Question

As a Senior Nurse Practitioner, a local health project requires you to establish and ascertain the causative organism for the disease Buruli Ulcer in a given population. Provide a systematic and chronological blueprint of your plan to achieve this purpose.

Based on the knowledge acquired from this course, provide an astute linkage of Microbiology to all the other fields of the health profession that you studied in other courses during this semester.

Please answer all for me

Answer 1

Ans.

Causative organism of Buruli Ulcer

Buruli ulcer, caused by Mycobacterium ulcerans, is a chronic debilitating disease that affects mainly affects the skin and sometimes bone. The organism belongs to the family of bacteria that causes tuberculosis and leprosy, which provides an opportunity for collaboration with these disease programmes.

The mode of transmission is not known, but recent evidence suggests that aquatic insects (Naucoris and Dyplonychus species) may be involved. Trauma to contaminated skin sites appears to be the means by which the organism enters the body. There is little proven evidence of transmission from person to person.

The symptoms of Buruli ulcer include: Swelling of the skin. Destroyed skin and soft tissue. One or more slow growing, generally painless ulcers.

Buruli ulcer is usually diagnosed by a doctor, based on:

1. medical history.
2. travel history – if you have travelled to an area associated with Buruli ulcer.
3. physical examination – to identify a slowly enlarging, painless ulcer.
4. swabs or biopsy taken from the ulcer, which are tested in a laboratory.

Buruli ulcer can be prevented by avoiding contact with aquatic environments in endemic areas; however, for those living in endemic areas, this may not be possible. The risk of acquiring Buruli ulcer can be reduced by wearing long sleeves and pants, using insect repellent, and cleaning and covering any wounds as soon as they're noticed.^] While there is no specific vaccine for Buruli ulcer, vaccination with the BCG vaccine offers temporary protection from disease.

Buruli ulcer is an ulcerative skin disease caused by the bacterium Mycobacterium ulcerans. ... Buruli ulcer can be cured with early detection and a combination of antibiotics. But, if diagnosed late, the condition can lead to permanent disfigurement and disability.

Buruli ulcer is treated through a combination of antibiotics to kill the bacteria, and wound care or surgery to support the healing of the ulcer. Since 2004, the World Health Organization has recommended eight weeks of daily treatment with oral rifampicin and intramuscular streptomycin.However, due to the nephrotoxicity of streptomycin, and the inconvenience of daily injections, several other antibiotics to partner with rifampicin have been investigated. The most widely used alternative is rifampicin plus twice daily oral clarithromycin, which is now also recommended by the World Health Organization.

Several other antibiotics are sometimes used to partner with rifampicin, namely ciprofloxacin, moxifloxacin, ethambutol, amikacin, azithromycin, and levofloxacin. A 2018 Cochrane review suggested that the many antibiotic combinations being used are effective treatments, but there is insufficient evidence to determine if any combination is more effective than the others. Approximately 1 in 5 people with Buruli ulcer experience a temporary worsening of symptoms 3 to 12 weeks after they begin taking antibiotics.^[24] This syndrome, called a paradoxical reaction, is more common in those with larger ulcers and ulcers on the trunk, and is more common in adults than children.The paradoxical reaction in Buruli ulcer is thought to be due to the immune system responding to the wound as bacteria die and the immune-suppresing mycolactone dissipates.

Treatment may also include surgery to remove necrotic ulcer tissue as well as scar tissue that can deform the muscles and joints.As ulcers can take months to heal, regular wound care plays a major role in treatment.The healing of severe ulcers can sometimes require skin grafts and/or daily wound dressings.

Buruli ulcer epidemiology

During 2010–2017, a total of 23,206 cases of Buruli ulcer were reported to WHO by 16 different countries, 14 in the African Region (AFRO) and 3 in the Western Pacific Region (WPRO). In 2017 alone, 2,217 cases of Buruli ulcer were reported globally, 1,923 in AFRO and 294 in WPRO.