Abstract
Buruli ulcer (BU), a neglected tropical disease of the skin, caused by Mycobacterium ulcerans, occurs most frequently in children in West Africa. Risk factors for BU include proximity to slow flowing water, poor wound care and not wearing protective clothing. Man-made alterations of the environment have been suggested to lead to increased BU incidence. M. ulcerans DNA has been detected in the environment, water bugs and recently also in mosquitoes. Despite these findings, the mode of transmission of BU remains poorly understood and both transmission by insects or direct inoculation from contaminated environment have been suggested. Here, we investigated the BU epidemiology in the Mapé basin of Cameroon where the damming of the Mapé River since 1988 is believed to have increased the incidence of BU. Through a house-by-house survey in spring 2010, which also examined the local population for leprosy and yaws, and continued surveillance thereafter, we identified, till June 2012, altogether 88 RT-PCR positive cases of BU. We found that the age adjusted cumulative incidence of BU was highest in young teenagers and in individuals above the age of 50 and that very young children (<5) were underrepresented among cases. BU lesions clustered around the ankles and at the back of the elbows. This pattern neither matches any of the published mosquito biting site patterns, nor the published distribution of small skin injuries in children, where lesions on the knees are much more frequent. The option of multiple modes of transmission should thus be considered. Analyzing the geographic distribution of cases in the Mapé Dam area revealed a closer association with the Mbam River than with the artificial lake.
Highlights
Buruli ulcer (BU), a neglected tropical disease (NTD) of the skin, is caused by Mycobacterium ulcerans [1] and if untreated, can lead to disability
Local BU incidence rates are highest in West Africa and Australia, where the classical lineage of M. ulcerans is found [2,3,4] and the disease occurs at different foci in the endemic countries
Buruli ulcer (BU) is an infectious disease caused by Mycobacterium ulcerans that is affecting mostly children in endemic areas of West Africa
Summary
Buruli ulcer (BU), a neglected tropical disease (NTD) of the skin, is caused by Mycobacterium ulcerans [1] and if untreated, can lead to disability. Local BU incidence rates are highest in West Africa and Australia, where the classical lineage of M. ulcerans is found [2,3,4] and the disease occurs at different foci in the endemic countries. Both sexes can be affected by the disease and individuals of all ages can get BU, most of the patients are less 15 years old [5]. Many BU cases identified in rural areas are still diagnosed based on clinical symptoms only, the use of laboratory diagnosis is highly recommended by the World Health Organization (WHO). Surgery and wound management remain critical aspects of BU care [15,16]
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