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EpidemiologyBU is uniformly associated with wetlands, particularly stagnant swamps and ponds. Many authorities believe transmission involves contamination of the human skin surface with M. ulcerans by contact with wetland environment (mud, water, plants, insects, fish, etc.) and that the organism is inoculated into the skin by the bite of insects such as waterbugs, or by trauma as slight as a hypodermic needle puncture or as severe as a gunshot or landmine wound. Virtually all patients contract the disease directly from environmental sources. Person-to-person transmission has not been established.The type of disease may be related to the size of inoculum and depth of inoculation into the skin. BU affects individuals of all ages, but children under 15 have the highest frequencies of infection. Countries with the highest known prevalences are the West African countries of Benin, Ghana, and Ivory Coast. Other endemic countries in Africa include Angola, Burkina Faso, Cameroon, Congo, Democratic Republic of Congo, Equatorial Guinea, Gabon, Guinea, Liberia, Nigeria, Sierra Leone, Sudan, and Togo. Australia, Papua New Guinea, Indonesia, Malaysia, China, and Japan have reported a few patients. In the Western Hemisphere, known endemic countries include Bolivia, French Guiana, Mexico, and Peru. Focal outbreaks have followed human migrations, manmade topographic modifications (ponds and dams), deforestation, and increased agriculture in wetlands. In Australia, koalas and possums acquire natural infections typical of BU. The map (left) shows the worldwide distribution of Buruli ulcer. In addition, 2 cases in China and 1 in Japan have been reported. |
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Website created: February 4, 2004