Presentation On Buruli Ulcer
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BURULI ULCER DISEASE
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WHAT IS BURULI ULCER ? Buruli ulcer, is a devastating skin disease caused
by Mycobacterium ulcerans. It is named after a region called Buruli, near the
Nile river in Uganda, where in 1961 the first large number of cases were reported. But the first case of BU was reported in Australia in 1948.
It is one of the most neglected but treatable tropical diseases.
The causative organism is from the family of bacteria which causes tuberculosis and leprosy but Buruli ulcer has received less attention than these diseases.
Infection leads to extensive destruction of skin and soft tissue with the formation of large ulcers usually on the legs or arms.
Patients who are not treated early often suffer long-term functional disability such as restriction of joint movement.
Early diagnosis and treatment are vital in preventing such disabilities.
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EPIDEMIOLOGY Buruli ulcer occurs most frequently among people
who live or work close to rivers and slow- moving bodies of water.
Activities that take place near water bodies, such as farming, are risk factors, and wearing protective clothing appears to reduce the risk of the disease.
The reasons for the growing spread of BU remain unclear.
All ages and sexes are affected, but most patients are among children under 15 years.
The disease can affect any part of the body, about 90% of the cases are on the limbs, with nearly 60% of all lesions on the lower limbs.
Unlike tuberculosis (TB), there is no evidence to suggest that infection with the human immunodeficiency virus (HIV) predisposes individuals to BU infection.
There is also no evidence that the disease can be transmitted from person to person.
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THE ORGANISM M. ulcerans is an environmental
mycobacterium. The organism does not live freely in the
environment The organism occupies a specific place
within aquatic environments (e.g. small aquatic animals, biofilms) from where it is transmitted to humans by an unknown mechanism.
M. ulcerans produces a destructive toxin, mycolactone, which causes tissue damage and inhibits the immune response.
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TRANSMISSION The exact mode of transmission is still under
investigation. More recent data from Australia suggest
that salt marsh mosquitoes test positive for M. ulcerans DNA,
Transmission by this type of mosquito has not been established.
Further research is in progress to establish the exact role of insects and other factors in the transmission of the disease to humans.
If confirmed, BU will be the only known mycobacterial disease to be transmitted by insects
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DISTRIBUTION OF THE DISEASE
About 33 countries worldwide report the disease. Eg. Benin,Cameron,Togo, Australia, Côte d'Ivoire, Papua New Guinea etc
In Ghana, Ashanti, Brong Ahafo, Central, Eastern, Greater Accra and Western regions routinely report on the disease.
Some endemic districts in Ghana are
Amansie West, Amansie Central, Ahafo Ano NorthAsante Akim NorthAtwima NwabiagyaSekyere Afram Plains
Upper DenkyiraGa WestAkwapim SouthAsutifi North & SouthSuhum Kraboa CoaltarDormaa East / West
GomoaBiaAhanta WestAsunafo North&SouthAhanta West
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COUNTRIES WHERE BURULI IS REPORTED
•Buruli ulcer is still considered a “mystery” disease that many people do not know about.(Health Workers, Teachers, Pastors, Herbalists, Jounalists, Lawmakers, Law enforcers , General Society)•As a result, it is under-reported (or poorly documented). •Today, Buruli ulcer is reported in 33 countries worldwide. •Within countries, Buruli ulcer occurs in some localized places .
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CONTROL STRATEGIES
In the absence of effective tools to control BU,current control strategies are aimed at reducing the prolonged suffering disabilities and socioeconomic burden associated with the disease
.Community level activities Early case detectionat the community level
using CBSVs Information,education and co,,unication (IEC)
campaigns in communities and schools Training of CBSVs and strenghtening of
comminity based surveillance system
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Strenghtening of health system Infracstucture,equipment and logistics
(decentralized health centers) training of health workers. Standardised recording and reporting
using BUO1, BUO2 and BUO4. Standardised case management Specific antibiotics Wound care Surgery POD laboratory confirmation of cases
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CLINICAL FORMS.
NODULE PLAQUE OEDEMA ULCER OSTEOMYELITIS
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NODULE STAGETHIS IS USUALLY PAINLESS,PALPABLE,FIRM LESION 1-2 CM IN DIAMETER,SITUATED IN THE SUBCUTANEOUS TISSUE AND TYPICALLY ATTACHED TO THE SKIN.
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PLAQUE STAGEIS USUALLY PAINLESS,WELL-DEMARCATED,ELEVATED,INDURATED
LESION,MORE THAN 2CM IN DIAMETER.
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OEDEMA STAGEDiffuse, extensive, usually non-pitting swelling. The affected area has ill-defined margins, is firm and painless and involves part or all of a limb or other part of the body. There may be colour changes over the affected area and the disease may be accompanied by fever.
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OSTEOMYELITIS
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ULCERATIVE STAGEA TYPICAL BU IS DEFINED AS A SKIN ULCER CHARACTERIZED BY NECROTIC SLOUGH AND UNDERMINED EDGES. IN THE ABSENCE OF SECONDARY BACTERIAL INFECTION, THE ULCER IS USUALLY
PAINLESS.
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CATEGORIES
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CATEGORY LA SINGLE LESION < 5CM IN DIAMETER. MOST CATEGORY 1 LESIONS MAY COMPLETELY HEAL WITH ANTIBIOTIC TREATMENT.
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CATEGORY IIA SINGLE LESION BETWEEN 5 AND 15 CM IN DIAMETER. SOME CATEGORY II LESIONS MAY COMPLETELY HEAL WITH ANTIBIOTIC TREATMENT
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CAT III A SINGLE LESION > 15 CM IN DIAMETER, MULTIPLE LESIONS, LESIONS AT CRITICAL SITES (EYE,BREAST,GENITALIA) AND OSTEOMYELITIS.IN ADDITION TO ANTIBIOTICS, MOST OF CATEGORY III LESIONS REQUIRE SURGERY(EXCISION,SKIN GRAFTING OR AMPUTATION IN SEVERE CASES).
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BURULI ULCER AT THE CRITICAL SITES
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TREATMENT
WHO RECOMMENDATION All patients with BU lesions should be
treated with streptomycin 15mg/
Body kg + Rifampicin 10mg/ Body kg for 8 weeks.
Surgery reserved as adjuvant therapy. Wound care Prevention of disability
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BEFORE AND AFTER ANTIBIOTIC TREATMENT
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BEFORE AND AFTER ANTIBIOTIC TREATMENT
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BEFORE AND AFTER SURGERY
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BEFORE AND AFTER SURGERY
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BURULI ULCER ACTIVITIES .Surveillance for early case detection.
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PUBLIC EDUCATION IN COMMUNITIES ANDVIDEO SHOW ON WHO BURULI ULCER DOCUMENTARY.
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WEEKLY FOLLOW UPS TO HEALTH CENTRES TO ENSURE PATIENTS COMPLY WITH CHEMOTHERAPY REGIMEN.
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SURGICAL MANAGEMENT OF CASES (DEBRIDEMENT AND SKIN GRAFTING)
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CONTINUED
Weekly Wednesday BU clinic in consulting room 3
Photograph of lesions (documentation)Dispensing of Antibiotics & other logistics.
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LABORATORY CONFIRMATION-FINE NEEDLE ASPIRATION (FNA)
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PUNCH BIOPSY
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SWAB
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DRESSING OF WOUNDS
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PREVENTION OF DISABILITY (POD)
THE TEN TASKS
Early diagnosis and treatment for Buruli ulcer
Hygiene Nutrition Wound and skin care Movement and Exercise Positioning Reduce swelling Scar care Participation Extra help or Referral
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LEGACY OF BURULI ULCER Buruli ulcer disease often leaves victims with
harrowing scars and severe contractures, resulting in social stigma and functional limitations such as :
Eye complications Contractures Amputations
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EYE COMPLICATIONS.
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CONTRACTURE
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CONTRACTURE
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AMPUTATION
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SOME CHALLENGES Insufficient knowledge of the disease
among both health workers and the general public, leading to significant underreporting.
Late reporting of cases . Lack of Funds to do active case
search. Difficulty for the patients to comply
with chemotherapy treatment.(injections)
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THANKTHANK
YOU.YOU.