Geographic Distribution, Age Pattern and Sites of Lesions in a Cohort of Buruli Ulcer Patients from the Mapé Basin of Cameroon

Abstract

Buruli ulcer (BU), a neglected tropical disease of the skin, caused by Mycobacterium ulcerans, occurs most frequently in children in West Africa. Risk factors for BU include proximity to slow flowing water, poor wound care and not wearing protective clothing. Man-made alterations of the environment have been suggested to lead to increased BU incidence. M. ulcerans DNA has been detected in the environment, water bugs and recently also in mosquitoes. Despite these findings, the mode of transmission of BU remains poorly understood and both transmission by insects or direct inoculation from contaminated environment have been suggested. Here, we investigated the BU epidemiology in the Mapé basin of Cameroon where the damming of the Mapé River since 1988 is believed to have increased the incidence of BU. Through a house-by-house survey in spring 2010, which also examined the local population for leprosy and yaws, and continued surveillance thereafter, we identified, till June 2012, altogether 88 RT-PCR positive cases of BU. We found that the age adjusted cumulative incidence of BU was highest in young teenagers and in individuals above the age of 50 and that very young children (<5) were underrepresented among cases. BU lesions clustered around the ankles and at the back of the elbows. This pattern neither matches any of the published mosquito biting site patterns, nor the published distribution of small skin injuries in children, where lesions on the knees are much more frequent. The option of multiple modes of transmission should thus be considered. Analyzing the geographic distribution of cases in the Mapé Dam area revealed a closer association with the Mbam River than with the artificial lake.

Geospatial Analysis of Buruli Ulcer Prevalence in Anambra North, Anambra State, Nigeria

“…Similarly, swimming with an exposed wound does not increase the risk of contracting BU infection. This finding is however contrary to the findings in Cameroon [4,23]. There was no evidence suggesting that the BU patients had wounds before contracting the disease.…”

“…This current result agrees with the findings of Bratschi et al in Cameroon where BU hotspots were identified around the Mbam River [4]. This study also found that the local BU endemic areas are larger than previously described by Chukwukezie et al [12] and Nwodo [9], though some the hotspots were not significant at 95%.…”

“…These Lakes may support the presence of M. ulcerans as the bacterium has been found to dwell more in slow-moving bodies of water. This result is in line with the other findings in Australia [13], Ghana [6], Cameroon [4], and Ogun State, Nigeria [8]. The presence of these lakes supports rice production and fishing activities in Anambra North.…”

“…BU is a chronic, devastating and necrotizing skin disease caused by a toxin-producing bacterium known as Mycobacterium ulcerans (M. Ulcerans) [1,[3][4][5]. It is one of the most neglected but treatable tropical diseases mostly found in rural areas located near wetlands or rivers [6].…”

Buruli ulcer: wound care and rehabilitation

“…4,5 The disease usually manifests itself as a painless nodule, a firm plaque, or an edematous lesion, which soon ulcerates with characteristic undermined edges.…”