Abstract
BackgroundBuruli ulcer is an infectious disease involving the skin, caused by Mycobacterium ulcerans. Its exact transmission mechanism remains unknown. Several arguments indicate a possible role for insects in its transmission. A previous case-control study in the Nyong valley region in central Cameroon showed an unexpected association between bed net use and protection against Buruli ulcer. We investigated whether this association persisted in a newly discovered endemic Buruli ulcer focus in Bankim, northwestern Cameroon.Methodology/Principal FindingsWe conducted a case-control study on 77 Buruli ulcer cases and 153 age-, gender- and village-matched controls. Participants were interviewed about their activities and habits. Multivariate conditional logistic regression analysis identified systematic use of a bed net (Odds-Ratio (OR) = 0.4, 95% Confidence Interval [95%CI] = [0.2–0.9], p-value (p) = 0.04), cleansing wounds with soap (OR [95%CI] = 0.1 [0.03–0.3], p<0.0001) and growing cassava (OR [95%CI] = 0.3 [0.2–0.7], p = 0.005) as independent protective factors. Independent risk factors were bathing in the Mbam River (OR [95%CI] = 6.9 [1.4–35], p = 0.02) and reporting scratch lesions after insect bites (OR [95%CI] = 2.7 [1.4–5.4], p = 0.004). The proportion of cases that could be prevented by systematic bed net use was 32%, and by adequate wound care was 34%.Conclusions/SignificanceOur study confirms that two previously identified factors, adequate wound care and bed net use, significantly decreased the risk of Buruli ulcer. These associations withstand generalization to different geographic, climatic and epidemiologic settings. Involvement of insects in the household environment, and the relationship between wound hygiene and M. ulcerans infection should now be investigated.
Highlights
Over the last five years, Buruli ulcer (BU) care has been greatly improved by implementation of antimicrobial therapy and more effective diagnosis methods
Participants Of the 195 probable Buruli ulcer cases recorded in Bankim district hospital since January 2007, 100 cases were contacted, 88 were questioned, and 77 retained for analysis
Through this study, we have demonstrated that the association between bed net use and protection against BU, found in a previous case-control study in Akonolinga, can be generalized to another climatic, geographical, environmental and ethnic context
Summary
Over the last five years, Buruli ulcer (BU) care has been greatly improved by implementation of antimicrobial therapy and more effective diagnosis methods. Much about the transmission of this devastating skin disease remains to be learnt. Studies aimed at identifying BU risk factors have repeatedly shown an association between the disease and activities such as wading [2,3] or washing clothes [4] in marshy areas of stagnant or slow-flowing waters. A previous case-control study in the Nyong valley region in central Cameroon showed an unexpected association between bed net use and protection against Buruli ulcer. We investigated whether this association persisted in a newly discovered endemic Buruli ulcer focus in Bankim, northwestern Cameroon
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