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Abstract
This study aimed to contribute to the understanding of Mycobacterium ulcerans (MU) ecology by analysing both clinical and environmental samples collected from ten communities along two major river basins (Offin and Densu) associated with Buruli ulcer (BU) at different seasons. We collected clinical samples from presumptive BU cases and environmental samples from ten communities. Following DNA extraction, clinical samples were confirmed by IS2404 PCR and environmental samples were confirmed by targeting MU-specific genes, IS2404, IS2606 and the ketoreductase (KR) using real-time PCR. Environmental samples were first analysed for IS2404; after which, IS2404-positive samples were multiplexed for the IS2606 and KR gene. Our findings indicate an overall decline in BU incidence along both river basins, although incidence at Densu outweighs that of Offin. Overall, 1600 environmental samples were screened along Densu (434, 27 %) and Offin (1166, 73 %) and MU was detected in 139 (9 %) of the combined samples. The positivity of MU along the Densu River basin was 89/434 (20.5 %), whilst that of the Offin River basin was 50/1166 (4.3 %). The DNA was detected mainly in snails (5/6, 83 %), moss (8/40, 20 %), soil (55/586, 9 %) and vegetation (55/675, 8 %). The proportion of MU positive samples recorded was higher during the months with higher rainfall levels (126/1175, 11 %) than during the dry season months (13/425, 3 %). This study indicates for the first time that there is a seasonal pattern in the presence of MU in the environment, which may be related to recent rainfall or water in the soil.
Highlights
Buruli ulcer (BU), caused by Mycobacterium ulcerans (MU), is the third most important mycobacterial disease of public health importance globally after tuberculosis and leprosy [1]
These river bodies were selected for the study because extensive disease and sero-epidemiological studies have shown high exposure of community member to the M. ulcerans 18 KDa heat shock protein 65 [6, 33, 34], and unlike other communities in Ghana which depend on passive case report, these sites are active in reporting BU cases to the national BU control programme (NBUCP) [35]
We looked for (1) the presence of MU DNA in the environment to contribute to understanding the pathogen ecology, (2) the associations between MU in the environment and other variables including BU endemicity and rainfall patterns and (3) the occurrence of BU cases within some selected communities
Summary
Buruli ulcer (BU), caused by Mycobacterium ulcerans (MU), is the third most important mycobacterial disease of public health importance globally after tuberculosis and leprosy [1]. Buruli ulcer, which affects the skin and its underlying soft tissues, begins usually as a painless papule or nodule under the skin at the site of trauma, but in some individuals, more severe diffuse forms occur such as a plaque and/or oedema. Failure to treat these early forms results in gradual erosion of the skin leaving a welldemarcated ulcer with wide undermined edges resulting from the cytopathic action of the plasmid-encoded macrolide toxin, mycolactone [3,4,5]. Rapid changes in landscape [9] such as deforestation, flooding, construction of dams and artificial lakes for irrigation, mining activities and extending swamps for growing rice and fish breeding have been associated with the emergence of the disease in some communities [8, 10,11,12,13]
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