@article{96094,
  keywords = {Infectious Diseases, Public Health, Environmental and Occupational Health},
  author = {Please HR and Vas Nunes JH and Patel R and Pluschke G and Tholley M and Ruf M and Bolton W and Scott JA and Grobusch MP and Bolkan HA and Brown JM and Jayne DG},
  editor = {Converse PJ},
  title = {Chronic wounds in Sierra Leone: Searching for Buruli ulcer, a NTD caused by Mycobacterium ulcerans, at Masanga Hospital},
  abstract = {<jats:sec id="sec001">
<jats:title>Background</jats:title>
<jats:p>Chronic wounds pose a significant healthcare burden in low- and middle-income countries. Buruli ulcer (BU), caused by <jats:italic>Mycobacterium ulcerans</jats:italic> infection, causes wounds with high morbidity and financial burden. Although highly endemic in West and Central Africa, the presence of BU in Sierra Leone is not well described. This study aimed to confirm or exclude BU in suspected cases of chronic wounds presenting to Masanga Hospital, Sierra Leone.</jats:p>
</jats:sec>
<jats:sec id="sec002">
<jats:title>Methodology</jats:title>
<jats:p>Demographics, baseline clinical data, and quality of life scores were collected from patients with wounds suspected to be BU. Wound tissue samples were acquired and transported to the Swiss Tropical and Public Health Institute, Switzerland, for analysis to detect <jats:italic>Mycobacterium ulcerans</jats:italic> using qPCR, microscopic smear examination, and histopathology, as per World Health Organization (WHO) recommendations.</jats:p>
</jats:sec>
<jats:sec id="sec003">
<jats:title>Findings</jats:title>
<jats:p>Twenty-one participants with wounds suspected to be BU were enrolled over 4-weeks (Feb-March 2019). Participants were predominantly young working males (62% male, 38% female, mean 35yrs, 90% employed in an occupation or as a student) with large, single, ulcerating wounds (mean diameter 9.4cm, 86% single wound) exclusively of the lower limbs (60% foot, 40% lower leg) present for a mean 15 months. The majority reported frequent exposure to water outdoors (76%). Self-reports of over-the-counter antibiotic use prior to presentation was high (81%), as was history of trauma (38%) and surgical interventions prior to enrolment (48%). Regarding laboratory investigation, all samples were negative for BU by microscopy, histopathology, and qPCR. Histopathology analysis revealed heavy bacterial load in many of the samples. The study had excellent participant recruitment, however follow-up proved difficult.</jats:p>
</jats:sec>
<jats:sec id="sec004">
<jats:title>Conclusions</jats:title>
<jats:p>BU was not confirmed as a cause of chronic ulceration in our cohort of suspected cases, as judged by laboratory analysis according to WHO standards. This does not exclude the presence of BU in the region, and the definitive cause of these treatment-resistance chronic wounds is uncertain.</jats:p>
</jats:sec>},
  year = {2021},
  journal = {PLOS Neglected Tropical Diseases},
  volume = {15},
  pages = {e0009862},
  publisher = {Public Library of Science (PLoS)},
  issn = {1935-2735},
  url = {https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0009862&type=printable},
  doi = {10.1371/journal.pntd.0009862},
  language = {eng},
}