Genetic Diversity of Staphylococcus aureus in Buruli Ulcer

Nana Ama Amissah,Anthony Ablordey,John W Rossen,Ymkje Stienstra,Caitlin S Tetteh,Corinna Glasner,Tjip S Van Der Werf,Jan Maarten Van Dijl,Nana Konama Kotey,Isaac Prah

doi:10.1371/journal.pntd.0003421

Abstract

BackgroundBuruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. Previous studies have shown that wounds of BU patients are colonized with M. ulcerans and several other microorganisms, including Staphylococcus aureus, which may interfere with wound healing. The present study was therefore aimed at investigating the diversity and topography of S. aureus colonizing BU patients during treatment.MethodologyWe investigated the presence, diversity, and spatio-temporal distribution of S. aureus in 30 confirmed BU patients from Ghana during treatment. S. aureus was isolated from nose and wound swabs, and by replica plating of wound dressings collected bi-weekly from patients. S. aureus isolates were characterized by multiple-locus variable number tandem repeat fingerprinting (MLVF) and spa-typing, and antibiotic susceptibility was tested.Principal FindingsNineteen (63%) of the 30 BU patients tested positive for S. aureus at least once during the sampling period, yielding 407 S. aureus isolates. Detailed analysis of 91 isolates grouped these isolates into 13 MLVF clusters and 13 spa-types. Five (26%) S. aureus-positive BU patients carried the same S. aureus genotype in their anterior nares and wounds. S. aureus isolates from the wounds of seven (37%) patients were distributed over two different MLVF clusters. Wounds of three (16%) patients were colonized with isolates belonging to two different genotypes at the same time, and five (26%) patients were colonized with different S. aureus types over time. Five (17%) of the 30 included BU patients tested positive for methicillin-resistant S. aureus (MRSA).Conclusion/SignificanceThe present study showed that the wounds of many BU patients were contaminated with S. aureus, and that many BU patients from the different communities carried the same S. aureus genotype during treatment. This calls for improved wound care and hygiene.

Highlights

Buruli ulcer (BU) is a neglected necrotizing skin disease caused by Mycobacterium ulcerans, emerging mainly in West Africa with Benin, Côte d’Ivoire and Ghana bearing the highest burden of disease [1]
Previous studies have shown that wounds of BU patients are colonized with M. ulcerans and several other microorganisms, including Staphylococcus aureus, which may interfere with wound healing
Buruli ulcer (BU) is a disease of the skin and soft tissue caused by Mycobacterium ulcerans

Summary

Introduction

Buruli ulcer (BU) is a neglected necrotizing skin disease caused by Mycobacterium ulcerans, emerging mainly in West Africa with Benin, Côte d’Ivoire and Ghana bearing the highest burden of disease [1]. Wounds of most BU patients are colonized with several other microorganisms in addition to M. ulcerans [10, 11]. Until now there are only two studies that describe the microorganisms colonizing the wounds of BU patients cultured from superficial swabs, indicating the presence of Pseudomonas aeruginosa, Proteus mirabilis, Enterobacteriaceae, Group A, B and C Streptococcus, and Staphylococcus spp., including Staphylococcus epidermidis and Staphylococcus aureus. Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. Previous studies have shown that wounds of BU patients are colonized with M. ulcerans and several other microorganisms, including Staphylococcus aureus, which may interfere with wound healing. The present study was aimed at investigating the diversity and topography of S. aureus colonizing BU patients during treatment

Methods

Results

Discussion

Conclusion