16/01/26

Thrombosis: Causes, Clinical Manifestations, Conventional Management, and Integrative Herbal Medicine Perspectives

By Livy-Elcon Emereonye

One of the main causes of preventable death around the world is blood clots. Being aware saves lives!

Thrombosis remains a leading cause of morbidity and mortality worldwide, underpinning major cardiovascular events such as stroke, myocardial infarction, and pulmonary embolism. It arises from complex interactions between vascular injury, blood flow abnormalities, and hypercoagulability. While conventional management relies heavily on anticoagulant and thrombolytic therapies, increasing attention is being directed toward integrative approaches that include lifestyle modification and evidence-based herbal interventions. This article provides a comprehensive academic review of thrombosis, encompassing its pathophysiology, risk factors, clinical presentation, diagnosis, and management, while critically examining the role of integrative and herbal medicine as adjunctive strategies in thrombosis prevention and long-term vascular health.

1. Introduction

Thrombosis is a pathological process characterized by the formation of a blood clot within the vascular system, leading to partial or complete obstruction of blood flow. Globally, thrombotic disorders account for a substantial proportion of cardiovascular deaths, with venous thromboembolism (VTE) alone affecting millions annually (World Health Organization [WHO], 2023).

Modern lifestyles—marked by physical inactivity, metabolic diseases, chronic inflammation, and aging populations—have significantly amplified the burden of thrombotic diseases. Although pharmacological interventions have improved outcomes, they are associated with limitations such as bleeding risk, drug interactions, and long-term dependency. Consequently, there is growing interest in integrative approaches that combine conventional medicine with lifestyle, nutritional, and herbal strategies aimed at restoring vascular balance and reducing thrombotic risk.

2. Definition and Classification of Thrombosis

A thrombus is an intravascular aggregation of platelets, fibrin, and blood cells that forms under pathological conditions. Thrombosis is broadly classified into:

2.1 Arterial Thrombosis
Arterial thrombosis typically occurs on ruptured atherosclerotic plaques and is platelet-rich. It is the principal mechanism behind:

• Ischemic stroke
• Myocardial infarction
• Peripheral arterial disease

2.2 Venous Thrombosis

Venous thrombosis is fibrin-rich and commonly manifests as:

• Deep vein thrombosis (DVT)
• Pulmonary embolism (PE)

Venous thromboembolism represents a major cause of preventable hospital mortality.

3. Pathophysiology: Virchow’s Triad

The development of thrombosis is classically explained by Virchow’s triad, which includes:

3.1 Endothelial Injury

Damage to the vascular endothelium exposes subendothelial collagen and tissue factor, activating platelet adhesion and the coagulation cascade. Causes include:

• Atherosclerosis
• Hypertension
• Smoking
• Surgical trauma
• Chronic inflammation

3.2 Abnormal Blood Flow

Stasis or turbulence disrupts laminar flow, facilitating clot formation. This is common in:

• Prolonged immobilization
• Long-haul travel
• Heart failure
• Varicose veins

3.3 Hypercoagulability

Hypercoagulable states may be inherited or acquired and include:

• Genetic thrombophilias
• Malignancy
• Pregnancy and oral contraceptive use
• COVID-19–related coagulopathy
• Chronic inflammatory disorders

1. Clinical Manifestations

The clinical presentation of thrombosis depends on the affected vascular territory.

4.1 Deep Vein Thrombosis

• Unilateral leg swelling
• Pain or tenderness
• Local warmth
• Skin discoloration

4.2 Pulmonary Embolism

• Sudden dyspnea
• Pleuritic chest pain
• Tachycardia
• Hemoptysis
• Syncope or sudden death in massive PE

4.3 Arterial Thrombotic Events

• Stroke: facial asymmetry, hemiparesis, aphasia
• Myocardial infarction: chest pain, diaphoresis, nausea, radiation to arm or jaw

1. Diagnostic Approaches

Diagnosis involves a combination of:

• Clinical risk assessment tools (e.g., Wells score)
• Laboratory tests (D-dimer)
• Imaging modalities:
  -Doppler ultrasonography
  -CT pulmonary angiography
  -Magnetic resonance imaging

1. Conventional Management of Thrombosis

6.1 Anticoagulant Therapy

Anticoagulants remain the cornerstone of thrombosis management:

• Unfractionated heparin
• Low-molecular-weight heparins
• Vitamin K antagonists (warfarin)
• Direct oral anticoagulants (DOACs)

6.2 Thrombolytic Therapy

Reserved for life-threatening cases, thrombolytics actively dissolve clots but carry significant hemorrhagic risk.

6.3 Interventional and Surgical Management

• Catheter-directed thrombectomy
• Inferior vena cava filters in selected cases

1. Integrative and Herbal Medicine Perspective

7.1 Rationale for Integrative Approaches

Integrative medicine seeks to address thrombosis not only as an acute event but as a manifestation of systemic vascular dysfunction, chronic inflammation, oxidative stress, and metabolic imbalance. Herbal medicine may contribute through:

• Antiplatelet activity
• Anti-inflammatory effects
• Improvement of endothelial function
• Modulation of lipid metabolism

7.2 Evidence-Based Medicinal Plants

Garlic (Allium sativum)

Garlic has demonstrated antiplatelet, fibrinolytic, and lipid-lowering effects. Studies indicate that garlic extracts reduce platelet aggregation and improve endothelial function (Bordia et al., 1998; Rahman & Lowe, 2006).

Ginger (Zingiber officinale)

Ginger inhibits thromboxane synthesis and platelet activation, offering mild antithrombotic effects (Verma et al., 1993).

Turmeric (Curcuma longa)

Curcumin exhibits anti-inflammatory and anticoagulant properties through inhibition of platelet aggregation and modulation of inflammatory pathways (Aggarwal & Harikumar, 2009).

Ginkgo (Ginkgo biloba)

Ginkgo improves microcirculation and reduces platelet-activating factor activity, making it relevant in cerebral and peripheral vascular disorders (Smith et al., 1996).

Omega-3 Fatty Acids

Although not herbal in origin, omega-3s from plant and marine sources reduce platelet aggregation and systemic inflammation (Mozaffarian & Wu, 2011).

7.3 Safety and Clinical Integration

Herbal interventions should be regarded as adjunctive, not substitutes for anticoagulant therapy. Potential interactions—especially with warfarin and DOACs—necessitate professional supervision. Standardization, dosage regulation, and pharmacovigilance remain essential.

8. Prevention and Lifestyle Integration

An integrative thrombosis prevention strategy includes:

• Regular physical activity
• Anti-inflammatory diets
• Weight management
• Smoking cessation
• Stress reduction
• Adequate hydration

These measures align with both conventional preventive cardiology and traditional holistic health systems.

9. Conclusion

Thrombosis is a multifactorial vascular disorder with profound public health implications. While conventional pharmacotherapy remains indispensable, integrative and herbal medicine offers promising complementary strategies aimed at prevention, vascular protection, and long-term health optimization. A scientifically grounded, patient-centered integrative model—anchored in evidence, safety, and interdisciplinary collaboration—represents a sustainable future direction in thrombosis management.

References

Aggarwal, B. B., & Harikumar, K. B. (2009). Potential therapeutic effects of curcumin. International Journal of Biochemistry & Cell Biology, 41(1), 40–59.

Bordia, A., Verma, S. K., & Srivastava, K. C. (1998). Effect of garlic on platelet aggregation. Prostaglandins, Leukotrienes and Essential Fatty Acids, 58(4), 257–263.

Mozaffarian, D., & Wu, J. H. (2011). Omega-3 fatty acids and cardiovascular disease. Journal of the American College of Cardiology, 58(20), 2047–2067.

Rahman, K., & Lowe, G. M. (2006). Garlic and cardiovascular disease. Journal of Nutrition, 136(3), 736S–740S.

Smith, P. F., Maclennan, K., & Darlington, C. L. (1996). Ginkgo biloba extracts for cognitive impairment. Journal of Ethnopharmacology, 50(3), 131–139.

Verma, S. K., Singh, M., Jain, P., & Bordia, A. (1993). Effect of ginger on platelet aggregation. Indian Journal of Medical Research, 98, 240–242.

World Health Organization. (2023). Cardiovascular diseases (CVDs): Fact sheet. WHO.

13/01/26

Being text of lecture delivered at 2026 Annual Convention of 1992 Set, PCC Ihioma

By Livy-Elcon Emereonye

Buruli ulcer (BU), locally referred to in parts of Igboland as Achaere, is a neglected tropical disease caused by Mycobacterium ulcerans. Despite effective antibiotic regimens recommended by the World Health Organization (WHO), delayed presentation, sociocultural interpretations, and inappropriate traditional interventions continue to fuel high morbidity, deformity, and disability in endemic regions.

An Integrative Medicine Approach to the Management of Achaere (Buruli Ulcer)

1. Introduction

Among the most severe but least addressed neglected tropical diseases (NTDs) is Buruli ulcer. Ranked after tuberculosis and leprosy among mycobacterial infections, BU disproportionately affects rural populations in West and Central Africa, including Nigeria, Ghana, Côte d’Ivoire, and Cameroon. In endemic Nigerian communities, particularly among the Igbo, the disease is colloquially known as Achaere, a term that often carries cultural, spiritual, or metaphysical interpretations.

These interpretations, though culturally meaningful, frequently delay biomedical intervention. Patients often present late, with advanced ulcers, secondary infection, bone involvement, and irreversible disability. At the same time, African traditional medicine remains the first line of care for many rural populations due to accessibility, affordability, and cultural trust.

This reality necessitates not a dismissal of traditional medicine, but a critical scientific engagement with it. The goal of this review is to examine medicinal plants traditionally used for Achaere, evaluate their evidence base, and propose a rational integrative framework that aligns ethnomedical knowledge with modern infectious disease management.

2. Epidemiology and Public Health Significance

Buruli ulcer is endemic in over 33 countries worldwide, with Africa accounting for the vast majority of cases. Children under 15 years constitute a significant proportion of patients, although adults are also affected. The disease is closely associated with riverine and swampy environments, agricultural activity, and limited access to healthcare.

In Nigeria, underreporting remains a major challenge. Many cases never reach hospitals, instead being managed in traditional settings until complications arise. This contributes to the perception that BU is incurable or spiritually driven, further entrenching harmful treatment practices.

3. Etiology and Pathophysiology

3.1 Causative Agent

Buruli ulcer is caused by Mycobacterium ulcerans, an environmental mycobacterium distinct from M. tuberculosis and M. leprae. Its unique pathogenicity lies in its production of mycolactone, a lipid toxin.

Mycobacterium ulcerans are rod-shaped, Gram positive bacteria that grow slowly, forming small transparent colonies after four weeks when viewed on a microscope.

Mosquitoes and other aquatic insects (like water bugs) are the primary vectors transmitting the ulcer-causing bacteria Mycobacterium ulcerans from the environment to people.

3.2 Role of Mycolactone

Mycolactone is a nasty toxin:

• Induces apoptosis of skin and subcutaneous cells leading to ulcers and tissue damage.
• Suppresses local immune responses
• Explains the painless nature of early lesions

As a result, patients often ignore early nodules or plaques until extensive tissue destruction has occurred.

3.3 The Role of Immunity

In Buruli ulcer, immunity plays a crucial role:

• The disease often affects people with weakened immune systems.
• Research suggests that a strong cell-mediated immune response is key to controlling M. ulcerans infection.
• Mycolactone suppresses the immune system, making it harder for the body to fight the infection.

Early treatment and a healthy immune system can improve outcomes.

4. Clinical Presentation

4.1 Early Lesions

• Painless nodules
• Firm plaques
• Diffuse, non-pitting edema

4.2 Advanced Disease

• Large ulcers with undermined edges
• Necrosis of skin and subcutaneous tissue
• Secondary bacterial infection
• Osteomyelitis
• Deformity and contractures

Pain typically appears late, often signaling secondary infection rather than primary disease activity.

5. Conventional Management of Buruli Ulcer

Diagnosis

• Clinical examination (in endemic areas)
• Laboratory confirmation:
  -PCR testing (gold standard)
  -Microscopy
  -Culture (slow)
• Histopathology in some cases

Treatment of Achaere (Buruli Ulcer)

Conventional Treatment

WHO-recommended treatment consists of 8 weeks of combination antibiotic therapy, usually:

• Rifampicin + Clarithromycin

This regimen achieves cure rates exceeding 90% when initiated early.

• (or Rifampicin + Streptomycin in some settings)

Wound Care

• Regular sterile dressing
• Debridement of dead tissue
• Skin grafting in advanced cases
• Physiotherapy to prevent deformities
• Psychosocial support.

Surgery

• Reserved for large or complicated ulcers
• Used alongside antibiotics, not alone

1. The Place of Traditional Medicine in Achaere

In many African communities, traditional medicine is not an alternative but the default healthcare system. However, in the context of Buruli ulcer, certain practices—scarification, caustic herbal pastes, hot compresses—have been shown to worsen tissue necrosis and delay healing.

The challenge, therefore, is to separate empirically harmful practices from potentially beneficial plant-based interventions, and to reframe traditional medicine as a supportive, regulated, and evidence-informed partner.

7. Medicinal Plants Used in the Supportive Management of Achaere

7.1 Azadirachta indica (Neem)

Neem is one of the most widely studied medicinal plants in tropical medicine. Its bioactive compounds—nimbidin, azadirachtin, quercetin—exhibit antibacterial, anti-inflammatory, and immunomodulatory properties.

Relevance to Achaere:
Neem shows inhibitory effects against Mycobacterium species and common wound pathogens. Mild decoctions may be used for wound cleansing, provided they are non-caustic and sterile.

7.2 Vernonia amygdalina (Bitter Leaf)

A cornerstone of Igbo ethnomedicine, V. amygdalina contains sesquiterpene lactones and flavonoids with antimicrobial and antioxidant effects.

It is used primarily as oral immune support and metabolic modulation rather than direct ulcer application.

7.3 Psidium guajava (Guava Leaves)

Guava leaves possess strong antibacterial and astringent properties, effective against Staphylococcus aureus and Pseudomonas aeruginosa—key secondary invaders in chronic ulcers.

It has adjunct role in wound cleansing and exudate control.

7.4 Carica papaya (Pawpaw)

Papaya latex contains papain, a proteolytic enzyme used in enzymatic debridement.

It should be noted that while beneficial when standardized, crude latex may cause irritation and should not be applied indiscriminately.

7.5 Aloe vera

Aloe vera promotes epithelialization, reduces inflammation, and minimizes scar formation.

It is best suited for healing stages rather than active necrotic ulcers.

7.6 Curcuma longa (Turmeric)

Curcumin exhibits anti-inflammatory, antioxidant, and immune-modulatory properties.

Its application should be for oral supplementation; and raw powder should not be packed into ulcers.

7.7 Ocimum gratissimum (Nchuanwu / Scent Leaf)

Contains eugenol and thymol with antimicrobial activity.

It can be used for mild topical cleansing and general skin hygiene.

7.8 Medical-Grade Honey

Unlike raw honey, medical-grade honey is sterilized and standardized.

It has demonstrated broad-spectrum antimicrobial activity and accelerates wound healing.

8. Safety, Ethics, and Cultural Responsibility

The integration of medicinal plants into Buruli ulcer management must adhere to:

• Non-maleficence
• Standardization
• Supervision
• Clear communication that herbs are adjunctive

Ethically, healthcare providers must respect cultural beliefs while firmly discouraging harmful practices.

9. Proposed Integrative Model for Achaere Management

• Early diagnosis and antibiotic therapy
• Professional wound care
• Selected herbal adjuncts with known safety profiles
• Nutritional rehabilitation
• Community education and surveillance

This model aligns biomedical efficacy with cultural relevance.

10. Future Research Directions

• Phytochemical isolation of anti-mycolactone compounds
• Toxicity profiling of commonly used herbs
• Controlled clinical trials of adjunctive herbal therapies
• Development of standardized African herbaceutical wound products

10. Conclusion

Achaere (Buruli ulcer) is neither mystical nor incurable. It is a bacterial disease whose devastation is amplified by delayed care and harmful interventions. African medicinal plants, when subjected to scientific scrutiny and ethical integration, hold value as supportive tools in comprehensive care. The future of Buruli ulcer management in Africa lies not in rejecting tradition, but in disciplining it with science.

Above all, every problem has a solution even at infinity.

Thanks and God bless.

Being text of lecture delivered at 2026 Annual Convention of 1992 Set, PCC Ihioma

By Livy-Elcon Emereonye

Buruli ulcer (BU), locally referred to in parts of Igboland as Achaere, is a neglected tropical disease caused by Mycobacterium ulcerans. Despite effective antibiotic regimens recommended by the World Health Organization (WHO), delayed presentation, sociocultural interpretations, and inappropriate traditional interventions continue to fuel high morbidity, deformity, and disability in endemic regions.

1. Introduction

Among the most severe but least addressed neglected tropical diseases (NTDs) is Buruli ulcer. Ranked after tuberculosis and leprosy among mycobacterial infections, BU disproportionately affects rural populations in West and Central Africa, including Nigeria, Ghana, Côte d’Ivoire, and Cameroon. In endemic Nigerian communities, particularly among the Igbo, the disease is colloquially known as Achaere, a term that often carries cultural, spiritual, or metaphysical interpretations.

These interpretations, though culturally meaningful, frequently delay biomedical intervention. Patients often present late, with advanced ulcers, secondary infection, bone involvement, and irreversible disability. At the same time, African traditional medicine remains the first line of care for many rural populations due to accessibility, affordability, and cultural trust.

This reality necessitates not a dismissal of traditional medicine, but a critical scientific engagement with it. The goal of this review is to examine medicinal plants traditionally used for Achaere, evaluate their evidence base, and propose a rational integrative framework that aligns ethnomedical knowledge with modern infectious disease management.

2. Epidemiology and Public Health Significance

Buruli ulcer is endemic in over 33 countries worldwide, with Africa accounting for the vast majority of cases. Children under 15 years constitute a significant proportion of patients, although adults are also affected. The disease is closely associated with riverine and swampy environments, agricultural activity, and limited access to healthcare.

In Nigeria, underreporting remains a major challenge. Many cases never reach hospitals, instead being managed in traditional settings until complications arise. This contributes to the perception that BU is incurable or spiritually driven, further entrenching harmful treatment practices.

3. Etiology and Pathophysiology

3.1 Causative Agent

Buruli ulcer is caused by Mycobacterium ulcerans, an environmental mycobacterium distinct from M. tuberculosis and M. leprae. Its unique pathogenicity lies in its production of mycolactone, a lipid toxin.

Mycobacterium ulcerans are rod-shaped, Gram positive bacteria that grow slowly, forming small transparent colonies after four weeks when viewed on a microscope.

Mosquitoes and other aquatic insects (like water bugs) are the primary vectors transmitting the ulcer-causing bacteria Mycobacterium ulcerans from the environment to people.

3.2 Role of Mycolactone

Mycolactone is a nasty toxin:

• Induces apoptosis of skin and subcutaneous cells leading to ulcers and tissue damage.
• Suppresses local immune responses
• Explains the painless nature of early lesions

As a result, patients often ignore early nodules or plaques until extensive tissue destruction has occurred.

3.3 The Role of Immunity

In Buruli ulcer, immunity plays a crucial role:

• The disease often affects people with weakened immune systems.
• Research suggests that a strong cell-mediated immune response is key to controlling M. ulcerans infection.
• Mycolactone suppresses the immune system, making it harder for the body to fight the infection.

Early treatment and a healthy immune system can improve outcomes.

4. Clinical Presentation

4.1 Early Lesions

• Painless nodules
• Firm plaques
• Diffuse, non-pitting edema

4.2 Advanced Disease

• Large ulcers with undermined edges
• Necrosis of skin and subcutaneous tissue
• Secondary bacterial infection
• Osteomyelitis
• Deformity and contractures

Pain typically appears late, often signaling secondary infection rather than primary disease activity.

5. Conventional Management of Buruli Ulcer

Diagnosis

• Clinical examination (in endemic areas)
• Laboratory confirmation:
  -PCR testing (gold standard)
  -Microscopy
  -Culture (slow)
• Histopathology in some cases

Treatment of Achaere (Buruli Ulcer)

Conventional Treatment

WHO-recommended treatment consists of 8 weeks of combination antibiotic therapy, usually:

• Rifampicin + Clarithromycin

This regimen achieves cure rates exceeding 90% when initiated early.

• (or Rifampicin + Streptomycin in some settings)

Wound Care

• Regular sterile dressing
• Debridement of dead tissue
• Skin grafting in advanced cases
• Physiotherapy to prevent deformities
• Psychosocial support.

Surgery

• Reserved for large or complicated ulcers
• Used alongside antibiotics, not alone

1. The Place of Traditional Medicine in Achaere

In many African communities, traditional medicine is not an alternative but the default healthcare system. However, in the context of Buruli ulcer, certain practices—scarification, caustic herbal pastes, hot compresses—have been shown to worsen tissue necrosis and delay healing.

The challenge, therefore, is to separate empirically harmful practices from potentially beneficial plant-based interventions, and to reframe traditional medicine as a supportive, regulated, and evidence-informed partner.

7. Medicinal Plants Used in the Supportive Management of Achaere

7.1 Azadirachta indica (Neem)

Neem is one of the most widely studied medicinal plants in tropical medicine. Its bioactive compounds—nimbidin, azadirachtin, quercetin—exhibit antibacterial, anti-inflammatory, and immunomodulatory properties.

Relevance to Achaere:
Neem shows inhibitory effects against Mycobacterium species and common wound pathogens. Mild decoctions may be used for wound cleansing, provided they are non-caustic and sterile.

7.2 Vernonia amygdalina (Bitter Leaf)

A cornerstone of Igbo ethnomedicine, V. amygdalina contains sesquiterpene lactones and flavonoids with antimicrobial and antioxidant effects.

It is used primarily as oral immune support and metabolic modulation rather than direct ulcer application.

7.3 Psidium guajava (Guava Leaves)

Guava leaves possess strong antibacterial and astringent properties, effective against Staphylococcus aureus and Pseudomonas aeruginosa—key secondary invaders in chronic ulcers.

It has adjunct role in wound cleansing and exudate control.

7.4 Carica papaya (Pawpaw)

Papaya latex contains papain, a proteolytic enzyme used in enzymatic debridement.

It should be noted that while beneficial when standardized, crude latex may cause irritation and should not be applied indiscriminately.

7.5 Aloe vera

Aloe vera promotes epithelialization, reduces inflammation, and minimizes scar formation.

It is best suited for healing stages rather than active necrotic ulcers.

7.6 Curcuma longa (Turmeric)

Curcumin exhibits anti-inflammatory, antioxidant, and immune-modulatory properties.

Its application should be for oral supplementation; and raw powder should not be packed into ulcers.

7.7 Ocimum gratissimum (Nchuanwu / Scent Leaf)

Contains eugenol and thymol with antimicrobial activity.

It can be used for mild topical cleansing and general skin hygiene.

7.8 Medical-Grade Honey

Unlike raw honey, medical-grade honey is sterilized and standardized.

It has demonstrated broad-spectrum antimicrobial activity and accelerates wound healing.

8. Safety, Ethics, and Cultural Responsibility

The integration of medicinal plants into Buruli ulcer management must adhere to:

• Non-maleficence
• Standardization
• Supervision
• Clear communication that herbs are adjunctive

Ethically, healthcare providers must respect cultural beliefs while firmly discouraging harmful practices.

9. Proposed Integrative Model for Achaere Management

• Early diagnosis and antibiotic therapy
• Professional wound care
• Selected herbal adjuncts with known safety profiles
• Nutritional rehabilitation
• Community education and surveillance

This model aligns biomedical efficacy with cultural relevance.

10. Future Research Directions

• Phytochemical isolation of anti-mycolactone compounds
• Toxicity profiling of commonly used herbs
• Controlled clinical trials of adjunctive herbal therapies
• Development of standardized African herbaceutical wound products

10. Conclusion

Achaere (Buruli ulcer) is neither mystical nor incurable. It is a bacterial disease whose devastation is amplified by delayed care and harmful interventions. African medicinal plants, when subjected to scientific scrutiny and ethical integration, hold value as supportive tools in comprehensive care. The future of Buruli ulcer management in Africa lies not in rejecting tradition, but in disciplining it with science.

Above all, every problem has a solution even at infinity.

Thanks and God bless.

An Integrative Medicine Approach to the Management of Achaere (Buruli Ulcer)

Being text of lecture delivered at 2026 Annual Convention of 1992 Set, PCC Ihioma

By Livy-Elcon Emereonye

Buruli ulcer (BU), locally referred to in parts of Igboland as Achaere, is a neglected tropical disease caused by Mycobacterium ulcerans. Despite effective antibiotic regimens recommended by the World Health Organization (WHO), delayed presentation, sociocultural interpretations, and inappropriate traditional interventions continue to fuel high morbidity, deformity, and disability in endemic regions.

1. Introduction

Among the most severe but least addressed neglected tropical diseases (NTDs) is Buruli ulcer. Ranked after tuberculosis and leprosy among mycobacterial infections, BU disproportionately affects rural populations in West and Central Africa, including Nigeria, Ghana, Côte d’Ivoire, and Cameroon. In endemic Nigerian communities, particularly among the Igbo, the disease is colloquially known as Achaere, a term that often carries cultural, spiritual, or metaphysical interpretations.

These interpretations, though culturally meaningful, frequently delay biomedical intervention. Patients often present late, with advanced ulcers, secondary infection, bone involvement, and irreversible disability. At the same time, African traditional medicine remains the first line of care for many rural populations due to accessibility, affordability, and cultural trust.

This reality necessitates not a dismissal of traditional medicine, but a critical scientific engagement with it. The goal of this review is to examine medicinal plants traditionally used for Achaere, evaluate their evidence base, and propose a rational integrative framework that aligns ethnomedical knowledge with modern infectious disease management.

2. Epidemiology and Public Health Significance

Buruli ulcer is endemic in over 33 countries worldwide, with Africa accounting for the vast majority of cases. Children under 15 years constitute a significant proportion of patients, although adults are also affected. The disease is closely associated with riverine and swampy environments, agricultural activity, and limited access to healthcare.

In Nigeria, underreporting remains a major challenge. Many cases never reach hospitals, instead being managed in traditional settings until complications arise. This contributes to the perception that BU is incurable or spiritually driven, further entrenching harmful treatment practices.

3. Etiology and Pathophysiology

3.1 Causative Agent

Buruli ulcer is caused by Mycobacterium ulcerans, an environmental mycobacterium distinct from M. tuberculosis and M. leprae. Its unique pathogenicity lies in its production of mycolactone, a lipid toxin.

Mycobacterium ulcerans are rod-shaped, Gram positive bacteria that grow slowly, forming small transparent colonies after four weeks when viewed on a microscope.

Mosquitoes and other aquatic insects (like water bugs) are the primary vectors transmitting the ulcer-causing bacteria Mycobacterium ulcerans from the environment to people.

3.2 Role of Mycolactone

Mycolactone is a nasty toxin:

• Induces apoptosis of skin and subcutaneous cells leading to ulcers and tissue damage.
• Suppresses local immune responses
• Explains the painless nature of early lesions

As a result, patients often ignore early nodules or plaques until extensive tissue destruction has occurred.

3.3 The Role of Immunity

In Buruli ulcer, immunity plays a crucial role:

• The disease often affects people with weakened immune systems.
• Research suggests that a strong cell-mediated immune response is key to controlling M. ulcerans infection.
• Mycolactone suppresses the immune system, making it harder for the body to fight the infection.

Early treatment and a healthy immune system can improve outcomes.

4. Clinical Presentation

4.1 Early Lesions

• Painless nodules
• Firm plaques
• Diffuse, non-pitting edema

4.2 Advanced Disease

• Large ulcers with undermined edges
• Necrosis of skin and subcutaneous tissue
• Secondary bacterial infection
• Osteomyelitis
• Deformity and contractures

Pain typically appears late, often signaling secondary infection rather than primary disease activity.

5. Conventional Management of Buruli Ulcer

Diagnosis

• Clinical examination (in endemic areas)
• Laboratory confirmation:
  -PCR testing (gold standard)
  -Microscopy
  -Culture (slow)
• Histopathology in some cases

Treatment of Achaere (Buruli Ulcer)

Conventional Treatment

WHO-recommended treatment consists of 8 weeks of combination antibiotic therapy, usually:

• Rifampicin + Clarithromycin

This regimen achieves cure rates exceeding 90% when initiated early.

• (or Rifampicin + Streptomycin in some settings)

Wound Care

• Regular sterile dressing
• Debridement of dead tissue
• Skin grafting in advanced cases
• Physiotherapy to prevent deformities
• Psychosocial support.

Surgery

• Reserved for large or complicated ulcers
• Used alongside antibiotics, not alone

1. The Place of Traditional Medicine in Achaere

In many African communities, traditional medicine is not an alternative but the default healthcare system. However, in the context of Buruli ulcer, certain practices—scarification, caustic herbal pastes, hot compresses—have been shown to worsen tissue necrosis and delay healing.

The challenge, therefore, is to separate empirically harmful practices from potentially beneficial plant-based interventions, and to reframe traditional medicine as a supportive, regulated, and evidence-informed partner.

7. Medicinal Plants Used in the Supportive Management of Achaere

7.1 Azadirachta indica (Neem)

Neem is one of the most widely studied medicinal plants in tropical medicine. Its bioactive compounds—nimbidin, azadirachtin, quercetin—exhibit antibacterial, anti-inflammatory, and immunomodulatory properties.

Relevance to Achaere:
Neem shows inhibitory effects against Mycobacterium species and common wound pathogens. Mild decoctions may be used for wound cleansing, provided they are non-caustic and sterile.

7.2 Vernonia amygdalina (Bitter Leaf)

A cornerstone of Igbo ethnomedicine, V. amygdalina contains sesquiterpene lactones and flavonoids with antimicrobial and antioxidant effects.

It is used primarily as oral immune support and metabolic modulation rather than direct ulcer application.

7.3 Psidium guajava (Guava Leaves)

Guava leaves possess strong antibacterial and astringent properties, effective against Staphylococcus aureus and Pseudomonas aeruginosa—key secondary invaders in chronic ulcers.

It has adjunct role in wound cleansing and exudate control.

7.4 Carica papaya (Pawpaw)

Papaya latex contains papain, a proteolytic enzyme used in enzymatic debridement.

It should be noted that while beneficial when standardized, crude latex may cause irritation and should not be applied indiscriminately.

7.5 Aloe vera

Aloe vera promotes epithelialization, reduces inflammation, and minimizes scar formation.

It is best suited for healing stages rather than active necrotic ulcers.

7.6 Curcuma longa (Turmeric)

Curcumin exhibits anti-inflammatory, antioxidant, and immune-modulatory properties.

Its application should be for oral supplementation; and raw powder should not be packed into ulcers.

7.7 Ocimum gratissimum (Nchuanwu / Scent Leaf)

Contains eugenol and thymol with antimicrobial activity.

It can be used for mild topical cleansing and general skin hygiene.

7.8 Medical-Grade Honey

Unlike raw honey, medical-grade honey is sterilized and standardized.

It has demonstrated broad-spectrum antimicrobial activity and accelerates wound healing.

8. Safety, Ethics, and Cultural Responsibility

The integration of medicinal plants into Buruli ulcer management must adhere to:

• Non-maleficence
• Standardization
• Supervision
• Clear communication that herbs are adjunctive

Ethically, healthcare providers must respect cultural beliefs while firmly discouraging harmful practices.

9. Proposed Integrative Model for Achaere Management

• Early diagnosis and antibiotic therapy
• Professional wound care
• Selected herbal adjuncts with known safety profiles
• Nutritional rehabilitation
• Community education and surveillance

This model aligns biomedical efficacy with cultural relevance.

10. Future Research Directions

• Phytochemical isolation of anti-mycolactone compounds
• Toxicity profiling of commonly used herbs
• Controlled clinical trials of adjunctive herbal therapies
• Development of standardized African herbaceutical wound products

10. Conclusion

Achaere (Buruli ulcer) is neither mystical nor incurable. It is a bacterial disease whose devastation is amplified by delayed care and harmful interventions. African medicinal plants, when subjected to scientific scrutiny and ethical integration, hold value as supportive tools in comprehensive care. The future of Buruli ulcer management in Africa lies not in rejecting tradition, but in disciplining it with science.

Above all, every problem has a solution even at infinity.

Thanks and God bless.

PRESS RELEASE

VICTORIOUS TD

URGENT: MEDICAL NEGLIGENCE CRISIS DEMANDS IMMEDIATE OVERHAUL OF NIGERIA’S HEALTH REGULATORY FRAMEWORK

As a medical negligence legal specialist, I must express grave concern about the recurring incidents of absolutely preventable deaths resulting from medical negligence by health practitioners across Nigeria. The recent tragic loss of Nkanu Nnamdi, one of the twin sons of renowned author Chimamanda Ngozi Adichie and her husband, Dr. Ivara Esege, has once again brought this critical national crisis to the forefront of public consciousness.

As my professional focus over the last 20 years has been medical malpractice, having been involved in over 50 cases, this unfortunate incident is yet another example of the unacceptable state of incompetence in some Nigerian hospitals. I am, quite honestly, not shocked that such a simple procedure at an acclaimed, reputable hospital has ended so terribly. Propofol, which was reportedly administered to Nkanu, requires exceptional care due to its potential for cardio-respiratory failure. An overdose can be fatal, and there appears to be a strong possibility of overdose in this case.

I commend the Lagos State Government for its prompt commitment to investigate this matter. I equally commend the hospital, Euracare, for agreeing to cooperate with investigators. However, I must emphasise that such investigations must be genuinely independent and transparent. I have witnessed instances where medical records are altered to avoid culpability.

This issue is deeply personal to me. I was misdiagnosed for an ailment that could have had serious consequences. My brother almost died due to an operation performed by a physician who presented himself as a surgeon. The cases of Peju Ugboma and numerous other Nigerians—including a woman who lost both kidneys following negligent surgery; a mother who died from haemorrhagic shock after childbirth due to delayed response; a 12-year-old whose intestine reportedly went “missing” during treatment; a doctor who was imprisoned for improperly setting a fracture without X-ray; and an elderly woman who died after being mistakenly given a paralysing injection during a routine visit—demonstrate the scale of this crisis. These are not isolated incidents but symptoms of a systemic crisis demanding urgent intervention. My practice currently has over 20 complaints on this issue and is actively handling 25 cases.

The fundamental problem underlying these tragedies is the complete failure of the legal and regulatory framework governing Nigeria’s health sector. In the old days, the healthcare system functioned under a robust supervisory structure. Chief Medical Officers and Health Inspectors were responsible for oversight of critical care, ensuring compliance with standards, and holding practitioners accountable. The last Chief Medical Officer of Nigeria was Dr. Samuel Layinka Manuwa.

Today, under the National Health Act and State Health Laws, this essential regulatory infrastructure no longer exists. Our health sector has become overcentralised under the Federal Minister of Health, causing states to become lax in oversight responsibilities. As a result, health facilities and medical practitioners operate with alarming impunity. There is no requirement for routine submission of reports, no systematic inspections, and no effective enforcement of professional standards.

Ministers of Health and Commissioners of Health have assumed roles that conflate policy-making with regulatory enforcement—a fundamental governance failure. There must be a clear separation of functions: Ministers and Commissioners should focus on policy development and strategic direction, whilst independent Health Inspectors and regulatory bodies must be empowered to enforce standards, conduct inspections, and ensure accountability.

I commiserate with all Nigerians who have been victims of medical negligence and with families who continue to suffer the devastating consequences of a broken healthcare regulatory system. The Chimamanda case has brought this national emergency further into public focus, but it represents only the visible tip of a much larger crisis affecting countless Nigerian families. I continue to speak out as loudly as I can that the state of medical care in Nigeria has reached a critical point, requiring emergency action.

I call for:

1. Immediate establishment of an independent Health Regulatory Authority with powers to inspect facilities, enforce standards, and sanction non-compliance;
2. Reinstitution of the Office of Chief Medical Officer at federal and state levels with clear enforcement mandates;
3. Mandatory registration and periodic inspection of all health facilities with transparent reporting requirements;
4. Independent investigation mechanisms with powers to access and preserve medical records, preventing tampering or alteration;
5. Clear separation between policy formulation and regulatory enforcement within the health sector governance structure;
6. Comprehensive legislative reform to update Nigeria’s health laws to reflect modern standards of care, accountability, and patient protection; and

The time for comprehensive overhaul of Nigeria’s health system is long overdue. We cannot continue to lose precious lives to preventable medical errors whilst the regulatory framework remains in shambles. This is a matter of national emergency that demands immediate legislative and executive action.

DR. OLISA AGBAKOBA SAN
SENIOR PARTNER & HEAD MEDICAL MALPRACTICE
OLISA AGBAKOBA LEGAL

12TH JANUARY 2026

Press Release

DICTA TD

13/01/26

The National Agency for Food and Drug Administration and Control (NAFDAC) has called on the general public to be vigilant and report
Adverse events or side effects related to the consumption of a sma infant formula across the Country

Ths public alert is coming amidst concerns arising from the voluntary global recall in over 50 countries by Nestlé UK of specific batches of its SMA Infant Formula and Follow-On Formula due to the potential presence of cereulide, a toxin, in the batches concerned.

The Agency in a media statement signed by the director general Professor Mojisola Adeyeye reassured the public, healthcare professionals, and relevant stakeholders particularly parents, and caregivers, that all Nestlé Infant Formulae currently approved for marketing in Nigeria are safe for consumption and are not part of the recalled batch.

The recall batches in the affected countries was due to the potential presence of cereulide in the UK batches, a toxin, which can trigger nausea and vomiting when consumed.
Cereulide is an extremely heat-resistant toxin produced by certain strains of the bacterium Bacillus cereus.

According to the regulatory Agency ,The SMA range sold in Nigeria are manufactured at Nestlé Tuas Factory, Singapore, and duly registered with NAFDAC are as follows:

SMA GOLD 1 NAFDAC Reg. No.: B1-2783
SMA GOLD 2 NAFDAC Reg. No.: B1-2780
SMA GOLD 3 NAFDAC Reg. No.: B1-2781.

NAFDAC reiterated that the SMA and NAN range of infant formulae produced for the Nigerian market are not part of the affected batches involved in the voluntary and precautionary recall in other countries.

This alert has been issued as a precautionary measure in the interest of public health, consistent with NAFDACs statutory responsibility to keep Nigerians duly informed of emerging global food safety concerns, even in circumstances where the likelihood of local exposure remains minimal.