Chapter 19, Problem 1EDCS

Buruli Ulcer

Jacques liked living in the Democratic Republic of the Congo (DRC)-opportunities abounded for exploration, adventure, and wildlife photography, the countryside was beautiful, and he found the people generally friendly. It was on a photographic excursion in the east of the country that Jacques met a not-so-friendly resident of the DRC: an emerging mycobacterial pathogen.

The photographer thought little of the small insect bite he received while documenting wildlife in the swamps along the great Congo River, but he should have been concerned; Mycobacterium ulcerans had found a new home in his hand. Jacques would pay a grievous price for his lack of care.

He continued to ignore the infection when it produced a small, painless nodule. He even ignored it when his finger swelled to twice its normal size; it was painless, and he could still meet his busy schedule. But the bacterium was producing a potent toxin known as mycolactone that destroys cells below the skin, especially fat and muscle cells. Though his hand continued to swell, making it difficult to work normally, it remained pain free.

After six weeks of this condition, pain began suddenly and excruciatingly. The swollen finger ruptured, and a foul-smelling fluid saturated his camera. It was time to see a doctor.

The physician diagnosed Buruli ulcer, an emerging disease that affects more and more people each year as a result of human encroachment into the swamps where Mycobacterium ulcerans lives. After two surgeries to remove dead tissue and bacteria, several skin grafts, and two months of treatment with the antimicrobial drugs rifampicin and streptomycin, Jacques returned home to France with scars that forever remind him of his adventure with M. ulcerans.

1. 1. What might be a reason why a Buruli ulcer is initially painless?
2. 2. Why was it necessary to administer antibacterial drugs for two months rather than two weeks?
3. 3. What environmental similarities exist in the endemic countries?