Talk:Buruli ulcer

Preliminary notes from SG

 * All of the other names in the infobox need to have redirects ... some missing. ✅
 * WP:NBSP, WP:DASHES, WP:MOSNUM and watch the p. vs. pp.
 * WP:OVERLINK unlikely anyone will click on country names from this article—sea of blue detracts from high-value links. ✅
 * User:Evad37/duplinks-alt is a dup link checker that will be run at FAC. ✅
 * Per MEDMOS, may need an Other animals section to be comprehensive ???
 * Peru mentioned in image caption but not in Epidemiology-- article leaves a strong impression about geographic location, and we only find Peru in image caption?
 * Complete citations:
 * "Buruli ulcer (Mycobacterium ulcerans infection) Fact sheet N°199". World Health Organization. April 2018. Retrieved 17 April 2018.
 * This is linking to a 2 April 2019 press release ... fix date, check for updates, use cite press release rather than cite web ... ??


 * "Buruli ulcer (Mycobacterium ulcerans infection)". World Health Organization. 21 May 2019.
 * Listed separately, but linking to the same page ?✅

Ajpolino, that is all for now; have not read article, pls ping me as you get closer to FAC and I will do a prose review. Not a fan of the word “just” as it is a value judgment ... unless sources use it. Sandy Georgia (Talk)  18:31, 6 July 2020 (UTC)

Lead says: Body says: Sandy Georgia (Talk)  11:44, 8 July 2020 (UTC)
 * M. ulcerans cannot be transmitted from one human to another.[1]
 * Human-to-human transmission is extremely rare (same source)
 * ✅ Resolved (for any interested, the discrepancy is because there is apparently one reported case of human-to-human transmission, thereby complicating our prose for all time). Ajpolino (talk) 15:16, 21 October 2020 (UTC)

Lead says 2,000 cases, but infobox and body mention 2 to 5. Sandy Georgia (Talk)  11:46, 8 July 2020 (UTC)
 * ✅ I think I've brought all the estimates to 3,000 to 5,000 (the true case count is probably much higher, but I haven't seen anyone dare estimate how much higher). Ajpolino (talk) 15:16, 21 October 2020 (UTC)

See top of User:SandyGeorgia for links on however, subsequently, consequently and other prose redundancies. Sandy Georgia (Talk)  11:59, 8 July 2020 (UTC)


 * Says it was established in 1998: https://www.who.int/initiatives/global-buruli-ulcer-initiative-(gbui) ( I will create that stub for you to remove the red link) Sandy Georgia (Talk)  23:33, 13 October 2020 (UTC)

Etcetera Sandy Georgia (Talk)  01:19, 9 July 2020 (UTC)
 * Society and culture section needed
 * witchcraft https://www.who.int/neglected_diseases/integrated_media/integrated_media_buruli/en/
 * also https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954709/ (MEDRS is relaxed for society and culture)
 * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085067/
 * https://books.google.com/books?id=WeuVDwAAQBAJ&pg=PA255&lpg=PA255&dq=buruli+witchcraft&source=bl&ots=9-YqdIR-Pk&sig=ACfU3U18IwAogQpdCwU6FbivP5h3knh7cg&hl=en&sa=X&ved=2ahUKEwikkdr-_r7qAhVbZc0KHeVZAPUQ6AEwBnoECAoQAQ#v=onepage&q=buruli%20witchcraft&f=false
 * https://books.google.com/books?id=3sPODwAAQBAJ&pg=PT110&lpg=PT110&dq=buruli+witchcraft&source=bl&ots=5oeKBZR5OT&sig=ACfU3U0y6viZnkuR_MUssmEnh8x9TYtD8Q&hl=en&sa=X&ved=2ahUKEwikkdr-_r7qAhVbZc0KHeVZAPUQ6AEwBXoECAkQAQ#v=onepage&q=buruli%20witchcraft&f=false
 * Anything on differential diagnosis? Sandy Georgia  (Talk)  18:27, 9 July 2020 (UTC)

will inquire about In pregnancy ... several journal articles describe treatment issues.Sandy Georgia (Talk)  01:22, 9 July 2020 (UTC)
 * Just a quick note to say thank you for the comments so far! I hope to have some time to start working on them this weekend or next week. Much appreciated. Ajpolino (talk) 17:48, 9 July 2020 (UTC)
 * You might be able to tell that I can barely contain my excitement at seeing two medical articles prepping for FAC! Sandy Georgia  (Talk)  18:21, 9 July 2020 (UTC)


 * Note to self: Anything useful to add from (secondary infections) or  (more info on abx)? Ajpolino (talk) 04:28, 9 August 2020 (UTC)
 * has some epi phrasing I'm looking for, as well as a nice differential. Ajpolino (talk) 06:45, 9 August 2020 (UTC)

I don't speak HarvRef, but my gadget is reporting an error here: Sandy Georgia (Talk)  18:23, 5 September 2020 (UTC)
 * Kpeli et al. Harv error: link from CITEREFKpeliYeboah-Manu2019227–228 doesn't point to any citation.
 * Fixed! Now that Spicy's FAC is wrapping up, I'm coming back around to this. Taking a look back through each section to see if I can add anything and improve my wording. Once I finish this pass I'll be knocking on your door looking for help with the prose. Lucid writing is not my specialty (yet, anyway). Thanks in advance! Ajpolino (talk) 22:22, 5 September 2020 (UTC)
 * I have to write up a FAC oppose that I am dreading because it will take days ... then I can turn my attention back to here. If I forget, bug me on my talk when you are ready ... Sandy Georgia  (Talk)  13:57, 21 September 2020 (UTC)

I noticed there is not much info on social and psychological effects of the disease - looks like it could be a good source for this. this may be useful as well. Spicy (talk) 13:40, 21 September 2020 (UTC)

Ajpolino, are you back at it ? Don't forget to follow the Spicy trail! Sandy Georgia (Talk)  22:11, 13 October 2020 (UTC)
 * After a (too) long break, I'm back! Forgive the chaos above, I may start striking through the items I've completed. Still on my to-do list: add info on treating pregnant women as well as society & culture (including stigma). I suspect I'll need lots of help cleaning up my prose and pointing out spots where info is missing. It is, after all, my first rodeo. Ajpolino (talk) 23:02, 13 October 2020 (UTC)
 * Let me know when you're done with the list. Then I'll check stylistic stuff. Then we call in more WPMED types for a med review. And finally I will bring in some non-med people for a jargon/accessibility check. Don't worry too much about prose at this stage; others can fix it (although I doubt many fixes will be needed; Spicy has remarkable clarity of prose. Here we go! (The final coup de grace is that you must bring in Tim V for a check :)  Sandy Georgia  (Talk)  23:20, 13 October 2020 (UTC)
 * Ok, finally got a chance to look for treatment during pregnancy and came up mostly empty-handed. I found a case report where folks decided to wait until the baby was delivered, then start treatment. Now that the treatment has changed to rifampicin and clarithromycin, I can't find any mention of pregnancy. Not being a physician, I'm not 100% certain of this. But from a quick Google it looks like pregnant women can safely take both drugs? If anyone watching this page knows different, please let me know. As we go through article improvements, I'll keep an eye out for any other info.
 * Also with that, I think my ability to see the problems with the article have reached a block. Whenever you've got the time to read it over, I'd be happy to hear your thoughts. Ajpolino (talk) 01:30, 31 October 2020 (UTC)
 * I will look in tomorrow, and then call in Colin, Graham, Spicy, Cas, WAID ... then Ceoil when med editors are done... unless they are watching already. Sandy Georgia (Talk)  01:36, 31 October 2020 (UTC)
 * I'm watching... I'll try to take a look either later tonight or tomorrow. Spicy (talk) 01:40, 31 October 2020 (UTC)

Random thoughts from Spicy
Some thoughts while skimming, feel free to disagree with my nitpicking... More to come... Spicy (talk) 02:44, 31 October 2020 (UTC) Forgive my nitpicking. This is a very clearly written and informative article. Spicy (talk) 04:57, 31 October 2020 (UTC)
 * What's the rationale for citations in the lead? Some things are cited and some are not; some of the things that are cited don't seem to be controversial or to fall under any of the categories at WP:When to cite, e.g. "Buruli ulcer is an infectious disease characterized by the development of painless open wounds"...
 * resulting in tissue death and immune suppression. - systemic immunosuppression or only at the site of the ulcer?
 * mostly in rural sub-Saharan Africa and Australia - are you saying "mostly in ... rural Australia" or "mostly in... Australia"?
 * in 1897 Uganda. I find this phrasing a bit awkward.
 * by an Australian group at Melbourne University. - I would think that a group at Melbourne University would be Australian by definition
 * Should probably use convert to provide sizes in inches as well as centimetres
 * In some people, the ulcer may heal on its own or remain small and linger unhealed for years - the phrase "remain small and linger unhealed" seems to imply that the small size is connected to the fact that it doesn't heal, but I'd think a larger ulcer would be less likely to heal on its own? would "remain small but linger unhealed" be better? (I haven't checked the source so not sure if this is accurate)
 * mycolactone ... diffuses into host cells and blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum.[10] When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis. - this is going to be really hard to understand for anyone who hasn't at least taken an AP biology class. Is it possible to explain this in more plain language while sticking to the sources? At least, Host (biology), Translation (biology) and Protein translocation should be linked.
 * causing the large open ulcer characteristic of disease - the disease?
 * link Cell signaling
 * cases are near stagnant bodies of water - "cases occur" sounds a lot better to me
 * Supporting this, - I would change this to "supporting this hypothesis" to make it entirely clear what you're referring to
 * Equipment required to run real-time PCR is prohibitively expensive and often available only at centralized diagnostic laboratories, - is this true for all areas? I would imagine it's not a problem in urban Australia and Japan for example
 * An additional method of diagnosis is microscopic examination of ulcer tissue by a trained pathologist. However, this requires more invasive sampling of ulcer tissue, as well as specifically trained personnel - does microscopy from swabs not require specially trained personnel?
 * Hmm the source's wording: For routine diagnosis of BU in the endemic African countries, histopathological analysis of tissue samples is impractical, as it necessitates sophisticated technology as well as specifically trained and highly experienced personnel. Moreover, adequate tissue specimens obtained from the centre of a non-ulcerative lesion or from the edge of an ulcer by invasive sampling techniques are required. I suppose I could cut as well as specifically trained personnel from my sentence without much changing its meaning. Do you have an alternative suggestion? (Sorry dispensed with the red so I didn't make a mess of the red+green). Ajpolino (talk) 23:17, 10 November 2020 (UTC)
 * What about something like "An additional method of diagnosis is microscopic examination of ulcer tissue. However, this requires more invasive sampling and review by a trained pathologist, so is rarely used in places where Buruli ulcer is endemic"? Spicy (talk) 00:06, 11 November 2020 (UTC)
 * That sounds great! Replaced. Ajpolino (talk) 00:29, 11 November 2020 (UTC)
 * Is it endemic to Japan, or are the small number of cases due to travel/migration?
 * I think it would be good to explicitly state that it's endemic. It's rather surprising since Japan is pretty far away from Africa... Spicy (talk) 04:06, 11 November 2020 (UTC)
 * I did a minimal clarification here. Instead I could change the first sentence of that paragraph to "Buruli ulcer is endemic to four areas...". If you have a strong opinion on the matter I'm happy to follow it. Ajpolino (talk) 04:06, 12 November 2020 (UTC)
 * several animals - pedantic, but do you mean "several animals" or "several species of animals"?
 * In some endemic areas, particularly rural communities in African endemic countries, people are aware of Buruli ulcer's association with the environment, yet simultaneously associate it with witchcraft or other supernatural causes - need to be very careful with how you phrase this. The source says are commonly perceived by the local population as somewhat mysterious ... are often associated with witchcraft or sorcery ... a concept of dual causality is frequently encountered... but the article states this without qualification, leading to the unintentionally racist implication that everyone in those areas believes this. I would imagine that African pathologists don't believe it's caused by witchcraft.
 * While M. ulcerans may have infected humans throughout history, "throughout history" is vague. The 19th and 20th centuries are history too. Can we be more specific - is there any archeological evidence predating the first description of the disease, for example?
 * Cook noted several patients with slow-healing ulcers, consistent with Buruli ulcer - phrasing - he couldn't have noted that they were consistent with Buruli ulcer since the concept of the disease didn't exist at the time. I don't think the second part of the sentence is necessary at all because the preceding and following sentences clearly connect Cook's observation to Buruli ulcer.
 * For much of the modern era - "modern era" is very vague, can we give an approximate date range?
 * "Cu001", isolated from a person in Adzopé, Côte d'Ivoire in 1996; "Mu1615", from a person in Malaysia in the 1960s; and "S1013" from someone in Cameroon in 2010 - we have "A person", "a person", then "someone". This is a little jarring.
 * Might be worthwhile to go into a little more detail about specific antibiotics and vaccine candidates that are being researched.
 * Added a few sentences of extra detail. There's not much written on the topic. Other proposed "vaccine candidates" exist, but haven't advanced to the level where they're being written about or moved into human trials, so I'd prefer not to cover them here. Perhaps they'd merit mention in a Buruli ulcer vaccine article... Ajpolino (talk) 18:34, 13 November 2020 (UTC)
 * Nitpickery is exactly what I'm looking for (though if you see large glaring issues, I'm happy to hear that too)! Thank you very much for the quick response! Will get to these ASAP. Halloween seems like a great day to think about mysterious gaping wounds that will not heal. Ajpolino (talk) 18:11, 31 October 2020 (UTC)


 * Anything on prognosis? What percentage of people develop permanent disability? Does anyone die from the disease or from complications - I would think having a large open wound that is prone to secondary infections would put someone at risk for sepsis? Spicy (talk) 12:40, 1 November 2020 (UTC)
 * Yes, I would think that too, but I can't find much in the way of numbers. Apparently having this giant open wound typically doesn't lead to systemic disease and death: a 2019 review says Buruli ulcer does not kill, but it is an important cause of morbidity because of scarring and fibrosis, my now-declared favorite review (2018) says only [Ulcers could remain small, or grow enormous and cause major disability]. With any course, the patients maintained general good health. The background of the Cochrane review calls out a specific study Vincent 2014a reported that among their 1043 laboratory-confirmed cases of Buruli ulcer in Benin, 229 people (22%) developed permanent functional impairment one year after their treatment, but without seeing other numbers around, I wasn't sure how to contextualize that information in the article... Anyway, will keep an eye out for anything usable... Ajpolino (talk) 23:48, 14 November 2020 (UTC)
 * Might want to archive the web sources so that the content remains verifiable even if the links die.
 * A picture of the bacteria in a tissue section/smear would be helpful. This image is public domain (CDC) but the resolution isn't great. Fig 2. here (CC-BY-4.0) is much clearer, but it's an experimentally induced infection in a mouse model.. not sure if this is as useful as a photomicrograph of a natural infection in a human? Spicy (talk) 20:32, 1 November 2020 (UTC)
 * Fig 2. here is quite nice and also under a compatible license. Spicy (talk) 20:57, 1 November 2020 (UTC)
 * Thank you for moving ahead with this. Again, sorry for being so slow the last two weeks. Ajpolino (talk) 04:10, 12 November 2020 (UTC)
 * Nothing wrong with taking your time. The article is coming along very nicely... I read through it again and made some copyedits. Please review and revert anything you disagree with. Spicy (talk) 20:07, 14 November 2020 (UTC)
 * To your question about the sentence In practice microscopy correctly detects M. ulcerans in just 30–40% of infected people, making it a relatively insensitive diagnostic test.. The source's wording is Microscopic study of smears made from swabs or FNA specimens that have been stained with Ziehl-Neelsen stain (an acid-fast stain), similar to what is used for tuberculosis, is used in many parts of Africa (20). A study in Ghana showed that this technique has a diagnostic sensitivity of 40% for nodules, which decreases to 30% for ulcers (21). I interpreted that to mean that if you had 20 samples, 10 each true positive/negative, the microscopists would have called 3 or 4 of the true positives as positives, and that the sentence gave no information on how they would rule on the true negative samples. So I meant to get across information about false negatives only. But I could be misinterpreting what the source meant. A second review claims When compared with [qPCR] the reported sensitivity rates of direct smear microscopy for the detection of M. ulcerans ranged between 26% and 67%. The efficacy of the detection of small numbers of [bacteria] depends strongly on technical skills of the microscopist and on quality of the microscopic equipment (this last bit raises the obvious question of how anyone could use microscopic equipment!?). I used the numbers from the first review because I've landed on the opinion that it is the best review of the bunch, and so I find its numbers most trustworthy. Anyway, laying all this out because this is more in your wheel house than mine, and I'm happy to hear your thoughts! Ajpolino (talk) 23:17, 14 November 2020 (UTC)
 * Yes, they're talking about false negatives. My problem is that the "correctly detects" wording raises the idea that it could be "incorrectly detected", which implies a false positive result. Maybe I'm overthinking this. But this could be solved by removing the word "correctly". 23:41, 14 November 2020 (UTC)

Pre-FAC notes from SandyGeorgia

 * As noted by Spicy, I would feel OK with removing the first two citations from the lead, but I like to cite hard data (the 3,000 to 5,000), because then we can easily check in the future if those numbers need updating, by mousing over the citation date.
 * Personal preference, your choice, but to my brain, parenthetical inserts cause me to read over the contents as if they are less important. And when reading there are three categories, I want to see first those three categories in each sentence.  I have been accused of having a very linear brain, so ignore me as you wish, but I would do this:
 * A single small (less than five centimeters) ulcer is category I. Larger ulcers (up to 15 centimeters) are category II. Ulcers that are larger, disseminated across the body, or include particularly sensitive sites (such as the eyes, bones, joints, or genitals) are called category III. -->
 * Category I describes a single small ulcer that is less than 5 cm. Category II describes ulcers that are larger and can be up to 15 cm. Category III is for ulcers that are larger, disseminated across the body, or include particularly sensitive sites such as the eyes, bones, joints, or genitals. Should there be an "even" before the larger on Cat III ... that is are they larger than 15 cm?  Take note also of need to convert ... whereever centimetres are first used is where we should use abbr=off, the rest can be on.
 * I would put a parenthetical after cytosol (the liquid found inside cells). I would also do the same for endoplasmic reticulum if I could find a short way to describe that, but not sure that can be done, if so, the wikilink will have to do. Could we put something after neutrophils like (parts of white blood cells)?
 * Is it possible to avoid using the word large twice in same sentence? For example,
 * This results in large-scale tissue death at the site of infection, causing the large open ulcer characteristic of disease.
 * This results in considerable tissue death at the site of infection, causing the large open ulcer characteristic of disease.
 * This leaves me wondering how often it happens and what were the circumstances ... I am imagining an extreme lack of hygiene.
 * Human-to-human transmission is extremely rare,
 * Extreme indeed, though perhaps not in the way you're imagining. The only recorded case of human-to-human transmission was in 2003 from a human bite (not as wild a story as it sounds at first blush. Both the biter and bitee were children playing, paper). Due to this one reported case, some authors call human-to-human transmission very rare. Others dispense with the qualification. The two (in my opinion) finest recent reviews on the topic for example state there has been no documentation of human-to-human transmission, and thus BU is not considered a contagious disease, and There is no evidence to support the possibility of human-to-human transmission of BU. . Now that I'm looking back at those two reviews, I've half a mind to switch to their wording... Thoughts? Ajpolino (talk) 00:33, 1 November 2020 (UTC)
 * I like the idea of including the bite incident ... but whatever you think best to remove the question for potential FAC reviewers. Put the bite incient as a footnote and switch to better review wording ?? Sandy Georgia (Talk)  00:55, 1 November 2020 (UTC)
 * After reading back through everything, it seems the higher quality reviews do not qualify their rejection of human-to-human transmission. Perhaps they have some reason for not believing the old case report? I think I'll defer to their expertise and use the harder wording that they did. Ajpolino (talk) 00:57, 15 November 2020 (UTC)
 * A lot of use of the word "long" in this para, can another word be used for "long" here ?
 * A role for biting insects in transmission has long been investigated,
 * Both of these are already linked in the lead, but only one is re-linked here ... I suggest this far into the article it is OK to relink both:
 * The most widely used antibiotic regimen is rifampicin plus twice daily oral clarithromycin,
 * A lot of this is total nit-picking, your choice ...
 * A 2018 Cochrane review suggested that the many antibiotic combinations being used are effective treatments, but there is insufficient evidence to determine if any combination is more effective than the others. -->
 * A 2018 Cochrane review suggested that while the antibiotic combinations used are effective, there is insufficient evidence to determine if any combination is the most effective.
 * Alt text would be helpful on images, but with out with COVID-19, I am not sure who might help.  Sandy Georgia  (Talk)  17:19, 31 October 2020 (UTC)
 * I do remember that post, but cannot find it where I expected to ... perhaps ... https://webaim.org/techniques/alttext/ Sandy Georgia (Talk)  01:31, 2 November 2020 (UTC)

That's it ... a whole lot of this is trivial. I won't ping in anyone else until you've had time to deal with comments from Spicy and me. Or would you prefer to put a call at WT:MED yourself? If so, remember to ping Casliber, Graham Beards, Colin, Jfdwolff, WhatamIdoing ... anyone else familiar with FA standards? Once all the med people are through, there are several non-med editors I can ping in for a non-med jargon review before you head to FAC. Bst, Sandy Georgia (Talk)  17:39, 31 October 2020 (UTC)
 * Could this bunch of text be moved up to after the first sentence in the paragraph, and then start a new paragraph with "Cases are concentrated ... "?
 * Globally, most countries do not report data on Buruli ulcer to the World Health Organization, and the extent of Buruli ulcer's spread is unknown.[33][28] Even in countries that do report Buruli ulcer, health systems likely do not record each case due to insufficient reach and resources, and so the reported case numbers are likely underestimates of the true disease prevalence.[34]
 * OK, here's something that is more substantial than my other nitpicks, and figuring out how to address could be difficult. There are 32 uses of the word "cases" in the article.  See Manual of Style/Medicine-related articles.  Some of these need to varied, and creative writing skills will be needed (that means someone other than moi :) Some, though, can be easily fixed:
 * Buruli ulcer cases tend to occur in rural areas near slow-moving or stagnant water. -->
 * Buruli ulcer tends to occur in rural areas near slow-moving or stagnant water..
 * In particular, cases tend to appear near water that has experienced human intervention, such as the building of dams or irrigation systems, flooding, or deforestation.
 * In particular, the disease tends to appear near water that has experienced human intervention, such as the building of dams or irrigation systems, flooding, or deforestation.
 * From or in??? have been described from koalas,
 * Redundancy?
 * In some endemic areas, particularly rural communities in African endemic countries, people are aware of Buruli ulcer's association ...
 * In some endemic areas, particularly rural communities in Africa, people are typically aware of Buruli ulcer's association ...
 * I was surprised to find this at the end of article ... could it/should it be mentioned earlier? It leaves me confused based on the countries where it occurs, so can more detail be given?
 * Since M. ulcerans can only grow in relatively cool temperatures,
 * Murine hosts needs link or explanation.
 * It is probably time now to ask to have a look; there are a lot of non-med editors I can ping in after they have had their say.  Sandy Georgia  (Talk)  23:10, 6 November 2020 (UTC)


 * There, M. ulcerans positive lesions have been described in koalas --> There, M. ulcerans-positive lesions have been described in koalas ... with a hyphen ??? Sandy Georgia  (Talk)  01:13, 15 November 2020 (UTC)
 * That seems right. Much like "Buruli ulcer-like" just above. Hyphen added. Good catch. Ajpolino (talk) 02:24, 15 November 2020 (UTC)

Images
I hadn't thought much about the images as I was working on the text. Now that I do, I'm not sure I've picked a batch that represent the disease well. Today I added images of early signs (lumps and bumps) and images of ulcers. My question for both of you (and anyone else watching)... have I overdone it? Since the pre-ulcer and ulcer can have many different forms, I'd like to illustrate that. But I get that it's not Wikipicturebooks. Thoughts? Ajpolino (talk) 21:55, 1 November 2020 (UTC)
 * Oh wait, I have an idea. Please hold. Ajpolino (talk) 21:56, 1 November 2020 (UTC)
 * Ok, how about that instead? I swapped the composite ulcer image into the lead, kicking out the ankle image. Is that better? Ajpolino (talk) 21:59, 1 November 2020 (UTC)
 * Yikes. Yep, that does the job.  hard to believe it is not painful! Sandy Georgia  (Talk)  22:20, 1 November 2020 (UTC)
 * Does it continue to be painless, once it reaches the open-ulcer stage?
 * @Ajpolino, another option for the images is to use a proper gallery. Compare-and-contrast uses are uncommon but officially allowed, and it would let you use larger images. WhatamIdoing (talk) 03:11, 11 November 2020 (UTC)
 * I'm not convinced this use would meet WP:GALLERY. But you can try to get it through FAC if you want ... but GALLERY is a policy page, not just a guideline. Sandy Georgia  (Talk)  03:23, 11 November 2020 (UTC)
 * I think this fits under "A gallery section may be appropriate in some Wikipedia articles if a collection of images can illustrate aspects of a subject that cannot be easily or adequately described by text or individual images....avoiding similar or repetitive images, unless a point of contrast or comparison is being made." If this doesn't pass the 'letter of the law', then having a single collage image doesn't, either.   WhatamIdoing (talk) 03:30, 11 November 2020 (UTC)
 * Good point ;) Sandy Georgia (Talk)  03:31, 11 November 2020 (UTC)
 * @WAID, unsettlingly enough, even the large open ulcers are painless. As an example, the leg ulcer in the lead collage is from this paper. The image caption notes On the picture, the lesion of a Nigerian 10 years old child on the right thigh and with the typical characteristic of a late stage of the disease: large painless ulceration with presence of necrosis and undermined edges.. As far as adding images, if the collages are ok, then I think I'm happy. If not, perhaps a gallery to show the different categories of ulcer and different early disease presentations would be appropriate. Ajpolino (talk) 04:02, 11 November 2020 (UTC)

Molecular biology, huh, what is it good for
Per the suggestions above, I tried several times to reword and clarify the part of the causes section with the molecular biology explanation for mycolactone's effect. After several unsuccessful attempts, I decided the problem may be that I'm writing for two totally different audiences there. I cut the molecular detail, since I suppose (agh! Pains me to say!) most people don't care. That said I care how mycolactone works. As an act of protest, I left the molecular explanation in a footnote. Eventually I plan to clean up the article mycolactone which would obviously hold a more detailed explanation. But... what do you think of this compromise? Better? Or am I just moving bad text around... Ajpolino (talk) 04:09, 9 November 2020 (UTC)
 * I don't think taking it out of the prose entirely is the right way to go. Some information on molecular biology seems warranted. People who are better writers than I might be able to give you some ideas on how to rephrase it... Spicy (talk) 17:28, 9 November 2020 (UTC)

Digging in (ps, I am useless on images and alt text): What you had:

What is left:

Several points: In either case, I think we have to accept that sometimes not every one can get every section. Bst, Sandy Georgia (Talk)  17:49, 9 November 2020 (UTC)
 * Different sections will have differing reading levels, and Causes is where we expect for things to get difficult; we don't have to keep EVERY section at a lower reading level. Dummies like me read this paragraph (only had high school biology well before AP existed), don't understand most of it, but get the general gist of what is going on anyway.
 * My only concern was that I couldn't figure out what the endoplasmic reticulum was (so as to add a short parenthetical) because that article didn't give me a short parenthetical ... that was the only part that hung me up.
 * Would a change like this work?
 * which diffuses into host cells and blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum. When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis. -->
 * which diffuses into host cells and blocks the action of the core translocation protein Sec61. When Sec61 is blocked, these proteins are translated into the cytosol rather than the endoplasmic reticulum, causing a pathological stress response that results in cell death by apoptosis.
 * If you do that, I don't need to know what the endoplasmic reticulum is ... I get that the stuff is going the wrong way.


 * Hmmm ok it seems I've over-corrected. Sorry for that; thanks both for the suggestions. I gave it another tweak, swapping out a few jargon words but mostly keeping it as it was before. Is it any easier to understand now? Ajpolino (talk) 01:26, 10 November 2020 (UTC)
 * I get the gist of it even though I have no idea what it is saying. This may be a sticking point at FAC, and you may just have to say that’s the best we can do.  Sandy Georgia  (Talk)  01:41, 10 November 2020 (UTC)
 * I'm not convinced it's an unfixably complex idea. I may just be too close to it to see clearer ways of expressing it. If you'll permit me a somewhat long and rambly explanation, perhaps we'll be on the same page and you (or someone) will think of a better way to phrase things?
 * Basically, cells communicate by secreting proteins into the area around them. Different proteins need to be secreted at different times and to different destinations, so it's all a logistics/sorting problem for the cell. To deal with this sorting problem our cells have developed a charming group of organelles that we collectively call the "secretory system". The first stop on the secretory system is the endoplasmic reticulum (affectionately, "the ER"). Proteins destined for secretion are produced (translated) directly into the ER. They then begin their merry journey through the secretory system, visiting the Golgi, various vesicles, and arriving at some destinations some time later. Sec61 is the doorway to the ER, and the target of mycolactone. Blocked Sec61 means no secreting proteins, which means no communicating with other cells (hence, no immune cells in the ulcers). Stuff that ought to go into the ER instead gets piled up outside it (in the cytosol). The accumulated junk makes the cell freak out and push the self-destruct button (apoptosis)... Put another way, if cells used the US Postal Service, the ER would be the blue box on the street corner (the Golgi would be the distribution center on the edge of town) and Sec61 would be the flap on the box that you push your mail through.
 * Either way, I'll keep thinking about it. All suggestions welcome. But if this is the best we can do, I suppose that's alright too. Thanks again for your time and suggestions Sandy and Spicy! Sorry I've been a bit slow to get to them! Ajpolino (talk) 02:04, 10 November 2020 (UTC)
 * All of that is what I get ... but I still don’t know what the endoplasmic reticulum is, in six words or less. Sandy Georgia (Talk)  02:08, 10 November 2020 (UTC)
 * PS, I see how fascinating the study of this stuff must be, but I don’t know how you sleep at night !! Sandy Georgia (Talk)  02:16, 10 November 2020 (UTC)
 * The endoplasmic reticulum is basically a tube that the protein/mail goes through on its way to its destination. A mid-century Pneumatic tube system might be a clearer analogy than a postal box on the street corner.  You create the protein/mail and put what you made straight in the tubes.  The system makes sure that your protein/mail gets routed to the correct destination. WhatamIdoing (talk) 03:26, 11 November 2020 (UTC)
 * We need a short parenthetical ... like six or eight words. Sandy Georgia (Talk)  03:28, 11 November 2020 (UTC)
 * Maybe something like "pathway for moving proteins out of the cell" would work. WhatamIdoing (talk) 03:32, 11 November 2020 (UTC)

Images 2
this article is getting very close to FAC ready; when you have time, could I interest you in reviewing the images? Regards, Sandy Georgia (Talk)  18:14, 10 November 2020 (UTC)
 * The images are all appropriately licensed. However, I am concerned about the accessibility of File:Buruli_ulcer_cases_2018.svg - it's difficult to distinguish which country is meant to be what shade. Nikkimaria (talk) 22:28, 10 November 2020 (UTC)
 * Ajpolino, I think this can be addressed by simply adding the country names for each color grouping to the caption ... that allows visually impaired to get the information without seeing the colors. Sandy Georgia  (Talk)  22:20, 11 November 2020 (UTC)
 * Forgive me, I don't have a good eye for this kind of thing. Is this color scheme any better? Either way, I can add the country names to the caption as well (or to the alt-text? That would be unusually long alt-text; so, perhaps the caption is best after all?). Ajpolino (talk) 01:21, 15 November 2020 (UTC)
 * that's definitely better than it was, but I would suggest adding the data in the caption as well. Nikkimaria (talk) 01:23, 15 November 2020 (UTC)
 * Done. Thanks for taking the time to look through the images! Ajpolino (talk) 02:21, 15 November 2020 (UTC)

Semi-arbitrary break for reading ease
Hi all, thank you for the comments. I think I've addressed everything above? If there's something you're still waiting for me to respond to, or you wanted to follow-up on something, please let me know. Otherwise, I can try reaching out to a few others to get their opinions? I'm in no big rush here. Thanks again! Ajpolino (talk) 20:28, 16 November 2020 (UTC)
 * what would you think of me now calling in a non-medical FA regular and asking only for a brief, is it lay-reader-friendly-only review? Once that is done, I think you're ready ... we have overthought this one to death :) Sandy Georgia  (Talk)  21:59, 16 November 2020 (UTC)
 * That would be great! Thank you. Ajpolino (talk) 22:00, 16 November 2020 (UTC)
 * Done ... and a reminder to you of all of the notes I gave Spicy for when you approach FAC. No "done" checkmarks.  I know there's no chance of you being combative with reviewers :0  And remember that it is very hard to entice reviewers, so keep responses as brief as possible to avoid overwhelming the FAC, and be sure to put up a catchy introductory blurb that will entice others to read ... mention that you've had medical and non-medical review, as well as image review.  As soon as you post the FAC, I will mention that I've checked that the sources are MEDRS-compliant, but have not done a copyvio check (and will make a joke that it's not needed since you work at CCI :)  Sandy Georgia  (Talk)  22:11, 16 November 2020 (UTC)

A layman's look
Okay, so these are liable to be a bit rough on the medical side, so please bear with me. I don't believe I've ever collaborated on a review with you before, so I'll go ahead and give a disclaimer that I tend to throw a lot of stuff out with an eye for discussion about smaller points, not that I'm trying to nitpick something to death.


 * "The World Health Organization receives between 3,000 and 5,000 reports of Buruli ulcer each year" - This to me almost asks for an "As of, ..." here
 * Hmmm the reference I cite is published in 2019 (Buruli ulcer has been reported in 33 countries, with 3000-5000 patients reported yearly [ref].) and itself cites a 2018 review that reprints the WHO data since 2002 (going back in time from 2018 to 2002, the annual case numbers are 2708, 2217, 1952, 2043, 2242, 2627, 3213, 4006, 4906, 5082, 5148, 5033, 5376, 4746, 4937, 3346, and 3245). So to say "As of 2019... 3,000 to 5,000... each year" doesn't seem quite right since I think the review author was trying to give some stable range that totals tend to fall within (though of course we can see some of the values fall outside that range). We could say "In 2018, the World Health Organization received 2708 reports of Buruli ulcer". Or be more explicit in mentioning that total report numbers vary but tend to be between 3,000 and 5,000. Or add a "typically" between "Organization and receives". Does one of those (or a different) options strike you as most accurate and interesting to read? Ajpolino (talk) 04:43, 17 November 2020 (UTC)
 * With that circumstance, I can see why the as of wouldn't really work. Personally, I think the "typically" addition would help quite a bit
 * Done. Ajpolino (talk) 17:47, 17 November 2020 (UTC)
 * It is still kind of begging for a time frame though ... how about something like ... As of 2018, the World Health Organization has typically received between 3,000 and 5,000 reports of Buruli ulcer each year since 2002. Sandy Georgia (Talk)  20:06, 17 November 2020 (UTC)
 * My personal preference is to leave it as is and let folks mouse over the reference to find out that the statement is a generality sourced to 2019. As a close second, I like the more specific wording of something like "In 2018, the World Health Organization received 2708 reports of Buruli ulcer." It's still informative and is quick to read. Ajpolino (talk) 02:04, 18 November 2020 (UTC)
 * After giving it another read, I think I prefer the 2018 number only. 7/17 of the year tallies we have are in the 3-5k range. 10/17 are outside that range. So I'm not sure that's the best range to hang our hats on anyway. Ajpolino (talk) 02:06, 18 November 2020 (UTC)
 * "Buruli ulcer occurs in rural areas near slow-moving or stagnant water. Most cases are in sub-Saharan Africa and Australia with fewer in Japan and South America" - To me, it almost seems better to put the geographic area before the rural. At least to my mind, it's Africa/Australia/Japan/South America that it's more endemic to, not just rural areas inherently.  I'm from rural Missouri, and Buruli ulcer isn't an issue there
 * Ah great point, order swapped. Ajpolino (talk) 04:43, 17 November 2020 (UTC)
 * Do we need the infobox cites for symptoms/causes/treatments
 * Removed. Ajpolino (talk) 04:43, 17 November 2020 (UTC)
 * Link DNA at the first mention, not the second
 * Good catch. Ajpolino (talk) 04:43, 17 November 2020 (UTC)
 * Is For microscopy, ulcer material is typically taken by fine-needle aspiration or swabbing the edge of the ulcer, then stained with the Ziehl-Neelsen stain which makes mycobacteria visible.[18] In practice microscopy correctly detects M. ulcerans in just 30–40% of infected people, making it a relatively insensitive diagnostic test and An additional method of diagnosis is microscopic examination of ulcer tissue. However, this requires more invasive sampling and review by a trained pathologist, so it is rarely used in places where Buruli ulcer is endemic. refer to the same practice? If so, maybe put them next to each other?  It seems to me like these are the same thing, but I'm also not medically inclined
 * Unclear wording on my part. They're intended to represent different things. In the first case, someone is sucking liquid out of the wound and looking for bacteria in it. In the second, someone is cutting a sample of flesh out of the wound and then examining it. The former is very common; the latter is uncommon in low-resource areas. I've taken a crack at rewording. Any better? Ajpolino (talk) 04:54, 17 November 2020 (UTC)
 * I, at least, think the new wording is a lot clearer
 * This is probably a very stupid question, but does onchocerciasis (in Africa) indicate that it only looks like onchocerciasis in Africa? Or is onchocerciasis something that is only common in Africa, so the comparison is only really relevant in Africa?
 * Not at all stupid. The latter is meant. I've cut the parenthetical, since it's probably more likely to confuse a reader than inform. Ajpolino (talk) 04:54, 17 November 2020 (UTC)
 * Presence of the disease in Papua New Guinea is mentioned in the map and the names section, but is not mentioned in the epidemiology section. Seems to me that maybe it should be
 * Oops. Sadly I can find almost no information on the cases in Papua New Guinea, so I've added a sentence just describing the national case numbers, and rephrased the lists elsewhere to include PNG. My apologies to PNG for the oversight. Ajpolino (talk) 05:31, 17 November 2020 (UTC)
 * "In South America, most Buruli ulcer is reported from French Guiana, with few cases described in surrounding countries.[34] A 2019 review found "strong" evidence for the presence of Buruli ulcer in French Guiana and Peru, and "moderate" evidence in Brazil, Mexico and Suriname" - Maybe the source classifies Mexico as South America, but that's not a classification I see often
 * Changed to "the Americas" in the section and lead. Ajpolino (talk) 05:31, 17 November 2020 (UTC)
 * Is possum the formal common name for those critters? Where I'm from, the spelling possum is unencyclopedic slang, but it's also referring to a different animal, so maybe it's the proper name for the ringtail possum.
 * These are indeed true "possum"s. I too am only personally familiar with its American cousin. Both decidedly strange animals. Ajpolino (talk) 05:47, 17 November 2020 (UTC)
 * Link neglected tropical disease in the body?
 * Done. Ajpolino (talk) 05:47, 17 November 2020 (UTC)

Okay, so I think that's all I see. Hog Farm Bacon 03:05, 17 November 2020 (UTC)
 * Thank you very much for taking the time to read through. If you don't mind, I'll reply inline to your points above. If that seems messy for you, let me know and I'll happily refactor things back out. Ajpolino (talk) 04:22, 17 November 2020 (UTC)
 * Gave a first response to each. Happy to hear your further thoughts on any. Thank you again for taking the time. As an aside, I was thrilled to see your recent updates to Battle of Pilot Knob and Fort Davidson. My +1 and I were finally going to see Taum Sauk a few weeks ago and had to pull over in Pilot Knob when the dog lost his breakfast in the back seat. The park is quite nice. A lovely walk, a sobering monument, and a public trash can for disposing of dog vomit. Next trip I'll reach out to see if we can take any useful pictures for you. Ajpolino (talk) 05:47, 17 November 2020 (UTC)
 * Okay, so I really like the changes made. Personally, I'd support this at an FAC, but I also know little about the subject matter, and my vote probably wouldn't be weighted too heavily at FAC.  As to Fort Davidson, I rewrote a good chunk of that late at night while quarantined, so the GAN has flagged an embarrassing number of issues. Hog Farm Bacon 17:05, 17 November 2020 (UTC)
 * Hog Farm, part of my devious plot to haul you in here where I usually call on Ceoil is to show more editors that they need not be scared off of reviewing medical FACs ... it wasn’t that bad after all ;) Thank you ever so much! Sandy Georgia  (Talk)  17:09, 17 November 2020 (UTC)
 * Thank you Hog Farm. Your comments are much appreciated, and an outsider's view is always immensely valuable. Ajpolino (talk) 17:47, 17 November 2020 (UTC)

Editnotice
As this article has been promoted to FA (congratulations Ajpolino!) I've created the editnotice at Template:Editnotices/Page/Buruli ulcer. Spicy (talk) 07:48, 30 December 2020 (UTC)
 * You mean I woke up in the middle of the night for nothing? . Thanks, Spicy, and congratulations to Ajpolino and all who helped! Sandy Georgia  (Talk)  07:55, 30 December 2020 (UTC)
 * Well, I didn't know that page existed until now, so rest assured your work is not in vain... :p Spicy (talk) 08:00, 30 December 2020 (UTC)
 * Thank you both for your commentary and guidance. The article wouldn't have made it across the FAC line without you both. Here's to many more overhauled articles and trips to FAC. Cheers! Ajpolino (talk) 08:08, 30 December 2020 (UTC)

Rethink the caption or image about Albert R. Cook
So that image is so, so problematic -- in that it includes a white man, who (assuming) forced a bunch of youth to stand around him. It definitely profiles his very colonial, missionary relationship to the local community -- however the caption doesn't critically engage with those issues -- and its rather unexpected as you read the article, and reinforces a "white non-African saviour to the rescue" kindof narrative in the history section. Could there be some other way to illustrate or engage with that section? Is there really not any description of African or Australian indigenous medicine or story telling about the topic? That whole section feels off with the way the image is contextualizing. Sadads (talk) 12:33, 24 March 2021 (UTC)
 * Yes I'm not crazy about the image either. Besides looking like it should be a hit on Google Images for "Colonialism", I don't think it's particularly informative to a reader. As far as replacements, Commons has this similar and just slightly less problematic image. But after a brief search, I haven't come up with anything too clever to take its place. Cook's original notes are digitized, but none of his sketches is particularly clear. I'd prefer an image that relates to the WHO Global Buruli Ulcer Initiative, but haven't found anything visually interesting. We could just chop this image, and instead add an image to "Research" (though then we might have two images of small mammals with ulcers). I had wanted to add this image which is appropriately licensed and shows a community health worker discussing BU in Benin, but couldn't decide where to slot it.
 * To your second question, there's almost certainly loads of indigenous medicine and story-telling on the topic, but sadly little of it has been catalogued. The first paragraph in the "Society and culture" section is basically all I could find. I tried to avoid having the text lionize white colonialists or disparage local understandings. If there's particular text that concerns you, I'm more than happy to address it. Ajpolino (talk) 15:07, 24 March 2021 (UTC)