The Unknown Flesh-Eating Disease in Nigeria’s Adamawa 

Abubakar Ibrahim woke one morning in June to find his leg swelling. By nightfall, the entire limb was ballooned and throbbing, leaving the 30-year-old terrified.

“I took some drugs to reduce the swelling, but my legs continued to swell,” said the indigene of Malabu in Adamawa State, northeastern Nigeria.

Within weeks, rashes had turned to sores, and he realised he was facing the same mysterious flesh-eating disease that had already struck his elder brother and neighbours. 

Like many others in Malabu, he assumed the disease was a flesh infection treatable with antibiotics and bandages. He went to the primary healthcare centre in the community, where the sores were cleaned and dressed. He started to recover, describing his situation as mild, compared to others like his brother, who had their flesh falling out. 

While some residents sought help at the primary healthcare centre, others resorted to traditional herbs. Over time, Abubakar noticed the situation worsening across the community. The disease spread faster, and those affected often died within two weeks of their first symptoms. People complained of intense pain, sleepless nights, and a foul odour from the infected wounds.

An outbreak 

HumAngle learnt that the first suspected case of the disease was reported at the Malabu Primary Healthcare Centre (PHC) in 2018, when a man developed swelling in his hand. Within months, rashes formed, then blisters, which turned into sores. His flesh eventually tore away until the bones became visible. He died.

“We never thought it was something that would come to affect some of us,” Abubakar said.

Soon after the man’s death, a few residents began to experience similar symptoms, starting with swelling in either their hands or legs. Many relied on the PHC for wound cleaning and dressing, which offered some relief. But as new cases appeared, conditions deteriorated. 

Residents say that a few people continued to exhibit the symptoms over time, but not in large numbers, until the recent mass outbreak in June this year, and it spread rapidly in the following month. No fewer than 67 persons have contracted the disease since the recent outbreak, according to Alhaji Sajo, a community leader, with eight deaths recorded so far.

Although adult men have been the most affected, residents told HumAngle that children have not been spared, unlike during previous outbreaks. 

“Most of the children that are currently affected are around the age of seven and above,” Abubakar stated. He added that the situation for children is worse. Unlike adults, who mostly get infected in their hands and legs, Abubakar explained that the affected children have sores covering part of their faces that continue to spread and eat into their faces. 

To contain the spread of the disease, the local health authorities identified about 28 critical cases in Malabu and have since transferred eight of the affected persons to the Multi Drug Resistance (MDR) ward at the Modibbo Adama University Teaching Hospital (MAUTH) in Yola, the state capital, while the other 20 declined. 

Residents told HumAngle that histology tests have been conducted by the National Centre for Disease Control (NCDC). “They said our samples would be taken for testing in laboratories […], according to them, the disease is not cancer,” Abubakar said, adding that Malabu residents have remained restless. “We need to figure out the cause of the disease and how it can be treated.”

Dr. Dahiru Ribadu, the chairperson of the Medical Advisory Committee at MAUTH, said the patients are undergoing treatment under close observation. 

“We are taking care of them the best way we can, and they don’t pay for the drugs or meals because it’s being covered by the local government,” he told HumAngle, adding that even though the disease remains unnamed, admitted patients are responding well to treatment.

Abubakar’s elder brother was among those admitted, but he died days later. While he describes his brother’s case as critical, Abubakar has accepted fate and now tends to his own wounds at home. His greatest concern, he says, is to finally know what this disease is and how it can be stopped.

Non-contagious?

At the hospital, frontline staff are also grappling with uncertainty. Mary Jacob, the nursing officer in charge of the MDR ward at MAUTH, told HumAngle that the patients were brought in on Sept. 4. “There is no diagnosis. We are waiting for the investigation,” she said, noting that the hospital cannot give a proper account of the ailment so far, as it’s a rare one. 

The nurse suggested that the disease might be non-contagious, since many relatives caring for patients remain unaffected. However, she warned that it could spread through open wounds.

“If someone has the disease and there is another person who has a cut on their skin and they touch them, then it can be transmitted through the cut,” she said. Mary noted that one of their biggest challenges at the MDR ward is managing the deep wounds, which require large amounts of bandages and gloves every day.

While the hospital can only manage symptoms, state health officials say they are working with national authorities to uncover the cause. Felix Tangwami, the state Commissioner for Health and Human Services, suggested that the disease might be Buruli ulcer. Tangwami stressed that, while they await official results from the National Reference Laboratory, the state government, in collaboration with the Federal Ministry of Health, is taking steps to curb the spread.

Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans, a bacterium from the same family that causes tuberculosis and leprosy. It often begins as painless swelling or nodules on the skin, which later break down into large ulcers that can expose bones and lead to severe disability if untreated. 

The World Health Organisation has documented thousands of cases, mainly in West and Central Africa, with outbreaks reported in countries including Nigeria. 

This wider pattern underscores why health officials in Adamawa are racing to confirm whether the Malabu outbreak is linked to Buruli ulcer. After the first samples were collected, Abubakar said that some NCDC officials returned three days later to take new swabs in Malabu. “They made provisions for some drugs and items for wound dressing at the PHC,” he said. 

In the meantime, residents are left anxious. 

“I want people to know that this disease is not just currently in Malabu alone, even though it started here. At the moment, other communities around Malabu have started recording cases, which means the disease is spreading,” Abubakar added. 

HumAngle reached out to the NCDC for details on the state of its investigation, but is yet to receive a response at the time of filing this report.