Dataset containing records of human cases of Buruli ulcer collated through literature review and ... more Dataset containing records of human cases of Buruli ulcer collated through literature review and from surveillance programmes by national control programmes.
Background Previous studies have reported that presence and severity of Buruli ulcer (BU) may ref... more Background Previous studies have reported that presence and severity of Buruli ulcer (BU) may reflect the underlying immunosuppression in HIV infected individuals by causing increased incidence of multiple, larger and ulcerated lesions. We report cases of BU-HIV coinfection and the accompanying programmatic challenges encountered in central Ghana. Methods Patients with PCR confirmed BU in central Ghana who were HIV positive were identified and their BU01 forms were retrieved and reviewed in further detail. A combined 16S rRNA reverse transcriptase / IS2404 qPCR assay was used to assess the Mycobacterium ulcerans load. The characteristics of coinfected patients (BU + HIV + ) were compared with a group of matched controls. Results The prevalence of HIV in this BU cohort was 2.4% (compared to national HIV prevalence of 1.7%). Eight of 9 BU + HIV + patients had a single lesion and ulcers were the most common lesion type. The lesions presented were predominantly category II (5/9) followe...
BackgroundBuruli ulcer (BU) is a disabling and stigmatising neglected tropical disease (NTD). Its... more BackgroundBuruli ulcer (BU) is a disabling and stigmatising neglected tropical disease (NTD). Its distribution and burden are unknown because of underdiagnosis and underreporting. It is caused by Mycobacterium ulcerans, an environmental pathogen whose environmental niche and transmission routes are not fully understood. Active BU case searches can limit morbidity by identifying cases and linking them to treatment, but these are mostly restricted to well-known endemic areas. A better understanding of environmental suitability for environmental reservoirs of M. ulcerans and BU disease would advance understanding of the disease’s ecology and burden, and could inform targeted surveillance.Methodology/Principal FindingsWe used previously compiled point-level datasets of BU and M. ulcerans occurrence, evidence for BU occurrence within national and sub-national areas, and diverse environmental datasets. We fitted relationships between BU and M. ulcerans occurrence and environmental predict...
Buruli ulcer, caused by Mycobacterium ulcerans, is highly endemic in West Africa. While the mode ... more Buruli ulcer, caused by Mycobacterium ulcerans, is highly endemic in West Africa. While the mode of transmission is unknown, many studies associate Buruli ulcer with different types of water exposure. We present results from the largest study to date to test for M. ulcerans in aquatic sites and identify environmental attributes associated with its presence. Environmental samples from 98 aquatic sites in the Greater Accra, Ashanti, and Volta regions of Ghana were tested for the presence of M. ulcerans DNA by polymerase chain reaction. The proportion of aquatic sites positive for M. ulcerans varied by region: Ashanti 66% (N = 39), Greater Accra 34% (N = 29), and Volta 0% (N = 30). We explored the spatial distribution of M. ulcerans positive and negative water bodies and found no significant clusters. We also determined both highly localized water attributes and broad scale remotely sensed land cover and terrain environmental characteristics associated with M. ulcerans presence through...
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2005
We studied hospital records of 750 consecutive Buruli ulcer patients in a highly endemic area in ... more We studied hospital records of 750 consecutive Buruli ulcer patients in a highly endemic area in Amansie West, Ghana. Although more Buruli ulcer lesions were found on the right side of the body, comparison of lesions on arms and legs showed a bilaterally symmetrical distribution. Upper and lower extremities were affected equally by Buruli ulcers, if correction was made for differences in body surface area. Patients from outside the Amansie West district presented significantly more often with ulcerated lesions, which were more often located on a joint, than patients who lived in Amansie West, suggesting that longer travel distance might have caused delay. Our observations of a bilaterally symmetrical distribution of lesions on extremities and equal upper and lower extremity involvement are compatible with a mode of transmission that involves passive exposure of exposed body parts. An asymmetrical distribution of lesions was found in an earlier study, suggesting transmission by vegetation near the ground, through activities like farming or play. Perhaps, transmission in or near water, e.g. by bites of infected aquatic insects, might favour the pattern of distribution of lesions that we found.
Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of W... more Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of West Africa, and current management is by surgical excision of skin lesions ranging from early nodules to extensive ulcers (Buruli ulcer). Antibiotic therapy would be more accessible to patients in areas of Buruli ulcer endemicity. We report a study of the efficacy of antibiotics in converting early lesions (nodules and plaques) from culture positive to culture negative. Lesions were excised either immediately or after treatment with rifampin orally at 10 mg/kg of body weight and streptomycin intramuscularly at 15 mg/kg of body weight daily for 2, 4, 8, or 12 weeks and examined by quantitative bacterial culture, PCR, and histopathology for M. ulcerans. Lesions were measured during treatment. Five lesions excised without antibiotic treatment and five lesions treated with antibiotics for 2 weeks were culture positive, whereas three lesions treated for 4 weeks, five treated for 8 weeks, and ...
Pan African Medical Journal Conference Proceedings
Introduction : buruli Ulcer (BU) is a chronic debilitating skin disease caused by Mycobacterium u... more Introduction : buruli Ulcer (BU) is a chronic debilitating skin disease caused by Mycobacterium ulcerans. It is the third most widespread mycobacterium infection after tuberculosis and leprosy globally but second in Ghana; causing morbidity in immuno-competent humans. M. ulcerans infection leads to chronic ulcers, deformities and functional limitation and its virulence depend on mycolactone. BU surveillance data are not adequately analysed to effectively identify the distribution of BU disease at regional levels. BU data was therefore analysed to identify the distribution of the disease in Greater Accra Region, Ghana. Methods : data from 2011 to 2015 was extracted from the BU02 forms in the Greater Accra Region. Variables collected were sex, age, district of residence, categories of lesions, location of lesions and clinical forms. Descriptive analysis was done and expressed as frequencies and graphs using Epi info7. b>Results : a total of 496 confirmed cases were reported in the region. The mean age of the patients was 28.9±21.5years. The minimum and maximum ages were 1 year and 100 years. Yearly trends showed cases decreased from 223 (45%) in 2011 to 27 (5.4%) in 2015 with 52.2% being males and 38.3% children Conclusion : the number of reported BU cases decreased considerably over the period with most patients presenting at the late stage (Cat III) of the disease. The majority of patients are in Ga South but access health care in Ga West. Public education and national awareness about the disease should be intensified and more resources allocated to Ga West.
The American journal of tropical medicine and hygiene, 2005
The reliability and validity of the earlier developed Buruli ulcer functional limitation score (B... more The reliability and validity of the earlier developed Buruli ulcer functional limitation score (BUFLS) questionnaire was assessed. Of 638 former Buruli ulcer patients (of 678 individuals examined), sufficient items on daily activities (>or= 13 of the 19) were applicable to calculate a score. To determine the validity, the functional limitation scores of the 638 individuals were compared with the global impression of the limitations, range of motion (ROM), and the social impact (change of occupation or education) of Buruli ulcer. To determine inter-observer reliability, the functional limitation score was reassessed in 107 participants within one and three weeks after the first interview by another interviewer and interpreter. Both global impression and ROM correlated well with the functional limitation scores (rho = 0.66 and rho = 0.61). The inter-observer reliability of 107 participants as measured by an intra-class correlation coefficient of 0.86 was very good. The functional l...
The American journal of tropical medicine and hygiene, 2004
Buruli ulcer, a disease with long-term consequences, is emerging in west Africa. Thus, a function... more Buruli ulcer, a disease with long-term consequences, is emerging in west Africa. Thus, a functional limitation scoring system is needed to assess its nature and severity. A list of daily activities was developed for this disease. Following treatment of Buruli ulcer, persons in Benin (n = 47) and Ghana (n = 41) were investigated. Nineteen items were identified with good internal consistency. Participants (median age = 14 years) could not perform 23% of their daily activities. Twenty-nine participants did not have any functional limitation. The average limitation score was 31% in Benin and 15% in Ghana (P = 0.006). The mean limitation score in participants without visible contractures (n = 65) was 13%, whereas patients with visible contractures (n = 20) or an amputation (n = 3) had a score of more than 50%. Validity and reliability should be further analyzed to optimize the scale for use in individual evaluation, as an end point in intervention trials, and in planning of resources nee...
Dataset containing records of human cases of Buruli ulcer collated through literature review and ... more Dataset containing records of human cases of Buruli ulcer collated through literature review and from surveillance programmes by national control programmes.
Background Previous studies have reported that presence and severity of Buruli ulcer (BU) may ref... more Background Previous studies have reported that presence and severity of Buruli ulcer (BU) may reflect the underlying immunosuppression in HIV infected individuals by causing increased incidence of multiple, larger and ulcerated lesions. We report cases of BU-HIV coinfection and the accompanying programmatic challenges encountered in central Ghana. Methods Patients with PCR confirmed BU in central Ghana who were HIV positive were identified and their BU01 forms were retrieved and reviewed in further detail. A combined 16S rRNA reverse transcriptase / IS2404 qPCR assay was used to assess the Mycobacterium ulcerans load. The characteristics of coinfected patients (BU + HIV + ) were compared with a group of matched controls. Results The prevalence of HIV in this BU cohort was 2.4% (compared to national HIV prevalence of 1.7%). Eight of 9 BU + HIV + patients had a single lesion and ulcers were the most common lesion type. The lesions presented were predominantly category II (5/9) followe...
BackgroundBuruli ulcer (BU) is a disabling and stigmatising neglected tropical disease (NTD). Its... more BackgroundBuruli ulcer (BU) is a disabling and stigmatising neglected tropical disease (NTD). Its distribution and burden are unknown because of underdiagnosis and underreporting. It is caused by Mycobacterium ulcerans, an environmental pathogen whose environmental niche and transmission routes are not fully understood. Active BU case searches can limit morbidity by identifying cases and linking them to treatment, but these are mostly restricted to well-known endemic areas. A better understanding of environmental suitability for environmental reservoirs of M. ulcerans and BU disease would advance understanding of the disease’s ecology and burden, and could inform targeted surveillance.Methodology/Principal FindingsWe used previously compiled point-level datasets of BU and M. ulcerans occurrence, evidence for BU occurrence within national and sub-national areas, and diverse environmental datasets. We fitted relationships between BU and M. ulcerans occurrence and environmental predict...
Buruli ulcer, caused by Mycobacterium ulcerans, is highly endemic in West Africa. While the mode ... more Buruli ulcer, caused by Mycobacterium ulcerans, is highly endemic in West Africa. While the mode of transmission is unknown, many studies associate Buruli ulcer with different types of water exposure. We present results from the largest study to date to test for M. ulcerans in aquatic sites and identify environmental attributes associated with its presence. Environmental samples from 98 aquatic sites in the Greater Accra, Ashanti, and Volta regions of Ghana were tested for the presence of M. ulcerans DNA by polymerase chain reaction. The proportion of aquatic sites positive for M. ulcerans varied by region: Ashanti 66% (N = 39), Greater Accra 34% (N = 29), and Volta 0% (N = 30). We explored the spatial distribution of M. ulcerans positive and negative water bodies and found no significant clusters. We also determined both highly localized water attributes and broad scale remotely sensed land cover and terrain environmental characteristics associated with M. ulcerans presence through...
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2005
We studied hospital records of 750 consecutive Buruli ulcer patients in a highly endemic area in ... more We studied hospital records of 750 consecutive Buruli ulcer patients in a highly endemic area in Amansie West, Ghana. Although more Buruli ulcer lesions were found on the right side of the body, comparison of lesions on arms and legs showed a bilaterally symmetrical distribution. Upper and lower extremities were affected equally by Buruli ulcers, if correction was made for differences in body surface area. Patients from outside the Amansie West district presented significantly more often with ulcerated lesions, which were more often located on a joint, than patients who lived in Amansie West, suggesting that longer travel distance might have caused delay. Our observations of a bilaterally symmetrical distribution of lesions on extremities and equal upper and lower extremity involvement are compatible with a mode of transmission that involves passive exposure of exposed body parts. An asymmetrical distribution of lesions was found in an earlier study, suggesting transmission by vegetation near the ground, through activities like farming or play. Perhaps, transmission in or near water, e.g. by bites of infected aquatic insects, might favour the pattern of distribution of lesions that we found.
Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of W... more Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of West Africa, and current management is by surgical excision of skin lesions ranging from early nodules to extensive ulcers (Buruli ulcer). Antibiotic therapy would be more accessible to patients in areas of Buruli ulcer endemicity. We report a study of the efficacy of antibiotics in converting early lesions (nodules and plaques) from culture positive to culture negative. Lesions were excised either immediately or after treatment with rifampin orally at 10 mg/kg of body weight and streptomycin intramuscularly at 15 mg/kg of body weight daily for 2, 4, 8, or 12 weeks and examined by quantitative bacterial culture, PCR, and histopathology for M. ulcerans. Lesions were measured during treatment. Five lesions excised without antibiotic treatment and five lesions treated with antibiotics for 2 weeks were culture positive, whereas three lesions treated for 4 weeks, five treated for 8 weeks, and ...
Pan African Medical Journal Conference Proceedings
Introduction : buruli Ulcer (BU) is a chronic debilitating skin disease caused by Mycobacterium u... more Introduction : buruli Ulcer (BU) is a chronic debilitating skin disease caused by Mycobacterium ulcerans. It is the third most widespread mycobacterium infection after tuberculosis and leprosy globally but second in Ghana; causing morbidity in immuno-competent humans. M. ulcerans infection leads to chronic ulcers, deformities and functional limitation and its virulence depend on mycolactone. BU surveillance data are not adequately analysed to effectively identify the distribution of BU disease at regional levels. BU data was therefore analysed to identify the distribution of the disease in Greater Accra Region, Ghana. Methods : data from 2011 to 2015 was extracted from the BU02 forms in the Greater Accra Region. Variables collected were sex, age, district of residence, categories of lesions, location of lesions and clinical forms. Descriptive analysis was done and expressed as frequencies and graphs using Epi info7. b>Results : a total of 496 confirmed cases were reported in the region. The mean age of the patients was 28.9±21.5years. The minimum and maximum ages were 1 year and 100 years. Yearly trends showed cases decreased from 223 (45%) in 2011 to 27 (5.4%) in 2015 with 52.2% being males and 38.3% children Conclusion : the number of reported BU cases decreased considerably over the period with most patients presenting at the late stage (Cat III) of the disease. The majority of patients are in Ga South but access health care in Ga West. Public education and national awareness about the disease should be intensified and more resources allocated to Ga West.
The American journal of tropical medicine and hygiene, 2005
The reliability and validity of the earlier developed Buruli ulcer functional limitation score (B... more The reliability and validity of the earlier developed Buruli ulcer functional limitation score (BUFLS) questionnaire was assessed. Of 638 former Buruli ulcer patients (of 678 individuals examined), sufficient items on daily activities (>or= 13 of the 19) were applicable to calculate a score. To determine the validity, the functional limitation scores of the 638 individuals were compared with the global impression of the limitations, range of motion (ROM), and the social impact (change of occupation or education) of Buruli ulcer. To determine inter-observer reliability, the functional limitation score was reassessed in 107 participants within one and three weeks after the first interview by another interviewer and interpreter. Both global impression and ROM correlated well with the functional limitation scores (rho = 0.66 and rho = 0.61). The inter-observer reliability of 107 participants as measured by an intra-class correlation coefficient of 0.86 was very good. The functional l...
The American journal of tropical medicine and hygiene, 2004
Buruli ulcer, a disease with long-term consequences, is emerging in west Africa. Thus, a function... more Buruli ulcer, a disease with long-term consequences, is emerging in west Africa. Thus, a functional limitation scoring system is needed to assess its nature and severity. A list of daily activities was developed for this disease. Following treatment of Buruli ulcer, persons in Benin (n = 47) and Ghana (n = 41) were investigated. Nineteen items were identified with good internal consistency. Participants (median age = 14 years) could not perform 23% of their daily activities. Twenty-nine participants did not have any functional limitation. The average limitation score was 31% in Benin and 15% in Ghana (P = 0.006). The mean limitation score in participants without visible contractures (n = 65) was 13%, whereas patients with visible contractures (n = 20) or an amputation (n = 3) had a score of more than 50%. Validity and reliability should be further analyzed to optimize the scale for use in individual evaluation, as an end point in intervention trials, and in planning of resources nee...
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