Mapping the global distribution of Buruli ulcer: a systematic review with evidence consensus

Abstract

Summary Background Buruli ulcer can cause disfigurement and long-term loss of function. It is underdiagnosed and under-reported, and its current distribution is unclear. We aimed to synthesise and evaluate data on Buruli ulcer prevalence and distribution. Methods We did a systematic review of Buruli ulcer prevalence and used an evidence consensus framework to describe and evaluate evidence for Buruli ulcer distribution worldwide. We searched PubMed and Web of Science databases from inception to Aug 6, 2018, for records of Buruli ulcer and Mycobacterium ulcerans detection, with no limits on study type, publication date, participant population, or location. English, French, and Spanish language publications were included. We included population-based surveys presenting Buruli ulcer prevalence estimates, or data that allowed prevalence to be estimated, in the systematic review. We extracted geographical data on the occurrence of Buruli ulcer cases and M ulcerans detection from studies of any type for the evidence consensus framework; articles that did not report original data were excluded. For the main analysis, we extracted prevalence estimates from included surveys and calculated 95% CIs using Byar’s method. We included occurrence records, reports to WHO and the Global Infectious Diseases and Epidemiology Network, and surveillance data from Buruli ulcer control programmes in the evidence consensus framework to grade the strength of evidence for Buruli ulcer endemicity. This study is registered with PROSPERO, number CRD42018116260. Findings 2763 titles met the search criteria. We extracted prevalence estimates from ten studies and occurrence data from 208 studies and five unpublished surveillance datasets. Prevalence estimates within study areas ranged from 3·2 (95% CI 3·1–3·3) cases per 10000 population in Côte d’Ivoire to 26·9 (23·5–30·7) cases per 10000 population in Benin. There was evidence of Buruli ulcer in 32 countries and consensus on presence in 12. Interpretation The global distribution of Buruli ulcer is uncertain and potentially wider than currently recognised. Our findings represent the strongest available evidence on Buruli ulcer distribution so far and have many potential applications, from directing surveillance activities to informing burden estimates. Funding AIM Initiative.

Vaccine-specific immune responses againstMycobacterium ulceransinfection in a low-dose murine challenge model

“…via an insect bite) (10-12). BU-endemic areas include certain regions of West and Sub-Saharan Africa and south eastern Australia (13, 14).…”

Structural Basis and Designing of Peptide Vaccine using PE-PGRS Family Protein of Mycobacterium ulcerans – An Integrated Vaccinomics Approach

“…Buruli ulcer is a neglected tropical disease of the skin characterized by chronic skin lesions and tissue necrosis leading to permanent cosmetic deformity and functional disability affecting thousands of people worldwide (Pluschke and Röltgen 2015;Simpson et al 2019;Barksby 2019). Despite being endemic to West and Central Africa (Johnson 2019), Buruli ulcer has been reported from more than 34 countries worldwide including countries from South America and Western Pacific regions (Pluschke and Röltgen 2015;Singh et al 2019;Simpson et al 2019). About 80% of cases were from West African countries i.e., Côte d'Ivoire, Ghana, Benin and Cameroon (Mitra AK 2017).…”

“…About 80% of cases were from West African countries i.e., Côte d'Ivoire, Ghana, Benin and Cameroon (Mitra AK 2017). However, there is no consensus on the current distribution of this mycobacterial disease, except for 12 countries which constitute ⁓34,890 reported cases worldwide from 2007 to 2016 (Simpson et al 2019). Buruli ulcer has become the third most common mycobacterial disease after tuberculosis and leprosy (Phillips et al 2015;Huygen et al 2009).…”

“…Mycobacterium ulcerans (M. ulcerans) is the causative agent of Buruli ulcer (N'krumah et al 2016;Singh et al 2019;Simpson et al 2019). The pathogen M. ulcerans has evolved from the fish pathogen M. marinum which rarely causes skin lesions in humans (Yip et al 2007;Petrini 2006).…”

“…Buruli ulcer has become a major public health concern due to the lack of specific treatment and preventive measures (Simpson et al 2019;Johnson 2019;Singh et al 2019). Despite the effectiveness of antibiotics against Buruli ulcer, failures of treatment are common and the pathogen is prone to develop resistance (Phillips et al 2015).…”