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Buruli ulcer (BU) is an infectious skin disease that occurs mainly in West and Central Africa. It can lead to severe disability and stigma because of scarring and contractures. Effective treatment with antibiotics is available, but patients often report to the hospital too late to prevent surgery and the disabling consequences of the disease. In a highly endemic district in Ghana, intensified public health efforts, mainly revolving around training and motivating community-based surveillance volunteers (CBSVs), were implemented. As a result, 70% of cases were reported in the earliest-World Health Organization category I-stage of the disease, potentially minimizing the need for surgery. CBSVs referred more cases in total and more cases in the early stages of the disease than any other source. CBSVs are an important resource in the early detection of BU.

Buruli ulcer is a tropical infection caused by Mycobacterium ulcerans. Typically, a large skin ulcer appears which is initially painless, but heals slowly. A common problem is that patients come to the hospital at an advanced stage, increasing the risk of serious scarring and contractures, leading to functional limitations. Previously, treatment for Buruli ulcer revolved around surgery followed by prolonged hospitalization, but during the last decade, an antibiotic regimen has become available, consisting of 8 weeks of daily rifampicin tablets and streptomycin injections – which is still long and painful. We have now shown that prolonged streptomycin administration also leads to irreversible hearing loss. We have also shown that for a subset of patients with small lesions, a reduction in treatment duration might be feasible. To ensure that patients come to the hospital with early, small lesions, we show that programs aimed at early detection are feasible. Trained community volunteers from endemic villages appear pivotal, resulting in significant impact on referral at an early stage, with excellent recovery resulting in high, unimpaired quality of life. We also studied wound care in endemic areas, and show that there is room for improvement, both through cheap and simple measures, and the introduction of modern wound dressings. Once a neglected condition leaving half of patients with considerable disability and prolonged severe suffering, Buruli ulcer – though still a Neglected Tropical Disease – has changed into a condition for which effective standardized therapy is available, provided that programs are in place to encourage patients to report early.