Abstract
Buruli ulcer (BU) is an emerging necrotizing disease of the skin and subcutaneous tissue caused by Mycobacterium ulcerans. While proximity to stagnant or slow flowing water bodies is a risk factor for acquiring BU, the epidemiology and mode of M. ulcerans transmission is poorly understood. Here we have used high-throughput DNA sequencing and comparisons of the genomes of seven M. ulcerans isolates that appeared monomorphic by existing typing methods. We identified a limited number of single nucleotide polymorphisms (SNPs) and developed a real-time PCR SNP typing method based on these differences. We then investigated clinical isolates of M. ulcerans on which we had detailed information concerning patient location and time of diagnosis. Within the Densu river basin of Ghana we observed dominance of one clonal complex and local clustering of some of the variants belonging to this complex. These results reveal focal transmission and demonstrate, that micro-epidemiological analyses by SNP typing has great potential to help us understand how M. ulcerans is transmitted.
Highlights
Infection with Mycobacterium ulcerans causes a chronic, necrotizing disease of the skin and the subcutaneous adipose tissue commonly known as Buruli ulcer [1]
Mycobacterium ulcerans causes a destructive skin disease known as Buruli ulcer (BU), which has been reported from more than 30 tropical or subtropical countries, with the highest prevalence in Western Africa
Due to the striking genetic monomorphism of African M. ulcerans populations, conventional genetic fingerprinting methods have largely failed to differentiate isolates coming from the same BU endemic area
Summary
Infection with Mycobacterium ulcerans causes a chronic, necrotizing disease of the skin and the subcutaneous adipose tissue commonly known as Buruli ulcer [1]. This serious infectious disease remains a major health problem in many parts of the world, but in particular, in Western and Central Africa [2]. Isolation of the slow growing M. ulcerans from an environmental source has been achieved only once so far, from an aquatic insect [4]. Seroepidemiological studies have indicated that infection with M. ulcerans may lead to disease only in a minority of exposed individuals [9]
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