Presumptive Diagnosis of Buruli Ulcer based on Clinical Presentations

Objectives: Buruli ulcer disease (BUD) is a neglected tropical disease of the skin, subcutaneous tissue and occasionally bone. Except in endemic areas, the diagnosis of BUD can be a challenge. This study was an attempt to presumptively identify cases of Buruli ulcer in the absence of a laboratory confirmation. Methods: A presumptive diagnosis of Buruli ulcer by directly comparing clinical presentations with WHO-confirmed pictorial images of the disease was carried out on patients with suspected Buruli ulcers presenting to two government-owned hospitals in Ogun State, South-West, Nigeria. Results: Eighteen suspected cases of BUD from as many outpatients were identified within a three-month period, comprising 13 (72.2%) females and five (27.8%) males. 10 (55.6%) and eight (44.4%) of them were from the tertiary and secondary health facilities, respectively. Eleven (61%) of the ulcers were located on the leg, four (22%) on the breast and four (22%) on the hand. 14 (77.8%) of the patients were above 40 years of age, two (11.1%) were between 18 and 30 years while only two (11.1%) were below 15 years. 16 (89%) of the patients could not remember how the ulcer started while two (11%) of them said their lesions started with a scratch. 7(39%) of the ulcers were painless; 11 (61%) were minimally painful while 15 (83%) had undermined edges which are presentations consistent with Buruli ulcer disease. Conclusions: The detection of these ulcers in just two hospitals and within a period of three months is significant and suggestive of Buruli ulcer being probably more prevalent in South-west Nigeria than aforethought. J Microbiol Infect Dis 2017; 7(1): 36-41

___

  • 1. Bratschi MW, Ruf M, Andreoli A, et al. Mycobacterium ulcerans Persistence at Village water Source of Buruli Ulcer Patients. PLoS Negl Trop Dis 2014; 8(3):e2756.
  • 2. Komolafe OO. Buruli ulcer in Malawi – a first report. Malawi Med J 2001; 13(3): 37-39.
  • 3. Walsh DS, Portaels F, Meyers WM. Buruli ulcer: Advances in understanding Mycobacterium ulcerans infection. Dermatol Clin.2011; 29(1): 1-8.
  • 4. Asiedu K, Raviglione M, Scherpbier R. Buruli ulcer (Mycobacterium ulcerans infection) (WHO/COS/CPE/GBUI/2000.1) Geneva: WHO (2000).
  • 5. Gray HH, Kingma S. Mycobacterial skin ulcers in Nigeria. Trans R Soc Trop Dis Hyg1967; 61(5):712- 14.
  • 6. Oluwasanmi JO, Solankee TF, Oluri EO, Itayemi SO, Alabi GO, Lucas AO. Mycobacterium ulcerans (Buruli) skin ulceration in Nigeria. Am J Trop Med Hyg 1976; 25:122-128.
  • 7. Janssens PG, Pattyn SR, Meyers WM, Portaels F. Buruli ulcer: an historical overview with updating to 2005. Bulletin des séances Académie Royale des Sciences d'outre-mer, Brussels 2005; 51:165-159.
  • 8. Chukwuekezie O, Ampadu E, Sopoh G, et al. Buruli ulcer, Nigeria (Letter). Emerg Infect Dis 2007; 13 (5): 782-783.
  • 9. Debackers M, Aguiar J, Steunou C. Mycobacterium ulcerans disease (Buruli ulcer) in rural hospital, Southern Benin (1997 – 2001). Emerg Infect Dis 2004; 10:1391-1398.
  • 10. Noeske J, Kuaban C, Rondini S. Buruli ulcer disease in Cameroon rediscovered. Am J of Trop Med Hyg 2004; 70: 520-6.
  • 11. Marion E, Carolan K, Adeye A, Kempf M, Chauty A, Marsollier L. Buruli ulcer in South Western Nigeria: A Retrospective Cohort Study of Patients Treated in Benin. PLoS Negl Trop Dis 2015; 9(1): e3443.
  • 12. Vincent QB, Ardant MF, Adeye A, et al. Clinical epidemiology of laboratory-confirmed Buruli ulcer in Benin: a cohort study. Lancet Glob Health 2014; 2(7): e422-430.
  • 13. Nakanaga K, Hoshino Y, Yotsu RR, Makino M, Ishii N. Nineteen cases of Buruli ulcer diagnosed in Japan from 1980 to 2010. J Clin Microbiol 2011; 49(11):3829-3836.
  • 14. Nienhuis WA, Stienstra Y, Thompson WA, et al. Antimicrobial treatment for early, limited Mycobacterium ulcerans infection: a randomized controlled trial. Lancet 2010; 375(9715):664-672.
  • 15. WHO. Treatment of Mycobacterium ulcerans Disease (Buruli ulcer): Guidance for health workers. Geneva 2012; 1-66.
  • 16. Velding K, Klis S, Abass KM, Tuah W, Stienstra Y, Werf T. Wound Care in Buruli Ulcer Disease in Ghana and Benin Am J Trop Med Hyg 2014; 91(2): 313–318.
  • 17.de Zeeuw J, Alferink M, Barogui YT, et al. Assessment and Treatment of Pain during Treatment of Buruli Ulcer. PLoS Negl Trop Dis.2015;9(9): e0004076.