Research Article: Complete Healing of a Laboratory-Confirmed Buruli Ulcer Lesion after Receiving Only Herbal Household Remedies

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.

Abstract: None

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) [1]—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 [4], 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 [5] 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 [6]. 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 [6]. Whole genome sequencing of the isolate reconfirmed that it belongs to the local clonal complex of M. ulcerans [7].

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 [9]. 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 [10]. Furthermore, patients with large lesions require physiotherapy and rehabilitation in addition to the antibiotic treatment and wound care [11,12].



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