Linking the Mycobacterium ulcerans environment to Buruli ulcer disease: Progress and challenges

Dhungel, Laxmi; Benbow, M. Eric; Jordan, Heather R.

doi:10.1016/j.onehlt.2021.100311

Cited by 18 publications

(13 citation statements)

References 96 publications

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“…No human-to-human transmission of this infection has ever been reported. The ecological characteristics and mode of transmission of M. ulcerans are not entirely understood, and several fundamental questions remain unanswered [16,17]. One key concern relates to the routes by which M. ulcerans crosses the human skin barrier.…”

Section: Introductionmentioning

confidence: 99%

A combined field study of Buruli ulcer disease in southeast Benin proposing preventive strategies based on epidemiological, geographic, behavioural and environmental analyses

Boccarossa

Degnonvi

Brou

et al. 2022

PLOS Glob Public Health

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Buruli ulcer is a neglected tropical disease caused by M. ulcerans, an environmental mycobacterium. This cutaneous infectious disease affects populations with poor access to sanitation, safe water and healthcare living in rural areas of West and Central Africa. Stagnant open bodies of surface water and slow-running streams are the only risk factor identified in Africa, and there is no human-to-human transmission. Appropriate and effective prevention strategies are required for populations living in endemic areas. Based on a multidisciplinary approach in an area in which Buruli ulcer is endemic in South Benin, we investigated the link between all human-environment interactions relating to unprotected water and behaviors associated with Buruli ulcer risk likely to affect incidence rates. We characterised the sources of water as well as water bodies and streams used by communities, by conducting a prospective case-control study directly coupled with geographic field observations, spatial analysis, and the detection of M. ulcerans in the environment. A full list of the free surface waters used for domestic activities was generated for a set of 34 villages, and several types of human behaviour associated with a higher risk of transmission were identified: (i) prolonged walking in water to reach cultivated fields, (ii) collecting water, (iii) and swimming. Combining the results of the different analyses identified the risk factor most strongly associated with Buruli ulcer was the frequency of contact with unprotected and natural water, particularly in regularly flooded or irrigated lowlands. We confirm that the use of clean water from drilled wells confers protection against Buruli ulcer. These specific and refined results provide a broader scope for the design of an appropriate preventive strategy including certain practices or infrastructures observed during our field investigations. This strategy could be improved by the addition of knowledge about irrigation practices and agricultural work in low-lying areas.

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Section: Introductionmentioning

confidence: 99%

A combined field study of Buruli ulcer disease in southeast Benin proposing preventive strategies based on epidemiological, geographic, behavioural and environmental analyses

Boccarossa

Degnonvi

Brou

et al. 2022

PLOS Glob Public Health

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“…ulcerans underneath the skin either through mechanical injury or through insect bites as mechanical vectors may be relevant for transmission of M . ulcerans from environmental reservoirs [ 22 , 23 ]. Understanding the route of transmission is critical to protect endemic communities.…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies investigated several risk factors that might facilitate the transmission of Buruli ulcer. For example, quantitative studies revealed that contact with unprotected fresh water bodies is associated with a high number of Buruli ulcer infections [ 16 , 22 , 23 , 31 ]. Stagnant and unprotected fresh water sources seem to present the highest risk [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Perceived water-related risk factors of Buruli ulcer in two villages of south-central Côte d’Ivoire

Leuenberger

Kone²,

N’krumah³

et al. 2022

PLoS Negl Trop Dis

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Background Buruli ulcer, caused by Mycobacterium ulcerans, is a neglected tropical skin disease that is primarily endemic in West and Central Africa, including Côte d’Ivoire. Studies indicate that M. ulcerans infections are caused by contact with an environmental reservoir of the bacteria, governed by specific human biological conditions. Yet, the nature of this reservoir and the exact mode of transmission remain unknown. Methodology To identify ecologic risk factors of Buruli ulcer in south-central Côte d’Ivoire, we pursued a qualitative study matched with geo-referencing inquiry. Embedded in a broader integrated wound management research project, we (i) mapped households and water sources of laboratory confirmed Buruli ulcer cases and (ii) interviewed 12 patients and four health care workers to assess exposure to surface water and to deepen the understanding of perceived transmission pathways. Principal findings Water availability, accessibility, and affordability were reported as key determinants for choosing water resources. Furthermore, perceived risks were related to environmental, structural, and individual factors. Despite the presence of improved water sources (e.g., drilled wells), communities heavily relied on unprotected surface water for a multitude of activities. The nearby Bandama River and seasonal waterbodies were frequently used for washing, bathing, and collection of water for drinking and cooking. Many residents also reported to cross the river on a daily basis for agricultural chores, and hence, are exposed to stagnant water during farming activities. Conclusions/significance Our study in two Buruli ulcer endemic villages in south-central Côte d’Ivoire revealed a wide range of water-related domestic activities that might expose people to an increased risk of contracting the disease. Environmental, biological, social, and cultural risk factors are closely interlinked and should be considered in future investigations of Buruli ulcer transmission. Active participation of the communities is key to better understand their circumstances to advance research and fight against Buruli ulcer and other neglected tropical diseases.

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“…Although transmission of M. ulcerans remains poorly understood, the main identified risk factor for acquiring Buruli ulcer is living in proximity of potentially contaminated water sources. One of the probable reservoirs of M. ulcerans is linked to the aquatic environment and humans are generally contaminated through activities involving sources of water as well as water bodies and streams [1][2][3][4][5][6]. M. ulcerans produces a toxin, mycolactone, which mediates host colonization and tissue damage [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…One of the probable reservoirs of M . ulcerans is linked to the aquatic environment and humans are generally contaminated through activities involving sources of water as well as water bodies and streams [ 1 – 6 ]. M .…”

Section: Introductionmentioning

confidence: 99%

Molecular and epidemiological characterization of recurrent Mycobacterium ulcerans infections in Benin

Gnimavo¹,

Besnard

Degnonvi

et al. 2021

PLoS Negl Trop Dis

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Background Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans, an environmental mycobacterium. Although transmission of M. ulcerans remains poorly understood, the main identified risk factor for acquiring Buruli ulcer is living in proximity of potentially contaminated water sources. Knowledge about the clinical features of Buruli ulcer and its physiopathology is increasing, but little is known about recurrence due to reinfection. Methodology/Principal findings We describe two patients with Buruli ulcer recurrence due to reinfection with M. ulcerans, as demonstrated by comparisons of DNA from the strains isolated at the time of the first diagnosis and at recurrence. Based on the spatial distribution of M. ulcerans genotypes in this region and a detailed study of the behavior of these two patients with respect to sources of water as well as water bodies and streams, we formulated hypotheses concerning the sites at which they may have been contaminated. Conclusions/Significance Second episodes of Buruli ulcer may occur through reinfection, relapse or a paradoxical reaction. We formally demonstrated that the recurrence in these two patients was due to reinfection. Based on the sites at which the patients reported engaging in activities relating to water, we were able to identify possible sites of contamination. Our findings indicate that the non-random distribution of M. ulcerans genotypes in this region may provide useful information about activities at risk.

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Linking the Mycobacterium ulcerans environment to Buruli ulcer disease: Progress and challenges

Cited by 18 publications

References 96 publications

A combined field study of Buruli ulcer disease in southeast Benin proposing preventive strategies based on epidemiological, geographic, behavioural and environmental analyses

A combined field study of Buruli ulcer disease in southeast Benin proposing preventive strategies based on epidemiological, geographic, behavioural and environmental analyses

Perceived water-related risk factors of Buruli ulcer in two villages of south-central Côte d’Ivoire

Molecular and epidemiological characterization of recurrent Mycobacterium ulcerans infections in Benin

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