Although several studies have associated Mycobacterium ulcerans (MU) infection, Buruli ulcer (BU), with slow moving water bodies, there is still no definite mode of transmission. Ecological and transmission studies suggest Variable Number Tandem Repeat (VNTR) typing as a useful tool to differentiate MU strains from other Mycolactone Producing Mycobacteria (MPM). Deciphering the genetic relatedness of clinical and environmental isolates is seminal to determining reservoirs, vectors and transmission routes. In this study, we attempted to source-track MU infections to specific water bodies by matching VNTR profiles of MU in human samples to those in the environment. Environmental samples were collected from 10 water bodies in four BU endemic communities in the Ashanti region, Ghana. Four VNTR loci in MU Agy99 genome, were used to genotype environmental MU ecovars, and those from 14 confirmed BU patients within the same study area. Length polymorphism was confirmed with sequencing. MU was present in the 3 different types of water bodies, but significantly higher in biofilm samples. Four MU genotypes, designated W, X, Y and Z, were typed in both human and environmental samples. Other reported genotypes were only found in water bodies. Animal trapping identified 1 mouse with lesion characteristic of BU, which was confirmed as MU infection. Our findings suggest that patients may have been infected from community associated water bodies. Further, we present evidence that small mammals within endemic communities could be susceptible to MU infections. M. ulcerans transmission could involve several routes where humans have contact with risk environments, which may be further compounded by water bodies acting as vehicles for disseminating strains.

Buruli ulcer (BU) belongs to the group of neglected tropical diseases and constitutes a public health problem in many rural communities in Côte d’Ivoire. The transmission patterns of this skin infection are poorly defined, hence the current study aimed to contribute to the understanding, perceptions and interpretations of its mode of transmission using a socio-environmental approach. Social and environmental risk factors that may expose people to infection, and the dynamics of local transfer of knowledge and practices related to BU, were assessed in two endemic locations in southern Côte d’Ivoire, i.e. Taabo and Daloa. Data were generated by the administration of a household questionnaire (N=500) between February and June 2012 to assess how the population perceived transmission of BU, focus group discussions with local communities (N=8) to analyse ideologies regarding transmission patterns and semi-structured interviews with patients or their parents, former BU patients and traditional healers (N=30). The interviewees’ empirical knowledge of the disease was found to be close to its biomedical description. Their aetiological perception of the disease was linked to natural (e.g. dirty water, insects) and supernatural (e.g. witchcraft, fate) causes. Some informants attributed the spread of the disease to recently immigrated neighbouring communities whose arrival coincided with an increase in reported BU cases. However, the general consensus seemed to be that the main mode of transmission was contact with infested soil or ulcerated wounds. The participants were aware that BU was a socio-environmental problem in these endemic areas, offering a good starting point for educational campaigns for at-risk communities. Buruli ulcer control programmes should therefore include educational campaigns and Water, Sanitation and Hygiene (WASH) interventions for those at risk in affected communities.

In Buruli ulcer (BU) endemic communities, most mycolactone-producing mycobacteria (MPM), including Mycobacterium ulcerans, the causative agent, are present in water bodies used by inhabitants; yet, their mode of transmission is still unclear. This study aimed to assess the distribution of MPM strains, both from human suspected cases and aquatic environments, for identifying possible transmission modes within two BU endemic districts, Daloa and Tiassalé (Taabo), in Côte d’Ivoire. Collected samples were processed using conventional polymerase chain reaction and screened for the presence of non-tuberculous mycobacteria (NTM) and MPMs using 16S rRNA, IS2404 and enoyl reductase (ER) primers. MPM-positive samples were further discriminated using variable number tandem repeat (VNTR) typing and sequencing. 16S rRNA and IS2404 sequences confirmed that 94% of the clinical samples contained MPMs. For environmental samples, 53% were contaminated with NTMs, of which 17% contained MPMs particularly M. ulcerans, suggesting that water-related activities could predispose inhabitants to BU transmission. MPM discrimination by VNTR at four M. ulcerans Agy99 loci identified genotype C, previously reported in Côte d’Ivoire as the most dominant profile. Phylogenetic clustering on the basis of genetic diversity in the MIRU 1 locus showed two main M. ulcerans lineages in Côte d’Ivoire.

Buruli ulcer is an infectious disease caused by Mycobacterium ulcerans. It begins with a lump, swelling, skin plate and progresses to severe ulceration and disabling sequelae . For over a decade, it is a real public health problem in Côte d'Ivoire. The institutions responsible for the fight against this disease advocate for patients in endemic areas early case detection and immediate recourse to specialized care centers. Despite this recommendation, the therapeutic itinerary of patients is multimodal. This study aims to analyze the therapeutic itinerary plural sick of Buruli ulcer and to determine the factors that justify the paradoxes and contradictions between state recommendations and behaviors of patients. It took place in three support centers in the health district of yamoussoukro. In a qualitative approach, with observation checklists, interview guides, this study was conducted with 50 patients, 18 healers in the care center and 4 traditional healers. Patients rely successively, alternatively or additionally to the African medicine and care center. Traditional medicine is the first therapeutic choice for most patients. The proximity of traditional healer, cultural beliefs and representations related to the disease, the constraints of hospitalization, ignorance of the disease make account plural therapeutic itineraries sick of Buruli ulcer. European Scientific Journal October 2016 edition vol.12, No.30 ISSN: 1857 -7881 (Print) e -ISSN 1857 264The patients do not adhere to early detection and immediate access to health care centers. Free medical care for Buruli ulcer is fraught with difficulties because of patient behaviors. The hospital management does not consider the social environment of patients and the relationship between the disease and culture that influence the therapeutic itinerary of patients.