Buruli Ulcer: multidisciplinary research for improvement of control in Africa (BURULICO)
Buruli ulcer (BU), a disease caused by Mycobacterium ulcerans, is a neglected disease of the poor in remote rural areas. BU is the third most common mycobacterial disease after tuberculosis and leprosy. It is most endemic in West Africa with incidences as high as 280 / 100,000, but cases occur around the globe. Currently, BU is treated by surgery - no anti-mycobacterial drug trials have been conducted. Surgery with wide margins resembles radical oncological surgery but this is not a modern therapy for an in fectious disease. Moreover, it is neither affordable nor sustainable in endemic regions; and it is poorly accepted among people in endemic areas. Indeed, fear for mutilating surgery has been identified as an important cause of patient delay, resulting in e ven more extensive lesions at presentation. Though mortality of the disease is low, morbidity and subsequent disability are very high, with up to half of those treated are left with disabilities that have long-term social and economic impact. New molecular tools are needed to explore epidemiology and transmission, and to improve diagnostics and treatment. This proposal is a multidisciplinary treatise that aims at the development of new tools and knowledge. In close networking of partners with different expe rtises the following activities are foreseen: 1) analysis of moleclar epidemiology of M. ulcerans, 2) analysis of environmental reservoirs and possible relationship to transmission, 3) evaluation of diagnostic principles with the aims of establishing guide lines, 4) treatment studies with the aim of establishing guidelines for therapy both with drugs and by surgery , 5) analysis of the in situ host response to obtain an understanding of the immune defense against M. ulcerans and to find possible correlates t o prognosis, 6) a socio-psychological study of the attitude towards BU and its consequences for compliance withold and new therapies.