Good Quality of Life in Former Buruli Ulcer Patients with Small Lesions: Long-Term Follow-up of the BURULICO Trial

Abstract

BackgroundBuruli Ulcer is a tropical skin disease caused by Mycobacterium ulcerans, which, due to scarring and contractures can lead to stigma and functional limitations. However, recent advances in treatment, combined with increased public health efforts have the potential to significantly improve disease outcome.ObjectivesTo study the Quality of Life (QoL) of former Buruli Ulcer patients who, in the context of a randomized controlled trial, reported early with small lesions (cross-sectional diameter <10 cm), and received a full course of antibiotic treatment.Methods127 Participants of the BURULICO drug trial in Ghana were revisited. All former patients aged 16 or older completed the Dermatology Life Quality Index (DLQI) and the abbreviated World Health Organization Quality of Life scale (WHOQOL-BREF). The WHOQOL-BREF was also administered to 82 matched healthy controls. Those younger than 16 completed the Childrens' Dermatology Life Quality Index (CDLQI) only.ResultsThe median (Inter Quartile Range) score on the DLQI was 0 (0–4), indicating good QoL. 85% of former patients indicated no effect, or only a small effect of the disease on their current life. Former patients also indicated good QoL on the physical and psychological domains of the WHOQOL-BREF, and scored significantly higher than healthy controls on these domains. There was a weak correlation between the DLQI and scar size (ρ = 0.32; p<0.001).ConclusionsBU patients who report early with small lesions and receive 8 weeks of antimicrobial therapy have a good QoL at long-term follow-up. These findings contrast with the debilitating sequelae often reported in BU, and highlight the importance of early case detection.

Paediatric Buruli ulcer in Australia

“…Surgery without antibiotics may be an effective option for selected small lesions; however, aggressive surgical resection is no longer required for most cases . Globally, this change in therapeutic strategy towards medical or combined therapy has resulted in reduced rates of invasive surgery and general anaesthesia, as well as reduced incidence of disability, disfigurement and disease recurrence . In resource‐limited settings of Western Africa, this also represents major advantages for children and families by reducing the financial strain of accessing limited and overburdened surgical services, and reducing the barriers to education and employment that disability, disfigurement and recurrent disease can pose …”

Former Buruli Ulcer Patients’ Experiences and Wishes May Serve as a Guide to Further Improve Buruli Ulcer Management

“…Physiotherapy is required to promote healing of the wounds and to prevent disabilities [7]. Over 90% of the early detected, limited cases (<10cm diameter) can be treated with antibiotics alone and have a good quality of life in long-term follow-up [8,9]. Health seeking behaviour among BU patients is complex [10–12]; If BU patients delay in seeking medical care, they run an increased chance to develop complications [13–15].…”

In-vitro Activity of Avermectins against Mycobacterium ulcerans

“…In case patients report early with limited lesions, the 8-week course of rifampicin and streptomycin delivers a good quality of life at long-term follow up [ 12 ]. However, the median time to heal is still 18 to 30 weeks, depending on the size of the lesion [ 10 ].…”