Buruli Ulcer in South Western Nigeria: A Retrospective Cohort Study of Patients Treated in Benin

Marion, Estelle; Carolan, Kevin; Adeye, Ambroise; Kempf, Marie; Chauty, Annick; Marsollier, Laurent

doi:10.1371/journal.pntd.0003443

Cited by 20 publications

(44 citation statements)

References 18 publications

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“…Fifteen (83%) of the lesions were on the limbs with 11 (61%) occurring on the lower limbs which is in conformity with previous studies [2]. However, unlike in other studies in Africa where children under 15 years of age predominate [10,11] only 2 (11%) of the patients in our study were children which correlates with some studies in Australia and Japan where BUD patients under 15years of age accounted for only 10% and 19% respectively [14]. However, the results of this study could probably have been different if the study period had been extended to allow more BUD-like cases present to the hospitals.…”

Section: Discussionsupporting

confidence: 88%

“…This we could not carry out in this study for logistic reasons. The value of this study however, is in creating awareness that BUD might be more prevalent in Ogun State than earlier thought, thus corroborating the reports of Marion et al [11] that a cohort of 127 patients from towns and villages in Ogun State that border Benin Republic had crossed into that country and were treated for BUD over a period of ten years. The fact that 18 ulcers that simulate classical Buruli ulcer images as documented by the WHO were observed within a period of 3 months in this study provides a solid basis for an enlarged Buruli ulcer case search to cover not only Ogun State but all the six states in SW Nigeria, bearing in mind that 24 BUD cases had earlier been reported from Ibadan in Oyo State [6] which is contiguous with Ogun State.…”

Section: Discussionsupporting

confidence: 86%

“…In the available epidemiological data in the West African sub-region which has now become the epicentre of BUD, Nigeria presents a notable gap in cases, compared with Benin Republic and Cameron which have highly endemic regions [10,11]. This gap may be due to lack of awareness of the disease among both the general public and healthcare givers leading to the misdiagnosis of disease, under-reporting and treatment failure [8].…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10]. A recent retrospective study of data of PCR-confirmed Nigerian patients with Buruli ulcer treated in Benin Republic gives credence to this fact [11]. The endemicity of the disease in the neighboring countries also makes it highly probable that BU could be endemic, in some yet to be identified areas in Nigeria.…”

Section: Buruli Ulcer Disease (Bud) Which Is Caused Bymentioning

confidence: 99%

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Presumptive Diagnosis of Buruli Ulcer based on Clinical Presentations

Oluniyi¹

2017

Journal of Microbiology and Infectious Diseases

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Objectives: Buruli ulcer disease (BUD) is a neglected tropical disease of the skin, subcutaneous tissue and occasionally bone. Except in endemic areas, the diagnosis of BUD can be a challenge. This study was an attempt to presumptively identify cases of Buruli ulcer in the absence of a laboratory confirmation. Methods:A presumptive diagnosis of Buruli ulcer by directly comparing clinical presentations with WHO-confirmed pictorial images of the disease was carried out on patients with suspected Buruli ulcers presenting to two government-owned hospitals in Ogun State, South-West, Nigeria.Results: Eighteen suspected cases of BUD from as many outpatients were identified within a three-month period, comprising 13 (72.2%) females and five (27.8%) males. 10 (55.6%) and eight (44.4%) of them were from the tertiary and secondary health facilities, respectively. Eleven (61%) of the ulcers were located on the leg, four (22%) on the breast and four (22%) on the hand. 14 (77.8%) of the patients were above 40 years of age, two (11.1%) were between 18 and 30 years while only two (11.1%) were below 15 years. 16 (89%) of the patients could not remember how the ulcer started while two (11%) of them said their lesions started with a scratch. 7(39%) of the ulcers were painless; 11 (61%) were minimally painful while 15 (83%) had undermined edges which are presentations consistent with Buruli ulcer disease. Conclusions:The detection of these ulcers in just two hospitals and within a period of three months is significant and suggestive of Buruli ulcer being probably more prevalent in South-west Nigeria than aforethought. J Microbiol Infect Dis 2017; 7(1): 36-41

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Buruli Ulcer Disease (Bud) Which Is Caused Bymentioning

confidence: 99%

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Presumptive Diagnosis of Buruli Ulcer based on Clinical Presentations

Oluniyi¹

2017

Journal of Microbiology and Infectious Diseases

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“…A 30-year-old female native of Sokoto, Western Nigeria, coming to the United States with fiancée for the first time presented to us one day after arrival at the hospital emergency room with a painful ulcerated lesion on her right ankle [1–7]. …”

Section: Presenting Historymentioning

confidence: 99%

Nigerian Female with Skin Lesions in the Leg and Face: Herpetic Sycosis Folliculitis

Dilorenzo

Channaveeraiah

Gilford

et al. 2016

Case Reports in Infectious Diseases

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Nongenital HSV 1 presents outside the mucus membrane. Our patient had unusual presentation that caused diagnostic dilemma. 30-year-old native Nigerian female coming with fiancée to the United States presented to our service one day after arrival through ER with a lesion on her right ankle. She was diagnosed with cellulitis, started on antibiotics, and admitted to hospital. She had fever of 39.1°C. Head and neck exam showed multiple sized lesions over tongue and palate and inner aspect of lower lip. Abdomen and genital exam was normal. Skin exam showed lesions over the face and lesions over the lateral aspect of the right leg. There was ulcerated lesion over the right lateral malleolus with surrounding erythema and edema. Her tests showed elevated ESR of 98; HIV test was negative; CT scan of the ankle showed no abscess or osteomyelitis. TB quantiferon was indeterminate; AFB stain and culture were negative; HSV IgM was elevated at 1 : 16; RPR was negative; ANA was negative; malaria screen was negative, and blood cultures were negative for bacteria, fungus, and virus. Debrided wound had no growth of bacteria or fungus or virus. This case illustrates the unusual presentation of the HSV1 outside the mucus membrane and how it can be confused with other conditions that required extensive tests. Therapeutic trail with antiviral medications resolved lesions over the leg and face.

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Drugs for treating Buruli ulcer (Mycobacterium ulcerans disease)

Yotsu

Richardson

Ishii

2018

Cochrane Database of Systematic Reviews

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While the antibiotic combination treatments evaluated appear to be effective, we found insufficient evidence showing that any particular drug is more effective than another. How different sizes, lesions, and stages of the disease may contribute to healing and which kind of lesions are in need of surgery are unclear based on the included studies. Guideline development needs to consider these factors in designing practical treatment regimens. Forthcoming trials using clarithromycin with rifampicin and other trials of new regimens that also address these factors will help to identify the best regimens.

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Buruli Ulcer in South Western Nigeria: A Retrospective Cohort Study of Patients Treated in Benin

Cited by 20 publications

References 18 publications

Presumptive Diagnosis of Buruli Ulcer based on Clinical Presentations

Presumptive Diagnosis of Buruli Ulcer based on Clinical Presentations

Nigerian Female with Skin Lesions in the Leg and Face: Herpetic Sycosis Folliculitis

Drugs for treating Buruli ulcer (Mycobacterium ulcerans disease)

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