls for dapsone to be administered together with the antibacterial drugs rifampin and clofazimine.