ABSTRACT:

Background: Buruli ulcer is a chronic, debilitating, necrotizing disease of the skin and soft tissue caused by Mycobacterium ulcerans. Early detection and appropriate treatment of the patients are currently the most important measures for preventing the debilitating consequences of the disease.

Objective: To assess the clinical profile of Buruli ulcer patients presenting in a referral hospital in Anambra state, Nigeria.
Methods: A cross-sectional descriptive study was carried out among a cohort of 39 Buruli ulcer disease patients referred to a referral hospital in Anambra State between July and December 2021. A semi-structured, interviewer-administered questionnaire was used to collect data on the socio-demographic characteristics and the clinical presentation of the patients. Data were analyzed using SPSS version 22; with alpha set at p-value ≤ 0.05.
Results: Twenty one (53.8%) of the study participants were males while 18 (46.2%) were females. Their mean age was 28.41±18.668. Active lesions in the form of ulcers were seen in 38 (97.4%) of the participants while lesions were seen in the lower limbs in 35 (87.2%) of them. Statistically significant association existed between the clinical presentation of Buruli ulcer disease and the occupation of the respondents (p ≤ 0.05).
Conclusions: Buruli ulcer still exists in the Nigeria and presents majorly with ulcers on the lower limbs. Public health efforts aimed at patient education and to assist with early detection of the disease to minimize associated morbidity should be instituted.

KEYWORDS:

Buruli ulcer, clinical profile, hospital, Anambra State, Nigeria

REFERENCES :

1) Walsh D, Portaels F, Meyers W. Buruli ulcer: Advances in understanding Mycobacterium ulcerans infection. Dermatol Clin. 2011;29:1-8.
2) Bratschi M, Bolz M, Minyem J, Grize L, Wantong F, Kerber S, et al. Geographic distribution, age pattern and sites of lesions in a cohort of buruli ulcer patients from the Mapé Basin of Cameroon. PLO Negl Trop Dis. 2013;7.
3) Zingue D, Bouam A, Tian R, Drancourt M. 2018. Buruli ulcer, a prototype for ecosystem-related infection caused by Mycobacterium ulcerans. Clin Microbiol Rev. 2018; 31:e00045-17.
4) Van der Werf T, Stienstra Y, Johnson R, Phillips R, Adjei O, Fleischer B, et al. Mycobacterium ulcerans disease. Bull World Health Organ. 2005; 83:785–791
5) Huang GKL, Johnson PD. Epidemiology and management of Buruli ulcer. Expert Rev Anti Infect Ther. 2014;12:855–65.
6) World Health Organization. Buruli ulcer disease factsheet. 2015. Available from:
http://www.who.int/mediacentre/factsheets/fs199/en/index.html [Accessed April 3, 2021]
7) World Health Organization. Incidence, prevalence and mapping of Buruli ulcer. Available from:
http://www.who.int/buruli/research/priorities/healthmapping/en/ [Accessed April 3, 2021]
8) Mavinga PD, Suykerbuyk P, Saunderson P, Ngwala LP, Masamba MJB, Imposo DB, et al. Burden of Mycobacteriumulcerans disease (Buruli ulcer) and the underreporting ratio in the territory of Songololo, Democratic Republic of Congo. PLoS Negl Trop Dis. 2013;7:e2563.
9) Merritt RW, Walker ED, Small PLC, Wallace JR, Johnson PDR, Benbow ME, et al. Ecology and Transmission of Buruli Ulcer Disease: A Systematic Review. PLoS Negl Trop Dis. 2010;4:e911.
10) World Health Organization. Buruli ulcer disease (Mycobacterium ulcerans infection). Available from:

http://www.who.int/mediacentre/factsheets/fs199/en/. [Accessed April 3, 2021]
11) Ukwaja KN, Meka AO, Chukwuka A, Asiedu KB, Huber KL, Eddyani M, et al. Buruli ulcer in Nigeria: results of a pilot case study in three rural districts. Infect Dis Poverty. 2016; 5: 39.
12) Chukwuekezie O, Ampadu E, Sopoh G, Dossou A, Tiendrebeogo A, Sadiq L, et al. Buruli ulcer, Nigeria. Emerg Infect Dis. 2007;13:782–3.
13) Gray HH, Kingma S, Kok SH. Mycobacterial skin ulcers in Nigeria. Trans R Soc Trop Med Hyg. 1967;61:712–4.
14) Oluwasanmi JO, Solankee TF, Olurin EO, Itayemi SO, Alabi GO, Lucas AO. Mycobacterium ulcerans (Buruli) skin ulceration in Nigeria. Am J Trop Med Hyg. 1976;25:122–8.
15) Janssens PG, Pattyn SR, Meyers WM, Portaels F. Buruli ulcer: an historical overview with updating to 2005. Bull Seances Acad R Sci Outre Mer. 2005;51:165–99.
16) Debacker M, Aguiar J, Steunou C, Zinsou C, Meyers WM, Guedenon A, et al. Mycobacterium ulcerans disease (Buruli ulcer) in rural hospital, southern Benin, 1997–2001. Emerg Infect Dis. 2004;10:1391–8
17) Noeske J, Kuaban C, Rondini S, Sorlin P, Ciaffi L, Mbuagbaw J, et al. Buruli ulcer disease in Cameroon rediscovered. Am J Trop Med Hyg. 2004;70:520–6.
18) Adogu POU, Igwe JC, Chineke HN, Egenti NB. Risk factors for buruli ulcer in a referral mission hospital in Anambra State, Nigeria: A case-control study. Edorium J Public Health. 2018;5:100018P1AP2018.
19) Yotsu RR, Murase C, Sugawara M, Suzuki K, Nakanaga K, Ishii N, et al. Revisiting Buruli ulcer. J Dermatol. 2015. 42 (11):1033-41.
20) O’Brien DP, Wynne JW, Buultjens AH, Michalski WP, Stinear TP, Friedman ND, et al. Exposure risk for infection and lack of human-to-human transmission of Mycobacterium ulcerans disease, Australia. Emerg Infect Dis. 2017;23(5):837–40.
21) Chany AC, Tresse C, Casarotto V, Blanchard N. History, biology and chemistry of Mycobacterium ulcerans infections (Buruli ulcer disease). Nat Prod Rep. 2013;30(12):1527-67.
22) Pommelet V, Vincent QB, Ardant MF, Adeye A, Tanase A, Tondeur L, et al. Findings in patients from Benin with osteomyelitis and polymerase chain reaction-confirmed Mycobacterium ulcerans infection. Clin Infect Dis. 2014 Nov 1. 59 (9):1256-64.
23) Minutilli E, Orefici G, Pardini M, et al. Squamous cell carcinoma secondary to buruli ulcer. Dermatol Surg. 2007;33(7):872-5.
24) Stienstra Y, van der Werf TS, Oosterom E, Nolte IM, van der Graff WTA, Etuaful S, et al. Susceptibility to Buruli ulcer is associated with the SLC11A1 (NRAMP1) D543N polymorphism. Genes Immun. 2006;7(3):185-9.
25) Foxcroft G. Witchcraft accusations: A protection concern for UNHCR and the Wider Humanitarian Community? Paper Presented to UNHCR. Lancaster, United Kingdom: Child Rights Information Network [online]. 2009. Available from:
www.crin.org/docs/Stepping_stones_witchcraft.pdf. [Accessed January 24, 2022]
26) Grietens KP, Boock AU, Peeters H, Hausmann-Muela S, Toomer E, Ribera JM. “It is me who endures but my family that suffers”: Social isolation as a consequence of the household cost burden of Buruli ulcer free of charge hospital treatment. PLoS Negl Trop Dis. 2008;2(10):e321.
27) Perera M, Whitehead M, Molyneux D, Weerasooriya M, Gunatilleke G. Neglected patients with a neglected disease? A qualitative study of lymphatic filariasis. PLoS Negl Trop Dis. 2007;1(2):e128.
28) Trubiano JA, Lavender CJ, Fyfe JA, Bittmann S, Johnson PD. The incubation period of Buruli ulcer (Mycobacterium ulcerans infection). PLoS Negl Trop Dis. 2013. 7(10):e2463.
29) Ogbechi J, Ruf MT, Hall BS, Bodman-Smith K, Vogel M, Wu HL, et al. Mycolactone-Dependent Depletion of Endothelial Cell Thrombomodulin Is Strongly Associated with Fibrin Deposition in Buruli Ulcer Lesions. PLoS Pathog. 2015;11 (7):e1005011
30) Buntine J, Crofts K. eds. World Health Organization. Global Buruli Ulcer Initiative 1002. Buruli ulcer: management of Mycobacterium ulcerans disease: a manual for health care providers. Available from :

https://apps.who.int/iris/handle/10665/67001. [Accessed April 13, 2021]
31) Zingue D, Bouam A, Tian R, Drancourt M. 2018. Buruli ulcer, a prototype for ecosystem-related infection, caused by Mycobacterium ulcerans. Clin Microbiol Rev. 2018;31:e00045-17.
32) Mueller YK, Bastard M, Nkemenang P, Comte E, Ehounou G, Eyangoh S, et al. The “Buruli Score”: Development of a Multivariable Prediction Model for Diagnosis of Mycobacterium ulcerans Infection in Individuals with Ulcerative Skin Lesions, Akonolinga, Cameroon. PLoS Negl Trop Dis. 2016;10(4):e0004593
33) Marsollier L, Severin T, Aubry J, et al. Aquatic snails, passive hosts of Mycobacterium ulcerans. Appl Environ Microbiol. 2004; 70(10):6296-8.
34) International Business Machines Corporation. IBM-Statistical Package for the Social Sciences (SPSS) Statistics 20. Somers New York: IBM Corporation; 2011.
35) Guarner J, Bartlett J, Whitney EA, Raghunathan PL, Stienstra Y, Asamoa K, et al. Histopathologic features of Mycobacterium ulcerans infection. Emerg Infect Dis. 2003;9(6):651-656.
36) Vincent QB, Ardant M-F, Adeye A, et al. Clinical epidemiology of laboratory-confirmed Buruli ulcer in Benin: a cohort study. Lancet Glob Health. 2014;2(7):e422–e430
37) Guidance on sampling techniques for laboratory-confirmation of Mycobacterium ulcerans infection (Buruli ulcer disease).Available from:

http://www.who.int/buruli/Guidance_sampling_techniques_MU_infection.pdf?ua=1 [Accessed April 8, 2021]
38) Ruf MT, Steffen C, Bolz M, Schmid P, Pluschke G. Infiltrating leukocytes surround early Buruli ulcer lesions, but are unable to reach the mycolactone producing mycobacteria. Virulence. 2017;8:1918–1926.
39) Phillips RO, Sarfo FS, Landier J, Oldenburg R, Frimpong M, Wansbrough-Jones M, et al. Combined inflammatory and metabolic defects reflected by reduced serum protein levels in patients with Buruli ulcer disease. PLoS Negl Trop Dis. 2014; 8(4):e2786.
40) Silva MT, Portaels F, Pedrosa J. Pathogenetic mechanisms of the intracellular parasite Mycobacterium ulcerans leading to Buruli ulcer. Lancet Infect Dis. 2009; 9(11):699-710
41) Ndiaye SM, Quick L, Sanda O, Niandous S. The value of community participation in disease surveillance: A case study from Niger. Health Promot. Int. 2003;18(2):89-98.
42) Gao GF, Tambo E, Zhou XN. Eds. Ebola outbreaks and community-based surveillance response systems. Available from:
https://www.biomedcentral.com/collections/EOCSRS. [Accessed February 16, 2022].

43) Care International. Promising practices for community-based surveillance: Experience from Care work with communitybased models of avian and human influenza surveillance in five countries. 2005. Available from:

http://www.comminit.com/la/node/286726. [Accessed February 16, 2022]
44) United Nations International Children’s Emergency Fund institute for statistics fact Sheet. Adult and youth literacy. 2015;23. Available from:

http://www.uis.unesco.org/literacy/Documents/fs32-2015-literacy.pdf.[Accessed February 16, 2022]
45) Tambo E, Ugwu EC, Ngogang JY. Need of surveillance response systems to combat Ebola outbreaks and other emerging infectious diseases in African countries. Infect Dis Poverty. 2014;3:29.