ABSTRACT
Buruli ulcer (BU) is an infectious skin disease that occurs mainly in West and Central Africa. It can lead to severe disability and stigma because of scarring and contractures. Effective treatment with antibiotics is available, but patients often report to the hospital too late to prevent surgery and the disabling consequences of the disease. In a highly endemic district in Ghana, intensified public health efforts, mainly revolving around training and motivating community-based surveillance volunteers (CBSVs), were implemented. As a result, 70% of cases were reported in the earliest-World Health Organization category I-stage of the disease, potentially minimizing the need for surgery. CBSVs referred more cases in total and more cases in the early stages of the disease than any other source. CBSVs are an important resource in the early detection of BU.
Subject(s)
Buruli Ulcer/prevention & control , Population Surveillance , Volunteers , Buruli Ulcer/epidemiology , Endemic Diseases , Ghana/epidemiology , HumansSubject(s)
Buruli Ulcer/complications , Buruli Ulcer/diagnosis , Pleural Effusion/diagnosis , Pleural Effusion/etiology , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Buruli Ulcer/pathology , Buruli Ulcer/therapy , Child , Debridement , Female , Ghana , Humans , Paracentesis , Pleural Effusion/pathology , Pleural Effusion/therapy , Radiography, Thoracic , Skin/pathologyABSTRACT
During August 2010-December 2012, we conducted a study of patients in Ghana who had Buruli ulcer, caused by Mycobacterium ulcerans, and found that 23% were co-infected with Mansonella perstans nematodes; 13% of controls also had M. perstans infection. M. perstans co-infection should be considered in the diagnosis and treatment of Buruli ulcer.
Subject(s)
Buruli Ulcer/epidemiology , Mansonella/isolation & purification , Mansonelliasis/epidemiology , Mycobacterium ulcerans/isolation & purification , Adolescent , Adult , Animals , Buruli Ulcer/diagnosis , Buruli Ulcer/microbiology , Child , Coinfection , Female , Ghana/epidemiology , Humans , Incidence , Male , Mansonelliasis/diagnosis , Mansonelliasis/parasitology , Middle Aged , Retrospective StudiesABSTRACT
BACKGROUND: Mycobacterium ulcerans (M. ulcerans) causes a devastating necrotising infection of skin tissue leading to progressive ulceration. M. ulcerans is the only human pathogen that secretes mycolactone, a polyketide molecule with potent cytotoxic and immunomodulatory properties. These unique features make mycolactone an attractive biomarker for M. ulcerans disease. We sought to measure the concentration of mycolactone within lesions of patients with Buruli ulcer before, during and after antibiotic treatment to evaluate its association with the clinical and bacteriological response to therapy. METHODS: Biopsies of M. ulcerans infected skin lesions were obtained from patients before, during and after antibiotic therapy. Lipids were extracted from the biopsies and concentration of mycolactone was assayed by mass spectrometry and a cytotoxicity assay and correlated with clinical and bacteriological response to therapy. RESULTS: Baseline concentration of mycolactone measured by mass spectrometry predicted time to complete healing of small nodules and ulcers. Even though intra-lesional concentrations of mycolactone declined with antibiotic treatment, the toxin was still present after antibiotic treatment for 6 weeks and also 4 weeks after the end of treatment for 8 weeks in a subgroup of patients with slowly healing lesions. Additionally viable bacilli were detected in a proportion of these slowly healing lesions during and after treatment. CONCLUSIONS: Our findings indicate that baseline intra-lesional mycolactone concentration and its kinetics with antibiotic therapy are important prognostic determinants of clinical and bacteriological response to antibiotic treatment for Mycobacterium ulcerans disease. Mycolactone may be a useful biomarker with potential utility in optimising antibiotic therapy.
Subject(s)
Anti-Bacterial Agents/pharmacokinetics , Buruli Ulcer/drug therapy , Buruli Ulcer/metabolism , Macrolides/pharmacokinetics , Mycobacterium ulcerans/isolation & purification , Subcutaneous Tissue/metabolism , Adolescent , Adult , Aged , Animals , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Female , Humans , Macrolides/therapeutic use , Male , Mass Spectrometry , Mice , Middle Aged , Skin/chemistry , Skin/metabolism , Subcutaneous Tissue/chemistry , Tissue Distribution , Young AdultABSTRACT
Buruli ulcer, an ulcerating skin disease caused by Mycobacterium ulcerans infection, is common in tropical areas of western Africa. We determined the clinical and microbiological responses to administration of rifampin and streptomycin for 2 weeks followed by administration of rifampin and clarithromycin for 6 weeks in 43 patients with small laboratory-confirmed Buruli lesions and monitored for recurrence-free healing. Bacterial load in tissue samples before and after treatment for 6 and 12 weeks was monitored by semiquantitative culture. The success rate was 93%, and there was no recurrence after a 12-month follow-up. Eight percent had a positive culture 4 weeks after antibiotic treatment, but their lesions went on to heal. The findings indicate that rifampin and clarithromycin can replace rifampin and streptomycin for the continuation phase after rifampin and streptomycin administration for 2 weeks without any apparent loss of efficacy.
