Bayonne Manou L S, Portaels F, Eddyani M, Book A U, Vandelannoote K, de Jong B C
Ministère de la Santé publique, BP 5258 Libreville, Gabon.
Institut de médecine tropicale d'Antwerpen, Belgique.
Med Sante Trop. 2013 Oct-Dec;23(4):450-7. doi: 10.1684/mst.2013.0259.
The first cases of Buruli ulcer (BU) in Gabon were described in the 1960s. Between 2005 and 2011, 301 clinically suspected cases of BU were found in all nine provinces of Gabon, and their lesions sampled for microbiological confirmation. Polymerase chain reaction (PCR) found 120 (39.9%) of these lesions positive and 181 (60.1%) negative for Mycobacterium ulcerans. The confirmed cases came mainly from the province of Moyen-Ogooué, particularly from localities along the Ogooué River (n=117; 52.5% of the samples in this province were PCR-positive). The detection rates per 100,000 inhabitants in this province ranged from 94.7 cases in 2005 to 28 in 2007, after an absence of active case-finding in 2006. The final three PCR-positive cases were found in the province of Estuaire. The characteristics of the confirmed BU patients (that is, PCR-positive) were identical to those described in other African countries: most patients were younger than 15 years old, and most lesions were found on both the upper and lower limbs. The group of suspected cases (PCR-negative) differed from the PCR-positive group for patient age (most patients were aged 15 to 49 years), lesion location (more frequently on the lower limbs), and ulceration (more frequent in the suspected cases). Some PCR-negative patients probably had other diseases; this underlines the importance of the differential diagnosis of BU. The cure rate of PCR(-)confirmed cases in our study was 88%; treatment was the antibiotic combination recommended by the World Health Organization (WHO). Our study demonstrates that BU is endemic in Gabon and is a public health problem there. Patients consult late with often extensive lesions. Awareness campaigns should be pursued to ensure earlier treatment of patients. The influence of HIV on BU in Gabon also deserves particular attention.
加蓬的首例布氏溃疡（BU）病例于20世纪60年代被描述。2005年至2011年期间，在加蓬所有9个省份共发现301例临床疑似布氏溃疡病例，并对其病变进行采样以进行微生物学确诊。聚合酶链反应（PCR）检测发现其中120例（39.9%）病变对溃疡分枝杆菌呈阳性，181例（60.1%）呈阴性。确诊病例主要来自中奥果韦省，特别是奥果韦河沿岸地区（n = 117；该省样本中52.5%的PCR检测呈阳性）。该省每10万居民中的检出率从2005年的94.7例到2007年的28例不等，2006年未进行主动病例发现。最后3例PCR阳性病例在河口省被发现。确诊的布氏溃疡患者（即PCR阳性）的特征与其他非洲国家描述的特征相同：大多数患者年龄小于15岁，大多数病变位于上肢和下肢。疑似病例组（PCR阴性）在患者年龄（大多数患者年龄在15至49岁之间）、病变部位（下肢更常见）和溃疡情况（疑似病例中更常见）方面与PCR阳性组不同。一些PCR阴性患者可能患有其他疾病；这凸显了布氏溃疡鉴别诊断的重要性。在我们的研究中，PCR确诊病例的治愈率为88%；治疗采用世界卫生组织（WHO）推荐的抗生素联合用药。我们的研究表明，布氏溃疡在加蓬呈地方性流行，是当地的一个公共卫生问题。患者就诊较晚，病变往往较为广泛。应开展宣传活动以确保患者能更早接受治疗。HIV对加蓬布氏溃疡的影响也值得特别关注。
