Tools4BU - New tools for early diagnosis and decentralized treatment of Buruli ulcer

Mycobacterium ulcerans is causing the chronic skin disease Buruli ulcer (BU) which is characterized by skin ulcers that expand over extended periods, if not treated. The major burden of BU falls on children in West Africa, where BU is often leading to stigmatization and permanent disabilities. As transmission pathways and preventable risks for infection are not clear, current disease control primarily relies on early diagnosis and rapid initiation of treatment. Efficient implementation of this control strategy is hampered by the fact that most infections occur in remote, rural areas, where access to healthcare is very limited.

The gold standard for laboratory diagnosis of BU is detection of M. ulcerans DNA by a PCR test. This requires a complex laboratory infrastructure and in the African BU endemic countries, this assay is therefore only available at a few reference centres. Consequently, many suspected BU patients receive treatment after only clinical diagnosis, which is not very reliable. We plan to convert our diagnostic ELISA tests into a lateral-flow based rapid diagnostic test that can be used in the communities without need for a laboratory. Currently recommended treatment for BU is an eight-week therapy with daily administration of two antibiotics. To achieve good compliance of patients, close observation of drug intake is required, which can be hardly achieved in the remote settings, where BU patients live. Therefore, a simpler and faster acting therapy is urgently needed. We plan to develop a short and fast acting antibiotic therapy incorporating the clinical tuberculosis drug candidate Q203, as we found that a single dose of Q203 can eliminate M. ulcerans in a validated mouse infection model.

Taken together, goal of this project is, to bring diagnosis and treatment of BU closer to the patients. This will prevent long-term suffering, stigmatization and permanent disabilities of the affected children.

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