Research Article Open Access Agbenorku and Saunderson, J Mycobac Dis 2013, 3:3 http://dx.doi.org/10.4172/2161-1068.1000133 Open Access Mycobacterial Diseases Volume 3 • Issue 3 • 1000133 J Mycobac Dis ISSN: 2161-1068 MDTL, an open access journal Mycobacterium ulcerans Disease of the Face: The Fate of the Victims Pius Agbenorku 1 * and Paul Saunderson 2 1 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana 2 American Leprosy Missions, USA *Corresponding author: Pius Agbenorku, Reconstructive Plastic Surgery & Burns Unit, Komfo Anokye Teaching Hospital, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, Tel: +233 20 630 0781; Fax: +233 51 22307; E-mail: pimagben@yahoo.com Received October 09, 2013; Accepted November 21, 2013; Published November 27, 2013 Citation: Agbenorku P, Saunderson P (2013) Mycobacterium ulcerans Disease of the Face: The Fate of the Victims. J Mycobac Dis 3: 133. doi:10.4172/2161- 1068.1000133 Copyright: © 2013 Agbenorku P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Mycobacterium ulcerans disease (MUD), often called Buruli ulcer (BU), can result in severe disabling of affected persons. It affects all parts of the body with the upper and lower extremities as the most affected areas. BU causes disabilities such as scarring, limb contractures, disigurements, as well as a great deal of distress if it affects the face. Patients with BU of the face encounter both physical and psychological problems that make their living dificult. The disease on the face can cause loss of eyes, nose, lips, repositioning of facial features and destruction of other soft face should be given physical, social, economic and emotional support. This form of support should span from health care providers, families and friends to enhance their quality of life. Physiotherapy is also of great importance to both patients and health workers, to achieve a better physical appearance and psychological wellbeing. Keywords: Mycobacterium ulcerans disease; Buruli ulcer; Face; Introduction Buruli ulcer (BU) caused by Mycobacterium ulcerans (M. ulcerans), represents the third most common mycobacterial disease in the world ater tuberculosis and leprosy [1]. It has emerged dramatically over the past two decades, particularly in Central and West Africa and has been conirmed by laboratory tests in 26 countries with reports in other countries around the world [2,3]. BU is a severe disiguring and disabling disease, which afects primarily children less than 15 years of age in many tropical and subtropical countries [3-5]. Globally, about 35% of lesions occur on the upper limbs, 55% on the lower limbs and 10% on the other parts of the body [5]. BU lesions on the face have been reported in diferent countries, but there is little information on their frequency [3,6-11]. he diiculties in treating BU of the face and the importance of a conservative surgical approach to its management are essential factors in BU disability prevention [3,6-11]. his paper seeks to reveal the challenges of patients with BU of the face. Epidemiology M. ulcerans infection was irst described in Australia in 1948 [12]. he disease was named ater Buruli County in Uganda now called Nakasongola District, because of the many cases that occurred there in the 1960s [13,14]. he disease is endemic to humid, oten rural, tropical climates and has been reported in 33 countries with tropical and subtropical climates [15-17]. he incidence of BU is highest in Africa especially in Benin, Cote d’Ivoire and Ghana, though cases also occur in Asia, South America, Papua New Guinea and Australia, where the disease is known as Bairnsdale ulcer [1,16-22]. Transmission BU is found in many places around the world, oten near water bodies but the exact mode of transmission of the germ from the environment to humans is not known [23]. However, it appears that diferent modes of transmission occur in diferent geographic areas and during the rainy season in Africa and exposure may occur in muddy farming ields [1,24,25]. In March 2008, researchers announced the irst isolation of M. ulcerans from the environment [26]. he available environment, rather than from person to person [6,19,27]. he disease is usually found in communities near rivers, swamps and wetlands [6,23]. he recent identiication of M. ulcerans in certain water insects has raised the possibility of mechanical transmission of the infection [5,6,19]. Pathogenesis Even though a particular vector of the disease has not been found, aquatic insects, notably naucoridae spp, adult mosquitoes or other biting arthropods may serve as vectors of M. ulcerans [5,28]. BU oten starts as a painless nodule in the skin and infection oten leads to extensive destruction of skin and sot tissue with the formation of large ulcers usually on the legs or arms [29,30] but no nodular stage was recorded on patients with BU of the head and neck region [30]. In early or pre- ulcerative lesions, M. ulcerans produces a lipid toxin, mycolactone, which is responsible for necrosis of the dermis, panniculus and fascia culminating in extensive ulceration [31]. he high prevalence of oedematous lesions among children may be attributed to multiple factors including immunity because children may have less efective protective immune response against M. ulcerans [1]; this is linked with the role that mycolactone plays in the pathogenicity of MUD [31- 33]. Other factors may include the physical aspects of children since they have shorter stature and their entire body is nearer to the ground [10,34]. Delayed treatment may cause irreversible deformity and long- term functional disability but antibiotic treatment can be successful when patients seek treatment in the early stage of the disease [5]. Review Article tissues of the face. This study aims to discuss the fate of persons with MUD of the face. Patients lives MUD of the Disability; Efects; Fate data suggests that the disease is transmitted from aquatic areas in the epidemiological settings [5]. BU has been observed more frequently