“Buruli ulcer should not shut out the heart. The silence around it should be broken.” These words ascended on the PowerPoint presentation video as it ended, allowing the audience to open their eyes from the graphic video on buruli ulcer. But no matter how tight they closed their eyes, it could not defeat the fact this flesh-eating disease is a harsh reality the victims have to endure, day-by-day, unless we act accordingly with open arms and minds.
On September 8th, 2009, the Friends of Ganser Library held the fall lecture featuring Millersville University’s very own Dr. John R. Wallace, a professor of biology. Presented in the Lehr Dining Room of Gordinier Hall at 7:30pm, Dr. Wallace fascinated the audience with his PowerPoint presentation on his commitment to researching and understanding the flesh-eating disease, buruli ulcer.
For those who are unaware of buruli ulcer, in its denotative meaning, it is a necrotic skin disease caused by an infection through a pathogen called mycobacterium ulcerans. This disease is also carried with leprosy and tuberculosis. Since it thrives well in wamer regions, around 30 – 33 Celsius, it exists in the equatorial regions of the world. The disease is an epidemic in more than 30 countries such as Australia and South America, though its peak severity is marked in West Africa, claiming the title of being the second most important disease after tuberculosis.
Buruli ulcer thrives in contaminated aquatic areas, which is an essential water source for Africans: agriculture, damming, irrigation, and flooding. The contaminated water carries the biofilm, buruli ulcer, attached to the surface of logs and the stems of plants. Although there is no exact mode of transmission, trauma to the skin, and arthropods such as mosquitoes carrying buruli ulcer, detritus, snails, and fish are also theories of transmission. The theoretical process of transmission is the biofilm attached to plant-life or prey, such as fish. A predator consumes the prey, also consuming the disease. These predators are then subjected to the disease, which is transmitted to humans when bitten.
Buruli ulcer has no serious symptoms at first, which prevents most victims from receiving early treatment. The early treatment is antibiotics, more specifically rifampicin and streptomycin. At this point, it is aerophilic, depending on oxygen to survive. The early symptoms are painless papules or nodules, and painless plaque with irregular edges, seemingly harmless. Then, if early treatment and prevention are not implemented, it extends into subcutaneous tissues and necrosis, forming large ulcers. This late into the disease, surgical practice is required and quite dangerous. Now, it depends on little to no oxygen, becoming microaerophilic. Thus, receiving its name, the flesh-eating disease, buruli ulcer at its final stage leads to the destruction of human flesh.
Buruli ulcer is not a new disease at all. In actuality, the disease has been dated back to 1897, when Sir Albert Cook, a British physician, found this skin ulcer as its first case. In 1948, Peter MacCallum discovered the disease, then-named Bairnsdale Ulcer in Australia. From the ‘60’s and ‘70’s, cases of buruli ulcer were recognized in Uganda, Democratic Republic of the Congo, and other countries. The year 1988 gave birth to action, when the World Health Organization launched the Global Buruli Ulcer Initiative. If the from 1988 to the 2007 sufficient progress was not made, the World Health Organization would intensify research on buruli ulcer. The death rate for buruli ulcer increased along with its discovery: four thousand in 1989 to six thousand in 1999. However, many victims are left unreported and thus, untreated. Around 80% of these victims in Africa are under 15. On the contrary, Australia’s victims are ages 55 or older. Generally, buruli ulcer affects persons of all ages, but some more than the rest. Although the death rate is high, most victims rarely die, but are left deformed and with permanent scarring. Additionally, it negatively impacts their lives, both job and education as children with a higher degree of buruli ulcer cannot attend school, and adults in the same regard cannot attend their respective jobs. Ultimately, it can affect a home’s structure when one or more members of a family can no longer complete their daily chores to keep the entire household stable.
This is where Dr. John Wallace steps in. A man fascinated in the world of biology, he received his Bachelor’s degree from Penn State University, Master’s Degree from Shippensburg University, and ultimately achieving his Ph.D at Michigan State University, his mission is to mobilize Millersville and the community as armies to support his studies to finding a cure for buruli ulcer. His results helped one of the theories surrounding buruli ulcer. By mashing up infected mosquitoes during Trophic Level Experiments in Africa, the result was learning mosquitoes did not ingest the disease. When mosquitoes land on a surface with the biofilm, it attaches to them. Then they land on a person, carried through contact rather than injection, supposedly. Other results were that the mycobacterium ulcerans strain is irrelevant to the disease. There is also strong evidence from the mycobacterium ulcerans passage that the disease moves up the food chain, explaining how it moves around. However, this is not sufficient. Millersville has supported his research financially through student organizations. The Biology club and the community, specifically a group called Thirty-Six Motorcycles, has supported him through donating t-shirts to recruit new members; and Ghana NGOS government agencies have also been supporting Dr. Wallace in his research. In his pursuit for a cure, his favorite quote in Tracy Kidder’s book, “Mountains Beyond Mountains” presents itself: “The goal was to improve the lives of others, not oneself. It’s about the quest for personal efficacy.”