Reprinted with permission by Robert Herriman, Infectious Disease Examiner

By: Robert Herriman

As four communities in the Ayamelum council of Anambra State of Nigeria battle an outbreak of buruli ulcer, health officials face another battle and it’s not the bacteria…it’s a belief in witchcraft as the cause.

With about 250 natives affected one of the biggest battles is educating and convincing the people that the sores are not the result of spells or witchcraft.

This is the battle state Commissioner for Health, Professor Amobi Ilika faces. Patients interviewed said the ulcer began as a tiny spot. As it makes progress, it manifests as a little painless noodle or just as a skin discoloration and so on, on any part of the body.

But because of superstitious beliefs, the people seek out remedies that do not cure the infection and in fact make it worse.

“But because the people believe that it is caused by a spell or witch craft, they resort to native doctors for a cure, or at most patent medicine dealers. In fact there is a patent medicine proprietor that is so popular in treating the affected persons and making them believe it will be well even when evidence of the eyes shows that it is worsening,” according to source.

Ilika says that patient’s perception may be changing as they eventually go to the hospital after the local patent medicine dealers have complicated their cases with burns and it then becomes very big ulcers.

But those who don’t get it taken care of after the bad treatment can get serious problems resulting in everything ranging from disabilities to disfigurements to even cancers.

“What is very important to us is for people to come in good time and get treated. We want people to know that it is not caused by witchcraft or poisoning or juju. That is the very important message we want to pass to the people”, says Head of Administration of the council, Chief R.O. Jideani.

What is Buruli ulcer?

Buruli ulcer is a bacterial infection by Mycobacterium ulcerans. Like the agent of tuberculosis, it is a slow-growing, acid fast bacilli. But unlike TB, it is an organism that is found in wetland type environments. Africa is the place most affected with Buruli ulcer.

There are differing opinions on what the source of the infections is, but most do agree that it involves introduction of the organism through some type of trauma.

Typically it presents itself painless skin wound with a necrotic white or yellow base, typically seen on the extremities. The incubation time from the time of infection to a visible ulcer may be up to 3 months and probably only a small percentage of people infected actually get the disease.

Untreated ulcers can cause bad scarring and ulceration resulting in severe deformities. The spread of the bacteria either directly or through the bloodstream, can affect the joints and bone. It is rarely fatal.

Transmission of the infection from person to person is extremely rare.

Antibiotics and in some severe cases, surgery and grafts, are the effective treatment for Buruli ulcer. Several things can be done to prevent the infection that include avoiding insect bites, prompt cleansing of wounds, early detection and treatment of the disease and the use of the BCG vaccine may offer short term protection. And of course, educating the population of the causes of this disease is important in the prevention of this overlooked but serious disease.

Robert Herriman, MPH, M(ASCP) has been a microbiologist for nearly 25 years working in variety of positions in the public and private sector. He spent 5 years in the Philippines working in the microbiology/parasitology lab at the USAF hospital in the 1980s. He writes about microbiology and infectious diseases for several web sites and blogs.