Fighting a Flesh-Eating Bacteria

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Jackson Barlea has Buruli ulcer, a debilitating disease caused by bacteria from the same family as tuberculosis and leprosy.Credit Nicholas Kristof

Aneri Pattani, a freshly minted graduate of Northeastern University, is the winner of Nicholas Kristof’s annual win-a-trip contest. She previously wrote about the importance of breastfeeding and a master carver with no fingers.

When I met Jackson Barlea, his entire left leg, from thigh to ankle, was raw and red. The skin had been eaten away by a little-known variety of bacteria. At one point, you could see straight through to the bone, a nurse told me.

It was one of the most painful conditions I have ever seen. Even as the nurses tenderly removed the dressing and reapplied gauze, I winced. I thought about the time I had fallen off my bike as a kid and scraped my knee raw. I cried the whole time my mom applied antiseptic.

Yet Jackson, 18, did not flinch. He had to go through this process every day.

Jackson has Buruli ulcer, a debilitating disease caused by bacteria from the same family as tuberculosis and leprosy. It is on the World Health Organization’s list of neglected tropical diseases, along with river blindness and elephantiasis. But with only 2,000 new cases reported in 2015, mostly from West and Central Africa, it’s not a disease that gets much attention.

These neglected tropical diseases primarily affect the world’s poorest and most marginalized people, and as a result, rarely get sufficient investments in research and health care. (If it weren’t for former president Jimmy Carter, a champion of fighting these diseases, there would be even less response.) Buruli ulcer is among the most neglected of the neglected tropical diseases.​

It often starts as a painless bump on the skin, but quickly ulcerates to form lesions across the area. Patients are treated with antibiotics, and their wounds are sometimes covered with skin grafts. The disease can affect bone, sometimes requiring amputation or leaving patients with permanent disfigurement and long-term disabilities.

“It’s among the most disfiguring lesions you can possibly imagine,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.

Because the disease is relatively unknown, it may be undercounted. It wasn’t known to be in Liberia until five years ago, but now many cases are diagnosed here.​

There are some cases reported in Australia, but the majority come from Benin, Cameroon, Ivory Coast, Ghana and Democratic Republic of the Congo. That makes it significant in the region, but not in the world, Hotez explained.

The other issue is that it’s not easy to treat. Though there’s some evidence that Buruli ulcer is transmitted through the bites of insects or fleas found in still water, scientists aren’t sure. That means there are no vaccines or preventative medications that can be distributed in mass campaigns. It certainly helps to begin treatment early, but treatment relies mostly on antibiotics and wound care for individuals after they’ve been infected – hardly an ideal case for governments and aid groups trying to save the most lives with limited resources.

The care of these patients falls on individual hospitals and treatment centers. In Liberia, one of those is the Ganta Leprosy and Tuberculosis Rehabilitation Center, which exclusively treats leprosy, tuberculosis and Buruli ulcer. Here, nurses spend hours redressing wounds for patients like Jackson every morning, seven days a week. It’s the only place Buruli patients can go for proper care, said John Brimah, a registered nurse who runs the hospital.

The center has seen a significant increase in the number of Buruli ulcer patients in recent years, Brimah said. More than 100 new cases were reported in Liberia in 2015, according to data from the W.H.O. That’s significantly more than other years, but experts say monitoring is often imprecise, making it difficult to make yearly comparisons.

The majority of patients I visited in the hospital had Buruli, and many of them were young, like Jackson. Data show that nearly half of all people suffering from Buruli ulcer in Africa are children under the age of 15.

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Catherine Tokpah was forced to drop out of fifth grade when she contracted Buruli ulcer.Credit Aneri Pattani

Most of these kids come from poor families, said Dr. Stephen Blount, chair of the Carter Center’s International Task Force for Disease Eradication. In many cases, the disease robs them of a chance for a better future.

“When they’re infected, people are unable to work and children are unable to go to school,” Dr. Blount said. “If you can’t learn, you can’t work and you can’t rise out of poverty.”

One girl I met was determined to defy the odds. Catherine Tokpah was forced to drop out of fifth grade when she contracted Buruli ulcer. Now she spends her days at the hospital in Ganta, where she is being treated for lesions on her ankle. She continues reading her textbook, though, so she’ll be ready to move on to sixth grade once she’s healed. She didn’t want to fall behind.