Abstract
BackgroundBuruli ulcer (BU), a necrotizing skin infection caused by Mycobacterium ulcerans is the third most important mycobacterial disease globally after tuberculosis and leprosy in immune competent individuals. This study reports on the retrospective analyses of microbiologically confirmed Buruli ulcer (BU) cases in seventy-five health facilities in Ghana.Method/Principal findingsPathological samples were collected from BU lesions and transported either through courier services or by car directly to the laboratory. Samples were processed and analysed by IS2404 PCR, culture and Ziehl-Neelsen staining for detection of acid-fast bacilli. From 2008 to 2016, we analysed by PCR, 2,287 samples of 2,203 cases from seventy-five health facilities in seven regions of Ghana (Ashanti, Brong Ahafo, Central, Eastern, Greater Accra, Northern and Volta). The mean annual positivity rate was 46.2% and ranged between 14.6% and 76.2%. The yearly positivity rates from 2008 to 2016 were 52.3%, 76.2%, 56.7%, 53.8%, 41.2%, 41.5%, 22.9%, 28.5% and 14.6% respectively. Of the 1,020 confirmed cases, the ratio of female to male was 518 and 502 respectively. Patients who were 15 years of age and below accounted for 39.8% of all cases. The median age was 20 years (IQR = 10–43). Ulcerative lesions were 69.2%, nodule (9.6%), plaque (2.9%), oedema (2.5%), osteomyelitis (1.1%), ulcer/oedema (9.5%) and ulcer/plaque (5.2%). Lesions frequently occurred on the lower limbs (57%) followed by the upper limbs (38%), the neck and head (3%) and the least found on the abdomen (2%).Conclusions/SignificanceOur findings show a decline in microbiological confirmed rates over the years and therefore call for intensive education on case recognition to prevent over-diagnosis as BU cases decline.
Highlights
Buruli ulcer (BU), a necrotizing skin and soft tissue disease, is caused by the environmental pathogen Mycobacterium ulcerans
Buruli ulcer (BU), a necrotizing skin disease caused by Mycobacterium ulcerans, is currently reported in 33 countries, with the greatest disease burden mostly in West African countries along the gulf of Guinea
The lack of pain associated with BU disease enhances delay in seeking medical treatment that could result to complications
Summary
Buruli ulcer (BU), a necrotizing skin and soft tissue disease, is caused by the environmental pathogen Mycobacterium ulcerans. BU is the third most important mycobacterial disease after tuberculosis and leprosy in immunocompetent individuals [1]. BU has been reported in 33 countries worldwide, mainly with tropical climates, and more than two thirds of the global cases reported in West African countries along the gulf of Guinea Cote d0Ivoire, Ghana, Benin and Cameroon [2]. The disease has variable clinical presentation based on geography; in the pacific regions BU may start as a papule, in West and Central Africa it may start as a painless nodule without the involvement of subcutaneous tissues [1]. Buruli ulcer (BU), a necrotizing skin infection caused by Mycobacterium ulcerans is the third most important mycobacterial disease globally after tuberculosis and leprosy in immune competent individuals. This study reports on the retrospective analyses of microbiologically confirmed Buruli ulcer (BU) cases in seventy-five health facilities in Ghana
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