Date Published: November 25, 2015
Publisher: Public Library of Science
Author(s): Arianna Andreoli, Ferdinand Mou, Jacques C. Minyem, Fidèle G. Wantong, Djeunga Noumen, Paschal K. Awah, Gerd Pluschke, Alphonse Um Boock, Martin W. Bratschi, Pamela L. C. Small. http://doi.org/10.1371/journal.pntd.0004102
Partial Text: On March 7, 2011, an 11-year-old boy from the town of Bankim in the Adamaoua Region of Cameroon—a known endemic focus of Buruli ulcer (BU) —was accompanied by his father to the district hospital in Bankim. The patient presented with a BU lesion classified as Category II, according to the classifications of the World Health Organization (WHO). The partially ulcerated plaque lesion, which was approximately 14 x 6 cm in size, had undermined edges characteristic of BU (Fig 1A) [2,3]. Following clinical examination and sample collection for diagnosis, the patient’s family refused the standard WHO-recommended treatment for BU, which consists of daily rifampicin (10 mg/kg orally) and streptomycin (15mg/kg intramuscularly) for eight weeks , and the patient left the hospital. Wound exudates collected from the patient tested positive in the Mycobacterium ulcerans-specific IS2404 quantitative polymerase chain reaction (qPCR) assay  with threshold cycle (Ct) values ranging from 20.0 to 28.6, indicating a high mycobacterial load. Swab exudates were also used for the initiation of a M. ulcerans primary culture on Löwenstein-Jensen medium, as previously described . After 8.5 weeks of incubation at 30°C, mycobacterial growth was observed, and the cultured mycobacteria were reconfirmed as M. ulcerans by IS2404 colony PCR . Whole genome sequencing of the isolate reconfirmed that it belongs to the local clonal complex of M. ulcerans .
The clinical presentation of M. ulcerans disease ranges from non-ulcerative nodules, plaques, or oedema to ulcers. The disease often starts as a non-painful nodule or indurated area, which may then ulcerate and develop BU-characteristic features, including undermined edges . Large ulcerative lesions at joints, like the one described here, often take a particularly long time to heal completely and are often associated with long-term complications, such as disabilities in the form of contractures or limitations in movement. These long-term sequelae of BU may occur even if the patient receives the recommended antibiotic treatment and regular wound care . Furthermore, patients with large lesions require physiotherapy and rehabilitation in addition to the antibiotic treatment and wound care [11,12].