Presumptive Diagnosis of Buruli Ulcer based on Clinical Presentations

Abstract

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

Keywords

• Buruli ulcer,presumptive diagnosis,clinical presentations,Ogun State,Nigeria

References

1. 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. 2. Komolafe OO. Buruli ulcer in Malawi – a first report. Malawi Med J 2001; 13(3): 37-39.
3. 3. Walsh DS, Portaels F, Meyers WM. Buruli ulcer: Advances in understanding Mycobacterium ulcerans infection. Dermatol Clin.2011; 29(1): 1-8.
4. 4. Asiedu K, Raviglione M, Scherpbier R. Buruli ulcer (Mycobacterium ulcerans infection) (WHO/COS/CPE/GBUI/2000.1) Geneva: WHO (2000).
5. 5. Gray HH, Kingma S. Mycobacterial skin ulcers in Nigeria. Trans R Soc Trop Dis Hyg1967; 61(5):712- 14.
6. 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. 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. 8. Chukwuekezie O, Ampadu E, Sopoh G, et al. Buruli ulcer, Nigeria (Letter). Emerg Infect Dis 2007; 13 (5): 782-783.

9. 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. 10. Noeske J, Kuaban C, Rondini S. Buruli ulcer disease in Cameroon rediscovered. Am J of Trop Med Hyg 2004; 70: 520-6.
11. 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. 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. 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. 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. 15. WHO. Treatment of Mycobacterium ulcerans Disease (Buruli ulcer): Guidance for health workers. Geneva 2012; 1-66.
16. 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. 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.