Are all Buruli ulcers caused by
            <i>Mycobacterium ulcerans</i>
            ?

Combe, Marine; Couppié, Pierre; Blaizot, Romain; Valentini, Alice; Gozlan, Rodolphe E.

doi:10.1111/bjd.19260

Cited by 4 publications

(13 citation statements)

References 7 publications

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“…Mycobacterium ulcerans is classically the microbe responsible for Buruli ulcers. However, Combe found in a small sample of specimens from Buruli ulcers in France that 50% contained not M. ulcerans but Mycobacterium gilvan , sometimes with mixed mycobacteria 14 . M. gilvan is a rapidly growing mycobacterium previously thought to be innocuous.…”

Section: Clinical Featuresmentioning

confidence: 95%

“…However, Combe found in a small sample of specimens from Buruli ulcers in France that 50% contained not M. ulcerans but Mycobacterium gilvan, sometimes with mixed mycobacteria. 14 M. gilvan is a rapidly growing mycobacterium previously thought to be innocuous. Similarly, although Mycobacterium marinum is classically associated with fish tank exposure, cases of Mycobacterium avium as well as an emerging strain, Mycobacterium iranicum, have been identified in cases of fish tank granuloma.…”

Section: Nontuberculous (Atypical) Mycobacteriamentioning

confidence: 99%

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Dermatology practice updates in mycobacterial disease

Barker,

Alshaikh,

Elston

2023

Int J Dermatology

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Atypical mycobacterial infections are commonly acquired through exposure to water, and tuberculosis remains highly endemic in many parts of the world. In this era of global connection, travel, and immigration, it is more important than ever to maintain a high index of suspicion for infection from cutaneous tuberculosis and atypical mycobacteria. Epidemics related to surgical procedures have been related to inadequate sterilization, as almost 50% of public water supplies harbor mycobacteria. Improved diagnostic techniques for these microbes, including Auramine–Rhodamine staining and rapid detection of mycobacteria and drug susceptibilities through PCR and MALDI‐TOF, have improved detection and treatment outcomes. Given an increasing number of patients on immunosuppressive therapies, clinicians must remain vigilant.

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Section: Clinical Featuresmentioning

confidence: 95%

Section: Nontuberculous (Atypical) Mycobacteriamentioning

confidence: 99%

Dermatology practice updates in mycobacterial disease

Barker,

Alshaikh,

Elston

2023

Int J Dermatology

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“…For this purpose, we collected a set of complete genomes and pMUM plasmids available for various variants and/or strains of MPMs. We included some M. marinum strains as controls and M. gilvum was also used as an outgroup since this mycobacterium was recently found to be associated with BU-like cases in French Guiana (South America) although it does not belong to the MPM complex [ 25 ]. We were therefore interested in the potential presence of ISs and the KR-B domain in its genome and/or plasmids that could explain its association and pathogenicity in humans (See “Genomes & Plasmids” in Supplementary Information ).…”

Section: Lack Of Specificity Of (Q)pcr-based Tests For M Ul...mentioning

confidence: 99%

“…However, and by contrast to previous considerations, other unidentified mycobacterial species ( Mycobacteria sp.) have been found in biopsies of BU or BU-like from French Guiana and associated with the presence of the M. ulcerans variant and M. gilvum , also suggesting potential co-infections [ 25 ]. Finally, the test may not be suitable for environmental samples in which several mycobacterial species and/or MPM variants could be present.…”

Section: Implementation Of Miru-vntr To Assess Genotypic Diversitymentioning

confidence: 99%

“…More recently, M. shinshuense , M. marinum and M. liflandii were found in BU-like cases diagnosed in Japan [ 21 , 22 ], Côte d’Ivoire (Africa) [ 23 ] and French Guiana (South America) [ 24 ], respectively. Interestingly, in Côte d’Ivoire Nguetta et al [ 23 ] also found other mycobacteria, not belonging to the MPM complex, associated with BU-like cases, such as M. chelonae and M. smegmatis , and M. gilvum was found associated with some BU-like cases in French Guiana [ 25 ]. Taken together, these results suggest that (1) all MPM should definitely be considered variants of the same MPM complex and (2) all MPM variants or even other mycobacteria species apparently not producing mycolactone could cause either the same BU disease or slightly different skin ulcerations all diagnosed as BU to date.…”

Section: Introductionmentioning

confidence: 99%

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What about Current Diversity of Mycolactone-Producing Mycobacteria? Implication for the Diagnosis and Treatment of Buruli Ulcer

Combe,

Cherif,

Blaizot

et al. 2023

IJMS

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The identification of an emerging pathogen in humans can remain difficult by conventional methods such as enrichment culture assays that remain highly selective, require appropriate medium and cannot avoid misidentifications, or serological tests that use surrogate antigens and are often hampered by the level of detectable antibodies. Although not originally designed for this purpose, the implementation of polymerase-chain-reaction (PCR) has resulted in an increasing number of diagnostic tests for many diseases. However, the design of specific molecular assays relies on the availability and reliability of published genetic sequences for the target pathogens as well as enough knowledge on the genetic diversity of species and/or variants giving rise to the same disease symptoms. Usually designed for clinical isolates, molecular tests are often not suitable for environmental samples in which the target DNA is mixed with a mixture of environmental DNA. A key challenge of such molecular assays is thus to ensure high specificity of the target genetic markers when focusing on clinical and environmental samples in order to follow the dynamics of disease transmission and emergence in humans. Here we focus on the Buruli ulcer (BU), a human necrotizing skin disease mainly affecting tropical and subtropical areas, commonly admitted to be caused by Mycobacterium ulcerans worldwide although other mycolactone-producing mycobacteria and even mycobacterium species were found associated with BU or BU-like cases. By revisiting the literature, we show that many studies have used non-specific molecular markers (IS2404, IS2606, KR-B) to identify M. ulcerans from clinical and environmental samples and propose that all mycolactone-producing mycobacteria should be definitively considered as variants from the same group rather than different species. Importantly, we provide evidence that the diversity of mycolactone-producing mycobacteria variants as well as mycobacterium species potentially involved in BU or BU-like skin ulcerations might have been underestimated. We also suggest that the specific variants/species involved in each BU or BU-like case should be carefully identified during the diagnosis phase, either via the key to genetic identification proposed here or by broader metabarcoding approaches, in order to guide the medical community in the choice for the most appropriate antibiotic therapy.

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What about Current Diversity of Mycolactone-Producing Mycobacteria: Implication for the Diagnosis and Treatment of Buruli Ulcer

Combe¹,

Cherif²,

Blaizot³

et al. 2023

Preprint

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The identification of an emerging pathogen in humans can remain difficult by conventional methods such as enrichment culture assays that remain highly selective, require appropriate medium and cannot avoid misidentifications, or serological tests that use surrogate antigens and are often hampered by the level of detectable antibodies. Although not originally designed for this purpose, the implementation of polymerase-chain-reaction (PCR) has resulted in an increasing number of diagnostic tests for many diseases. However, the design of specific molecular assays relies on the availability and reliability of published genetic sequences for the target pathogen as well as enough knowledge on the genetic diversity of species and/or variants giving rise to the same disease symptoms. Usually designed for clinical isolates, molecular tests are often not suitable for environmental samples in which the target DNA is mixed with a mixture of environmental DNA. A key challenge of such molecular assays is thus to ensure high specificity of the target genetic markers when focusing on clinical and environmental samples in order to follow the dynamics of disease transmission and emergence in humans. Here we focus on Buruli ulcer (BU), a human necrotizing skin disease mainly affecting tropical and subtropical areas, commonly admitted to be caused by Mycobacterium ulcerans worldwide although other mycolactone-producing mycobacteria and even mycobacterium species were found associated with BU or BU-like cases. By revisiting the literature, we show that many studies have used non-specific molecular markers (IS2404, IS2606, KR) to identify M. ulcerans from clinical and environmental samples and propose that all mycolactone-producing mycobacteria should be definitively considered as variants from the same group rather than different species. Importantly, we provide evidence that the diversity of mycolactone-producing mycobacteria variants as well as mycobacterium species potentially involved in BU or BU-like skin ulcerations might have been underestimated. We also suggest that the specific variants/species involved in each BU or BU-like case should be carefully identified during the diagnosis phase, either via the key of genetic identification proposed here or by broader metabarcoding approaches, in order to guide the medical community in the choice for the most appropriate antibiotic therapy.

show abstract

Are all Buruli ulcers caused by Mycobacterium ulcerans ?

Cited by 4 publications

References 7 publications

Dermatology practice updates in mycobacterial disease

Dermatology practice updates in mycobacterial disease

What about Current Diversity of Mycolactone-Producing Mycobacteria? Implication for the Diagnosis and Treatment of Buruli Ulcer

What about Current Diversity of Mycolactone-Producing Mycobacteria: Implication for the Diagnosis and Treatment of Buruli Ulcer

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