Buruli Ulcer - Infection that Consumes Skins

Buruli Ulcer is a disease caused by infection by the Mycobacterium ulcerans. It is one of the most neglected disease in the world, specifically in the developing countries. Mycobacterium (other bacteria of the same family) is also the bacteria that causes tuberculosis and leprosis; however, Buruli ulcer has received the least attention.

Infection of this disease occurs mainly in tropical areas such as Australia, West Africa, Southeast Asia and New Guinea. Among which, this disease has the largest impact in developing countries, mainly due to the lack of knowledge in the disease.

It has been reported that the mycobacteria strives within aquatic environments (such as small aquatic animals, biofilms). Transmission mode to humans is still under investigation. Thus, Buruli ulcers usually occurs near water sources, infecting children under 15 years mainly. There is no evidence that this disease can be transmitted from person to person.

A young boy with Buruli ulcers
Picture Source: click here

Symptoms in General

Buruli ulcer begins with a painless mobile swelling in the skin (any part of the body). The more severe infection can be painful. Buruli ulcer is a long term, necrotizing disease that slowly destroys the skin and soft tissue by the toxin secreted by the mycobacteria.Without treatment, massive ulcerations take place and if the bone is affected, gross deformities will be the consequence.  If the ulcers develop on the limbs, the movement of the patients will be greatly restricted; even after the lesions have healed, the massive scarring will affect the mobility of the patients. In more severe cases, lifetime disabilities are norm in the patients. Can you imagine the pain the patients are enduring?

Treatment And Prevention

The most efficient treatment of Buruli ulcer is the surgical removal of the ulcers. For disease in more advanced stage, prolonged treatment with skin grafting will be necessary. However, surgical practice is scarcely available in developing countries. A combination of antibiotics can be used to reduce the requirement for surgery.

Bacille Calmette–Guérin (BCG) vaccination has been observed to provide short-term protection against the disease. Although only limited protection is available, it will still be useful by ensuring a complete coverage of this vaccine in the heavily affected regions. Once again, people in developing countries have very minor chances to receive such vaccination due to extreme poverty as well as lack of knowledge in diseases.

Noma - The Disease that Destroys Smiley Faces

There are many unfortunate people around the world, especially people in the developing countries. They do not even have the basic food and necessities to allow them to live healthily. Horrifying diseases roam, leaving the people in great agony. 

Gangrenous stomatitis, commonly known as Noma, is a condition whereby the mucous membrane of the mouth and other tissues of the patients are destroyed. This disorder usually occurs in developing countires where there is malnutrition and poor cleanliness. This is also more often seen in young, severely malnourished children of young age (2- to 5-year-old).  

Once infected, Noma causes rapid tissue destruction, the gums and cheeks become inflammed and ulcers develop. The ulcers and destroyed tissues lead to severe breath odor. Infection of the tissues then spread to the skin, lips and cheeks, eventually destroying the soft tissue and bone around the infected regions. The infection will lead to deformities and loss of teeth. The patients' facial features will be severely disfigured and the normal functions of the jaws will be greatly impaired. 

The actual cause of the disorder is still not known. However, it might be due to a type of bacteria. Antibiotics and improved nutrition can aid in controlling the disorder. The condition can be fatal in some cases if left untreated; on the other hand, the condition might heal eventually even without treatment. To treat the disorder, surgery might be required to remove the destroyed tissues, and plastic surgery will be required to reconstruct the facial bones. Patients recovered from the disorder will have horrifying scars on their faces. 

This might look horrifying to you, do bear in mind that this kid
do not have a choice, if he does, a life free of disease is all he desires.

To reduce the risk of Noma, it is important to improve hygiene level and nutrition. However, sad to say, these two basic preventions are often the hardest to fulfill in most of the developing countries. 

Maggot Therapy - The Smallest Surgeons

For centuries, maggots have been well known for their ability to accelerate the healing of wounds. During warfare, the military doctors observed that the wounds of soldiers that were infested by maggots had a faster recovery rate and the soldiers' chances of death from infection of wounds were much lower than those whose wounds were not infested with maggots. However, after the discovery of the antibiotic penicillin, the Maggot Therapy is outdated due to several reasons. People believe that the use of penicillin to cure wounds is a more hygienic method, and patients find the antibiotic much more acceptable as compared to the use of maggots.

Source: Click here.

Many years later, the ideal healing rate of wounds induced by the maggots resulting in the reintroduction of maggot therapy (also known as Maggot Debridement Therapy) in modern medical field. One of the reasons is that the bacteria that causes infections has grown to be immune to antibiotics. The medicinal maggots work in three actions:

1. Remove (by eating) the dead necrotic, infected tissue on the wounds. In order for a wound to heal, it is vital to remove the dead tissue as it will promote the growth of bacteria on the wound and thus resulting in further infections.
2. Disinfect the wounds by killing bacteria. The secretion by the medicinal maggots create a condition that is not suitable for bacteria to strive.
3. The secretions of the maggots also found to have the ability to stimulate the growth of new tissues (human fibroblasts).

After seeing the benefits of maggot therapy, let's have a look at the limitations of it.

Maggot therapy does not work on dry wounds and the wounds on body cavities. For a medicinal maggot to feed, the wounds must be moist, and adequate amount of oxygen is present. Also, many patients may reject the use of live maggots on their wounds. As a result, a dressing is applied to the wounds where the maggots feed to prevent escape and hide the sight of maggots having their meals on the wounds from the patients.