03381nas a2200313 4500000000100000008004100001260003700042653002400079653005700103100001400160700001700174700001200191700001500203700001400218700001000232700001300242700001300255700001600268700001400284700001300298700001300311700001600324245012400340856009900464300001300563490000700576520247000583022001403053 2021 d bPublic Library of Science (PLoS) 10 aInfectious Diseases 10 aPublic Health, Environmental and Occupational Health 1 aPlease HR 1 aVas Nunes JH 1 aPatel R 1 aPluschke G 1 aTholley M 1 aRuf M 1 aBolton W 1 aScott JA 1 aGrobusch MP 1 aBolkan HA 1 aBrown JM 1 aJayne DG 1 aConverse PJ 00 aChronic wounds in Sierra Leone: Searching for Buruli ulcer, a NTD caused by Mycobacterium ulcerans, at Masanga Hospital uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0009862&type=printable ae0009862 0 v15 3 a
Background
Chronic wounds pose a significant healthcare burden in low- and middle-income countries. Buruli ulcer (BU), caused by Mycobacterium ulcerans 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.
Methodology
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 Mycobacterium ulcerans using qPCR, microscopic smear examination, and histopathology, as per World Health Organization (WHO) recommendations.
Findings
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.
Conclusions
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.
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