Nutritional interventions at a community level may be the best way forward to both prevent and treat the “flesh-eating” skin infection Buruli ulcer in the fight against neglected tropical diseases (NTDs), according to a new study from the University of Surrey.

In collaboration with the Kwame Nkrumah University of Science and Technology and a series of hospitals in Ghana, the Surrey researchers looked to analyse the diets and blood samples of at-risk Ghanaian communities to investigate potential links between nutrition and Buruli ulcer.

The research, funded by the Wellcome Trust and Nestle Foundation, studied people with the infection and community members without, who all lived in the Ashanti region of Ghana, and found that the diets of the whole study group frequently fell short of recommended vitamin and mineral levels, with vitamin C and zinc levels being lower than normal in their blood levels too. The study also highlighted that Buruli ulcer patients had poorer diets and were more likely to have vitamin and mineral deficiencies than those without the condition.

Professor Rachel Simmonds, Professor of Immunopathogenesis at the University of Surrey, who led the work said:

“The diets of these at-risk communities are rarely studied, precluding the discovery of potential links between poor diets and infectious diseases. We have now demonstrated how diets poor in protein and key micronutrients may affect the ability to fight off Buruli ulcer disease. Supplementing the diets of these communities and patients with Buruli ulcer may be valuable in its prevention and treatment and could also be a cost-effective strategy to reduce the burden of skin neglected tropical diseases more broadly.”

Buruli ulcer is a serious bacterial skin infection that first manifests as a painless lump, but if untreated the bacteria spread, and the infection can become large open wound. The disease mostly affects poor rural communities in parts of sub-Saharan Africa, but there is also currently a serious outbreak in the suburbs of Melbourne, Australia. Even with modern antibiotic treatments the ulcers can take up to a year to heal.

The study collected data from two groups of Buruli ulcer patients and non-sufferers. The first group included people who were asked about their diet including what they ate and how much, while the second had previously donated blood samples which allowed for the measurement of different vitamins, minerals and inflammation markers.

Professor Simmonds is a world-leading Buruli ulcer researcher, and one of the Chairs of the World Health Organization’s working groups for skin NTDs. Her group discovered the mechanism of action of the toxin that destroys the tissue - mycolactone. Her group recently published another study in eLife, which showed how mycolactone damages blood vessels, causing them to leak fluids and triggering blood clots, which leads to tissue death.

Professor Simmonds says:

“The research shows that damaged blood vessels are a key factor to the disease, not just direct cell-killing by the toxin, which suggests that reducing blood clots could be a promising approach to improve wound-healing in patients and to develop more effective treatments.”