The location of Australian Buruli ulcer lesions—Implications for unravelling disease transmission

Yerramilli, Arvind; Tay, Ee Laine; Stewardson, Andrew J.; Kelley, Peter; Bishop, Emma J.; Jenkin, Grant A.; Starr, Mike; Trevillyan, Janine M; Hughes, Andrew; Friedman, N. Deborah; O’Brien, D. P.; Johnson, Paul D R

doi:10.1371/journal.pntd.0005800

Cited by 44 publications

(63 citation statements)

References 23 publications

(37 reference statements)

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“…This suggests that more people would have been exposed or infected in autumn, March-April (4.5 months median lag period) or November-February (9 months maximum lag period), which is the summer period in Victoria. This was similar to previous studies (15,35,36). This is not surprising as more outdoor activities occur during the summer and autumn periods.…”

Section: However Space-time Analysis Reports Disease Clustering In Besupporting

confidence: 93%

Descriptive analysis in time and space of recorded data for Buruli Ulcer occurrence in Victoria over 22 years

Avumegah¹,

Tay²,

Alexandersen

et al. 2018

Preprint

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BackgroundBuruli ulcer (BU) is a subcutaneous necrotic infection of the skin caused by Mycobacterium ulcerans. There has been increasing BU incidence in Victoria, Australia. The aim of this study to provide an epidemiological update of BU cases in Victoria to understand the pattern of distribution over time and space and attempt to identify local risk factors. MethodsA comprehensive descriptive epidemiological analyses were performed on BU notification data from 1994 to 2016. In addition, retrospective temporal, spatial and spatio-temporal analyses were conducted to understand the distribution of cases. Quantum GIS was used to generate maps. Demographic, new housing settlements and historical rainfall data were analysed to assess their effects on BU incidence in Victoria. FindingsThere were a total of 902 patients notified from 1994-2016. The incidence rate was 0.8/100,000 persons in Victoria. Space and time analyses showed that the most likely disease cluster was the Bellarine and Mornington Peninsulas with incidence rate 50 times higher than the State of Victoria rate. Gender was not a risk factor, but age was, with increased susceptibility among the over 60 year old group. There was an unusual high risk in the 15-24 age group in Point Lonsdale. Correlation analyses indicated that increase in population and construction of new settlements might be some of the reasons contributing to the rise in cases in Victoria.

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Section: However Space-time Analysis Reports Disease Clustering In Besupporting

confidence: 93%

Descriptive analysis in time and space of recorded data for Buruli Ulcer occurrence in Victoria over 22 years

Avumegah¹,

Tay²,

Alexandersen

et al. 2018

Preprint

Self Cite

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“…Buruli ulcer lesions are most common on limbs [1, 9, 12–16]. We postulate that skin on these areas of the body is more likely to be exposed to a contaminated environment than other areas of the body, for example the trunk.…”

Section: Introductionmentioning

confidence: 99%

“…This suggests an additional factor or factors are involved in the localisation of lesions beyond just direct environmental contact. For example, trauma, insect bites, or the preference of M. ulcerans to grow at cooler body sites [9]. This study aimed to investigate whether skin surface temperature distribution can explain variation in Buruli ulcer incidence in different regions of the body and between different demographics (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…Thirdly, M. ulcerans may be aerosolised from contaminated natural bodies of water, spread into the environment, then be inhaled and disseminated in the body [8]. The bacteria could then reactivate at cooler body sites [8, 9] as M. ulcerans prefers to grow in vitro at 30-33°C and growth is inhibited at higher temperatures [6], in a way analogous to Mycobacterium leprae , the causative organism of leprosy [10]. Human-to-human transmission is not thought to be of public health significance [11].…”

Section: Introductionmentioning

confidence: 99%

“…We postulate that skin on these areas of the body is more likely to be exposed to a contaminated environment than other areas of the body, for example the trunk. Recently, computer-generated density maps of Buruli ulcer lesion distribution have been created by analysing the locations of 649 confirmed lesions in Victoria, Australia from 1998-2015 [9]. A highly non-random distribution was found, favouring distal limbs, particularly ankles, calves and elbows.…”

Section: Introductionmentioning

confidence: 99%

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Does skin surface temperature variation account for Buruli ulcer lesion distribution?

Sexton-Oates

Stewardson

Yerramilli

et al. 2019

Preprint

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AbstractBackgroundBuruli ulcer is a necrotising infection of skin and soft tissue caused by Mycobacterium ulcerans (M. ulcerans). Buruli ulcer most often occurs on limbs, and it is hypothesized this is explained by direct exposure to the environment. However, even on exposed areas Buruli ulcer is not randomly distributed. M. ulcerans prefers an in vitro temperature of 30-33°C and growth is inhibited at higher temperatures. This study investigated whether variations in skin surface temperature distribution in healthy volunteers could partly account for Buruli ulcer lesion distribution.Methodology/Principal FindingsIn this observational study, a thermal camera (FLIR E8) was used to measure skin surface temperature at the sternal notch and at 44 predetermined locations on the limbs of 18 human participants. Body locations of high, middle and low Buruli ulcer incidence were identified from existing density maps of lesion distribution. Skin temperature of the three incidence location groups were compared, and differences in age and sex groups were also analysed.We found an inverse relationship between skin temperature and lesion distribution, where high incidence locations were significantly cooler and low incidence locations significantly warmer (Kruskal-Wallis test p<0.0001). Linear mixed effects regression analysis estimated that skin surface temperature accounts for 9.5% of the variance in Buruli ulcer lesion distribution (marginal R-squared = 0.095). Men had warmer upper and lower limbs than females (Mann-Whitney U test p=0.0003 and p<0.0001 respectively).Conclusions/SignificanceWe have found an inverse relationship between skin temperature and Buruli ulcer lesion distribution, however this association is weak. Additional unknown factors are likely to be involved that explain the majority of the variation in Buruli lesion distribution.Author SummaryBuruli ulcer is a destructive soft tissue infection caused by the bacterium Mycobacterium ulcerans. The precise mode of transmission remains unknown. One theory proposes that transmission occurs by direct contact with a contaminated environment. Lesions occur mostly on limbs, and it is hypothesized this is explained by direct exposure to the environment. However even on exposed areas, lesions are not randomly distributed. This study investigated whether skin surface temperature can partly explain Buruli ulcer lesion distribution. We measured the skin surface temperature of 18 healthy participants using a thermal camera and compared temperature distribution to the distribution of Buruli ulcer lesions investigated in a previously published study. We found that there is a negative correlation between skin temperature and Buruli ulcer lesion incidence. However, the association is weak and other factors e.g. clothing choice and insect biting patterns may explain the majority of Buruli ulcer lesion distribution.

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The body distribution of scabies skin lesions

Osti

Sokana²,

Lake

et al. 2022

JEADV Clinical Practice

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Background: The clinical diagnosis of scabies relies on the assessment of signs and symptoms and an improved understanding of the distribution of skin lesions may lead to improved diagnostic performance.Objectives: To investigate the detailed body distribution of scabies lesions and to explore the accuracy of simplified, focused examination approaches.Methods: We did a prospective, cross-sectional study in the Western Province of Solomon Islands (2019). Consenting individuals of all ages were eligible. The entire skin surface was examined, and the presence and number of typical scabies lesions were recorded at 98 topographic body sites, corresponding to 5 regions and 16 subregions. We compared the distribution at sites, regions and subregions overall, and by age and sex. We also calculated the expected sensitivity of examination of limited body areas. Choropleth maps were generated to provide detailed descriptions of the distribution of lesions.Results: A total of 467 individuals were enrolled (median age: 9 years [range: 0-86]; female: 54.6%) of whom 269 (57.6%) participants had typical scabies lesions.The most common sites for scabies lesions were the dorsal fingers (65.7% of participants with scabies lesions), dorsal finger web spaces (62.1%) and dorsal hands (61.7%). Of those less than 2 years old with scabies, eight (30.8%) had lesions at the head and neck region compared to 10.8% of those aged 2-5. Genital lesions were more common in males than females (27.3% vs. 7%, relative risk 3.9, 95% confidence interval: 1.2-2.1). Simplified, focused examinations were estimated have very high sensitivity (hands and wrists only: 93.3%; exposed arms and legs: 99.3%) compared to whole-body examinations. Conclusion:We report highly detailed descriptions of the body distribution of scabies lesions, including differences by age and sex. These data are valuable for training and diagnosis and support the use of simplified, focused examinations for scabies mapping.

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The location of Australian Buruli ulcer lesions—Implications for unravelling disease transmission

Cited by 44 publications

References 23 publications

Descriptive analysis in time and space of recorded data for Buruli Ulcer occurrence in Victoria over 22 years

Descriptive analysis in time and space of recorded data for Buruli Ulcer occurrence in Victoria over 22 years

Does skin surface temperature variation account for Buruli ulcer lesion distribution?

The body distribution of scabies skin lesions

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