SUPERIOR HEALTH FOUNDATION

SUSPECTED
BURULI/TROPICAL ULCER
OUTBREAK IN FUNGE
By Dr. Metuge Alain, Executive Director SHF
9/10/2019
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Superior Health Foundation

Healthier and More Health-Conscious Communities.

P.O Box 416 Buea, SW Region Cameroon

Tel: 679869763/670675968

Info@shealthfoundation.org

Reg No: 343/G37/VOL1/SASC

SUSPECTED BURULI/ TROPICAL ULCER OUTBREAK REPORT IN FUNGE VILLAGE, ILLOR

HEALTH AREA, EKONDO TITI HEALTH DISTRICT

On the 8th of August 2019 during one of SHF’s outreach field activities for the distribution of clean
emergency delivery kits, the field team came across some form of an ulcer outbreak in Funge, a village
under illor Health Area. The team without proper equipment to deal with an outbreak took a detailed
history of the cases and took picture. The information brought by the team revealed that

 The ulcers started with a single child as a small itchy and painful pustule which ruptured after 8
days and rapidly turned into a painful discharging ulcer. Within two weeks after the first case
the ulcer spread and within four weeks there are 20 cases with similar history, presentation and
progression.
 Only 3 of the 20 patients were female while 17 of the 20 patients were male
 19 of the patients were above 5years of age and only one was less than five year old
 All ulcers began as either painful or itchy pustules, blisters or boils which starts ulcerating after
rupture.
 All 20 patients complained of severe pain at the ulcer sites
 All ulcers were circular or oval in shape and discharge either sero-sanguineous fluid or muco-
purulent fluid
 4 of the 20 patients complained of fever

The SHF field team left the field with the impression of an epidemic/ contagious ulcer.

Their first differential was a tropical ulcer outbreak due to the classical presentations, progression and
the fact that it seemed to spread pretty quickly. Also the demographic presentation is classical of
tropical ulcer. However, tropical ulcer outbreaks have not been reported from this area.

The next differential was that of Buruli ulcer, since the area is endemic for the disease. The ulcers and
disease progression are very unlike buruli ulcers. Buruli ulcers are not painful and they usually have
classical undermined edges.

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Another differential the team considered was that of yaws, the demographics, size and location and the
contagious nature of the ulcers support the diagnosis. But then yaws ulcers often progress to involve
other body parts and the ulcers normally are non-discharging.

The team reported their findings to the Ekondo Titi Health district which liaised the SHF team to the
Ekondo Titi District hospital which is a Buruli ulcer treatment center.

The SHF team managed to return to the community after 2weeks and collected wound swaps from 20
patients. These were handed over for AFB analysis at the Ekondo Titi District Hospital. After analysis, 3
of the 20 samples were positive for AFB.

Superior Health Foundation reported the results to the National Secretary in charge of Buruli at the
Ministry of Public Health. After sharing all patients’ information the director said the cases were very
unlikely to be buruli ulcer cases.

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Challenges
Funge is an extremely hard to reach community. The health center is not active due to the ongoing
crisis.

No definitive diagnosis has been made yet.

No health intervention to help reduce the suffering of the patients, or treat their ulcers has been done
yet.

It is still unclear if the 3 cases positive for Acid fast bacilli are to be treated as true Buruli ulcer cases or
some epidemic ulcer with super imposed infection from a mycobacterium.

Recommendations
A micro plan to determine the propose response to this suspected ulcer outbreak should be drawn up
by the relevant authorities in collaboration with partners on ground.

This micro plan should outline actions to be taken towards definitive diagnosis of what this epidemic
ulcer actually is, and a plan for a health intervention for the affected community. This should include
sample collection and testing to rule out the main differential. Provision of supplies and staffs to provide
clean wound dressings for the children while waiting on the definitive diagnosis; Follow up and
monitoring of existing cases and recording and follow up of new cases.

In light of the security concerns that exist most a partner with access to the community and the
competence to deal with the issue at hand. The Superior Health Foundation Team is made up of
Doctors, Nurses, Lab technicians and public health specialists and epidemiologist. We understand what
is at stake and what must be done. However, we lack the funds to cover the logistic and other financial
cost associated with dealing with this suspected outbreak.

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