Laboratory confirmation of Buruli ulcer cases in Ghana, 2008-2016

Abstract

BackgroundBuruli ulcer (BU), a necrotizing skin infection caused by Mycobacterium ulcerans is the third most important mycobacterial disease globally after tuberculosis and leprosy in immune competent individuals. This study reports on the retrospective analyses of microbiologically confirmed Buruli ulcer (BU) cases in seventy-five health facilities in Ghana.Method/Principal findingsPathological samples were collected from BU lesions and transported either through courier services or by car directly to the laboratory. Samples were processed and analysed by IS2404 PCR, culture and Ziehl-Neelsen staining for detection of acid-fast bacilli. From 2008 to 2016, we analysed by PCR, 2,287 samples of 2,203 cases from seventy-five health facilities in seven regions of Ghana (Ashanti, Brong Ahafo, Central, Eastern, Greater Accra, Northern and Volta). The mean annual positivity rate was 46.2% and ranged between 14.6% and 76.2%. The yearly positivity rates from 2008 to 2016 were 52.3%, 76.2%, 56.7%, 53.8%, 41.2%, 41.5%, 22.9%, 28.5% and 14.6% respectively. Of the 1,020 confirmed cases, the ratio of female to male was 518 and 502 respectively. Patients who were 15 years of age and below accounted for 39.8% of all cases. The median age was 20 years (IQR = 10–43). Ulcerative lesions were 69.2%, nodule (9.6%), plaque (2.9%), oedema (2.5%), osteomyelitis (1.1%), ulcer/oedema (9.5%) and ulcer/plaque (5.2%). Lesions frequently occurred on the lower limbs (57%) followed by the upper limbs (38%), the neck and head (3%) and the least found on the abdomen (2%).Conclusions/SignificanceOur findings show a decline in microbiological confirmed rates over the years and therefore call for intensive education on case recognition to prevent over-diagnosis as BU cases decline.

Global Epidemiology of Buruli Ulcer, 2010–2017, and Analysis of 2014 WHO Programmatic Targets

“…The PCR for the M. ulcerans IS2404 region has a high sensitivity and specificity to detect Buruli ulcer (35). A study in Ghana showed that >50% of 2,203 clinically diagnosed Buruli ulcer cases were actually not Buruli ulcer, as shown by PCR, culture, and histology (36). To avoid overdiagnosis of Buruli ulcer and unnecessary preemptive antimicrobial therapy, we suggest performing PCR in all cases before the initiation of chemotherapy, which is not the current common practice in many countries because of unavailability of the assay and long turnaround time for results where it is available.…”

Buruli Ulcer: Epidemiological, Clinical and Biological Profile of Patients in the Centre de Depistage et de Traitement d’Allada (Benin) from 2010 to 2014

“…The detection rate of BU in the Allada's CDTUB from 2010 to 2014 was 65 cases/year. This result is significantly higher than that observed in Ghana in 2016 [3] and Australia [4] A study in Guyana showed a decrease in incidence over time from an average of 6.07 cases/year in 1969 to 3.49 cases/year in 2013. These authors concluded that there was a change in the epidemiological profile of BU in Guyana from a…”

“…This is confirmed because children under 15 years of age constituted the majority of cases (57.7%). This is the age group reported as the most frequent in most studies conducted in endemic countries of West and Central Africa [3] [18]- [23]. This child dominance could be explained by several hypotheses of which the vulnerability of this age group due to a still immature immune system.…”

“…In our study, there was a clear predominance of ulcerous lesions; 69% versus 25.4% of pre-ulcerative lesions. The majority of previous studies, even in developed countries, report a prevalence well above 65% [3] [43]. This percentage must decrease to 60% in each district or country according to the WHO objective because ulcerative lesions require heavier therapeutic measures and more frequently lead to disabling sequelae [5].…”

Implementing active community-based surveillance-response system for Buruli ulcer early case detection and management in Ghana

“…The epidemiology of BU in endemic countries is not entirely known, due to several factors including the focal distribution of cases, late reporting of cases and lack of health facilities among others in endemic countries of Africa [10]. In Ghana, the first passive surveillance system reported about 1,200 BU cases between 1993 and 1998 and more than 9,000 BU cases were also reported between 2004 and 2014 [9, 11].…”