Ultra-short-course and intermittent TB47-containing oral regimens produce stable cure against Buruli ulcer in a murine model and prevent the emergence of resistance for

Buruli ulcer (BU), caused by

Subchronic Toxicity Study of the Extract of Sacoglottis gabonensis (Baille) Urban (Humiriaceae) in Wistar Rats

Introduction:Sacoglottis gabonensis (Baille) Urban (Humiriaceae) is a medicinal plant used in the treatment of Buruli ulcer in Ivory Coast. To ensure its effect over along period of use, the subchronic toxicity of the total aqueous extract of S. gabonensisstem bark (ETASg) in rats was evaluated.Methods:80 rats were homogeneously distributed in 4 lots of 20 rats each, including 10 males and 10 females. ETASg was administered daily orally for 90 days for 2 mL/100 g body weight (b.w.) rats at doses of 3.5; 35 and 350 mg/kg b.w. The control group received distilled water. A venous blood sample is taken every 30 days for 90 days to determine serum biochemical parameters Results:The study showed that ETASg did not influence serum biochemical markers at the therapeutic dose of 3.5 mg/kg b. w. significant increases in ASAT serum activity, ALT, PAL, and LDH in rats tested at 35 and 350 mg/kg b. w. was found on the 60th and 90th days. Administration of ETASg did not affect most of the metabolites and electrolytes studied at doses of 3.5; 35 and 350 mg/kg b. w. After 30 days of discontinuing oral administration of ETASg, the increase observed at the 350 mg/kg b. w. is moderate and reversible.Conclusion:This study revealed that ETASg is nontoxic for biochemical parameters, at doses of 3.5; 35 and 350 mg/kg b. w. during 90 days of administration in rats

Clonality of Mycobacterium ulcerans by Using VNTR-MIRU Typing in Ivory Coast (Côte d’Ivoire), West Africa.

Background: Buruli ulcer (BU) is neglected skin disease caused by Mycobacterium ulcerans. The lack of early diagnosis and treatment causes severe disability. In Central and in West Africa, BU is endemic and its control is difficult because the most cases occur in rural regions. The molecular particularity of M. ulcerans was the acquisition of the virulence plasmid pMUM001. Genetic analyses have demonstrated the high diversity with variable number tandem repeats (VNTR) and Mycobacterial Interspersed Repetitive Units (MIRU) in M. ulcerans and in mycolactone producing Mycobacteria (MPMs) Objective: The objective of this study was to investigate the molecular diversity by using MIRUVNTR method in clinical samples of BU patients in Côte d’Ivoire. Study Design: 21 clinical samples were collected from BU patients in different sites and were first analyzed in molecular diagnosis of BU using two targets insertion sequence IS2404 and keto reductase-B-domain (KR). In a second step, we have analyzed the strains by PCR typing for four specific and sensitive markers MIRU1, VNTR6, ST-1 and VNTR19. Results and Conclusion: 100% of clinical samples were positive in molecular tests for IS2404 and 95% for KR and confirm M. ulcerans in the samples. By PCR typing, we have found 61.9 % positive for MIRU1 and 52%, 85.7%, and 61.9% for VNTR6, ST-1 and VNTR19 respectively. One of sample was negative for all genotyping markers. Two different genetic profiles were identified by MIRU1 and ST-1 loci by gel-analyzed of the amplified products. The VNTR profile C (3,1,1) corresponding of 3 copies MIRU1, 1 copy VNTR6 and 1 copy ST-1 was detected in 28.5% of samples and confirms the West African genotype in Côte d’Ivoire. Different genetic strains of M. ulcerans were co-circulated in the same endemic region in the country. This study has described first the circulating of different genetic strains of M. ulcerans in Côte d’Ivoire.

Health-Related Quality of Life of Adult Patients Healed from Buruli Ulcer in Benin.

Background: The implementation of the antimicrobial therapy greatly improved Buruli Ulcer (BU) care. Nevertheless, the disease still imposes significant burden. In rural endemic areas, many patients are being healed from the disease with disabling sequels. They are living without social assistance in a context of poverty. Various researches have evaluated the therapeutic modalities that are used to control the BU disease, but any study on the quality of life (QOL) of the patients healed from BU has been reported. Methodology/Principal Findings: A total of 105 patients healed from Buruli ulcer and, 105 control subjects without Buruli ulcer history are enrolled in the study after giving well-informed consent. The Medical Outcome Study Short Form (SF-36) is administrated to access their QOL. The study is approved by the Ethical committee of the Faculty of Health Sciences of the University of Abomey-Calavi (UAC). All the patients have a weak QOL than control subjects. The deterioration affects their physical functioning, their physical role, their emotional role and their mental health (p<0.05). However, in spite of their low QOL, subjects aged from 40 years old and over (p = 0.003), and subjects married, divorced or widowed (p = 0.01) work physically better than the other subgroups, even if they are mentally weaker. In a Spearman correlation test, we have observed significant relationships of socio-economic variable with the decrease of SF-36 subscale values. Conclusion/Significance: BU patients are healed in a long-term physically and psychologically marked by the sequels induced by the disease. The results of the present study suggest that interventions and supports are needed to improve the QOL of these patients.

Buruli Ulcer Disability in Ghana: The Problems and Solutions.

Buruli ulcer (BU) is a tropical disease caused by Mycobacterium ulcerans (M. ulcerans) but with “unknown” means of transmission. In order to help reduce this disease, many preventive and treatment measures have been recommended and used in the past years around the globe. This aims to review BU disability problems, prevention and treatment procedures used in Ghana. The review was done by soliciting information from literatures, published articles, news reports and presentations on Buruli ulcer disability prevention and treatment in Ghana. BU disease results in disabilities such as contractures, amputation of the arms and legs, loss of eyes and eyelids and loss of nose among others. Antimicrobial therapies, prevention of deformities and surgical interventions have been the main treatment options for BU in Ghana. Prevention of disabilities caused by BU can be achieved by early detection, treatment of the disease supported by intensive health education programs within the prone areas and empowerment of patients through small-scale welfare grants.

Buruli Ulcer in the Proximal Right Thigh and Groin: A Case Report

We report a case of histopathologically proven Buruli ulcer (BU) in a 25-year-old man which was found at the proximal right thigh and groin – an unusual site of occurrence. Laboratory results including Gram and ZN stains were negative while a culture on Lowenstein Jensen media at 33oC from the tissues produced a positive growth of Mycobacterium ulcerans. Histology of the edges of the ulcer showed a granulomatous lesion consistent with BU. This highlights the differentiation of Buruli ulcer from tropical ulcer and, to a lesser extent other forms of skin malignancies and benign skin lesions. The ulcer presented by the young man was Buruli ulcer.

A disseminated case of Buruli ulcer at Macenta in the forest region of Guinea in West Africa

The author report a confirmed case of Buruli ulcer at Macenta in the forest region of Guinea in West Africa. An 8 years old girl came to the general hospital of Macenta located in the forest region of Guinea at 800km south-west of Conakry. Her story reveals that she used to swim in the local river of Man region in Ivory Coast. There is no notion of trauma or insect bite .The disease started 2 years ago by a nodule of the skin in her right leg which had ulcerated; she received various traditional treatments.

Úlcera de Buruli / Buruli ulcer

A úlcera de Buruli, uma doença infecciosa causada pela Mycobacterium ulcerans (M. ulcerans),é a terceira micobacteriose em ocorrência, após a hanseníase e a tuberculose. Essa micobacteriose atípica tem sido relatada em mais de 30 países, principalmente, nos que têm climas tropicais e subtropicais, mas a sua epidemiologia permanece obscura. Recentemente, os primeiros casos autóctones do Brasil foram relatados, fazendo com que dermatologistas brasileiros estejam atentos a esse diagnóstico. O quadro clínico varia: nódulos, áreas de edema, placas, mas a manifestação mais típica é uma grande úlcera, que ocorre, em geral, nas pernas ou nos braços. Apesar do amplo conhecimento quanto ao seu quadro clínico em países endêmicos, nas outras áreas, esse diagnóstico pode passar despercebido. Assim, médicos devem ser orientados quanto à úlcera de Buruli, pois o diagnóstico precoce, o tratamento específico e a introdução de cuidados na prevenção de incapacidades são essenciais para uma boa evolução.

Buruli ulcer, an infectious disease caused by Mycobacterium ulcerans, is the third most prevalent mycobacteriosis, after tuberculosis and leprosy. This atypical mycobacteriosis has been reported in over 30 countries, mainly those with tropical and subtropical climates, but its epidemiology remains unclear. The first autochthonous cases of infection in Brazil have recently been described, making this diagnosis important for Brazilian dermatologists. Clinical manifestations vary from nodules, areas of edema, and plaques, but the most typical presentation is a large ulcer, usually in the limbs. Despite considerable knowledge about its clinical manifestations in some endemic countries, in other areas the diagnosis may be overlooked. Therefore, physicians should be educated about Buruli ulcer, since early diagnosis and treatment, including measures to prevent disability, are essential for a good outcome.

Búsqueda de úlcera de Buruli en el Urabá Chocoano y Antioqueño, Colombia 2006 / Search of Buruli in Choco and Antioquia, Uraba Colombia, 2006

Introducción: en Colombia no se ha reportado ningún caso de úlcera de Buruli (UB), aún teniendo regiones con características similares a zonas endémicas. En nuestro medio, la proximidad geográfica y las condiciones ambientales similares con los países de Sur y Centro América donde se han reportado casos, motivan a buscar activamente pacientes sospechosos de UB, y aplicar técnicas de laboratorio moleculares específicas para brindar un adecuado diagnóstico. Objetivo: buscar casos de úlcera de Buruli (UB) en Urabá chocoano y antioqueño, (Colombia) durante el año 2006. Materiales y métodos: se estudiaron casos provenientes de las áreas de estudio, para establecer la causa etiológica de las lesiones utilizando métodos de diagnóstico clínico, microbiológico, histopatológico y molecular. Resultados: en cinco pacientes (6%) no se pudo establecer la causa etiológica de la úlcera (leishmaniosis, micosis, úlceras venosas o arteriales, cáncer). El examen clínico de estos pacientes no fue concluyente de UB, sin embargo debido a la falta de documentación de casos en Colombia, se procesó biopsia de la lesión para detectar ADN de Mycobacterium ulcerans por reacción en cadena de la polimerasa (PCR). Todas las pruebas de PCR fueron negativas para ADN de Mycobacterium ulcerans. Conclusiones: debido a indicadores epidemiológicos que señalan a Colombia con condiciones geográficas y ambientales similares a las que se presentan en regiones endémicas, como Perú, Guyana Francesa, México, Surinam, es necesario continuar con su búsqueda.

Introduction: in Colombia there are no reported cases of Buruli ulcer (BU), however the geographic and environmental characteristics are similar to endemic regions, and the proximity to other countries in South and Central America where there are reported cases, makes it an important issue to search for them, using molecular techniques specific for BU diagnostic. Objectives: to search for Buruli ulcer (BU) at the Urabá region of Chocó and Antioquia in Colombia, during 2006. Materials and methods: patients with skin ulcer from the study region were tested to establish the etiologic cause of the lesions, using clinical, microbiological, pathological and molecular methods. Results: Five patients were tested for BU using PCR test, since other etiologic causes of the ulcer (leishmaniosis, mycosis, venous or arterial ulcer, others) were not determined. Clinical examination of the patients was not conclusive of BU; but due to the lack of documented cases in Colombia, biopsies were taken from patients for detection of M. ulcerans by PCR. All the samples samples tested negative for DNA of Mycobacterium ulcerans. Conclusions: due to the epidemiological indicators that show that Colombia has the geographic and environmental conditions similar to endemic regions, as Perú, French Guyana, México and Surinam it is necessary to continue with the search.