BackgroundEarly detection of several skin-related neglected tropical diseases (skin NTDs)–including leprosy, Buruli ulcer, yaws, and scabies- may be achieved through school surveys, but such an approach has seldom been tested systematically on a large scale in endemic countries. Additionally, a better understanding of the spectrum of skin diseases and the at-risk populations to be encountered during such surveys is necessary to facilitate the process.MethodsWe performed a school skin survey for selected NTDs and the spectrum of skin diseases, among primary schoolchildren aged 5 to 15 in Côte d’Ivoire, West Africa. This 2-phase survey took place in 49 schools from 16 villages in the Adzopé health district from November 2015 to January 2016. The first phase involved a rapid visual examination of the skin by local community healthcare workers (village nurses) to identify any skin abnormality. In a second phase, a specialized medical team including dermatologists performed a total skin examination of all screened students with any skin lesion and provided treatment where necessary.ResultsOf a total of 13,019 children, 3,504 screened positive for skin lesions and were listed for the next stage examination. The medical team examined 1,138 of these children. The overall prevalence of skin diseases was 25.6% (95% CI: 24.3–26.9%). The predominant diagnoses were fungal infections (n = 858, prevalence: 22.3%), followed by inflammatory skin diseases (n = 265, prevalence: 6.9%). Skin diseases were more common in boys and in children living along the main road with heavy traffic. One case of multi-bacillary type leprosy was detected early, along with 36 cases of scabies. Our survey was met with very good community acceptance.ConclusionWe carried out the first large-scale integrated, two-phase pediatric multi-skin NTD survey in rural Côte d’Ivoire, effectively reaching a large population. We found a high prevalence of skin diseases in children, but only limited number of skin NTDs. With the lessons learned, we plan to expand the project to a wider area to further explore its potential to better integrate skin NTD screening in the public health agenda.

Background Skin-related neglected tropical diseases (skin NTDs) occur against a background of a very high prevalence of common skin diseases in sub-Saharan Africa. In this study, we examined the knowledge, attitude and practices (KAP) and the impact of common skin diseases in children living in a leprosy and Buruli ulcer (BU) co-endemic district in a west African country of Cô te d'Ivoire, in order to help inform disease control efforts for skin NTDs. Methods and principle findings Fourteen focus group discussions (FGDs) with schoolchildren, 5 FGDs with parents of a child affected with skin disease(s), and 27 in-depth semi-structured interviews with key personnel were conducted. The Children's Dermatology Quality of Life Index (CDLQI) questionnaire was applied to 184 schoolchildren with skin diseases. We found that there was ignorance or neglect towards skin diseases in general, due to their high prevalence and also the perceived minimal impact on children's daily lives. While the median score for the CDLQI questionnaire was 5 (IQR 2-9) out of 30, a range of scores was observed. Symptoms such as pruritus and experiencing bullying by classmates contributed to reduction in their quality of life. Poor hygiene was considered as a major cause of skin diseases. Conclusions/Significance Despite their high impact on affected populations, we observed a high level of ignorance and neglect toward common skin diseases. There is a critical need to increase awareness PLOS NEGLECTED TROPICAL DISEASES

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Mycobacterium ulcerans is a slow-growing mycobacterium responsible for Buruli ulcer. The pathogenic virulence of MU is being linked to the expression of toxin called Mycolactone, whose form varies according to the origin of the productive strains. Forms A and B are secreted by African and Malaysian strains, C by Australian strains and D by Asian strains. Forms E and F of mycolactone are secreted by animal mycolactone producing mycobacteria strains. The genes for the biosynthesis of Mycolactone are located on a plasmid called pMUM001. We investigated the circulation of Mycolactone in body fluids coupled to the detection of virulence factors in MU strains. Suspicious BU patients and healthy subjects (negative controls) were selected in three Ivorian endemic areas. Exudates, fine needle aspiration (FNA) and blood samples were collected. Microscopy by Ziehl-Neelsen-staining, culture and PCR diagnostics using IS2404 and KR were performed in patient samples. The Mycolactone detection by HLPC coupled to MS was performed in patient and control samples. PCR using IS2404, IS2606, KR and ER were also performed in MU strains. Ziehl-Neelsen-microscopy detected acid-fast bacilli in 19% of samples while PCR were positive in 76.2% for IS2404 and 52.4% for KR. Mycolactone A/B was detected in 31% of exudates and in 42.8% of sera. No Mycolactone was detected in control subjects. 17 strains isolated from exudates possessed both IS2404 and IS2606. 70.6% of those strains were positive for KR and ER gene. The study shows that Mycolactone A/B was actually present in most of BU patients selected in three Ivorian endemic areas. With the methods used we detected very low concentrations in patient fluids. Plasmid and ER gene were found in the majority of MU strains. But they were not found in about 30% of strains. Mycolactone was detected only in patients infected by strains in which plasmid was found.