Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
National Buruli Ulcer Control Program, Ghana Health Service, Accra, Ghana.
PLoS Negl Trop Dis. 2018 Jun 5;12(6):e0006560. doi: 10.1371/journal.pntd.0006560. eCollection 2018 Jun.
Buruli ulcer (BU), a necrotizing skin infection caused by Mycobacterium ulcerans is the third most important mycobacterial disease globally after tuberculosis and leprosy in immune competent individuals. This study reports on the retrospective analyses of microbiologically confirmed Buruli ulcer (BU) cases in seventy-five health facilities in Ghana.
METHOD/PRINCIPAL FINDINGS: Pathological samples were collected from BU lesions and transported either through courier services or by car directly to the laboratory. Samples were processed and analysed by IS2404 PCR, culture and Ziehl-Neelsen staining for detection of acid-fast bacilli. From 2008 to 2016, we analysed by PCR, 2,287 samples of 2,203 cases from seventy-five health facilities in seven regions of Ghana (Ashanti, Brong Ahafo, Central, Eastern, Greater Accra, Northern and Volta). The mean annual positivity rate was 46.2% and ranged between 14.6% and 76.2%. The yearly positivity rates from 2008 to 2016 were 52.3%, 76.2%, 56.7%, 53.8%, 41.2%, 41.5%, 22.9%, 28.5% and 14.6% respectively. Of the 1,020 confirmed cases, the ratio of female to male was 518 and 502 respectively. Patients who were 15 years of age and below accounted for 39.8% of all cases. The median age was 20 years (IQR = 10-43). Ulcerative lesions were 69.2%, nodule (9.6%), plaque (2.9%), oedema (2.5%), osteomyelitis (1.1%), ulcer/oedema (9.5%) and ulcer/plaque (5.2%). Lesions frequently occurred on the lower limbs (57%) followed by the upper limbs (38%), the neck and head (3%) and the least found on the abdomen (2%).
CONCLUSIONS/SIGNIFICANCE: Our findings show a decline in microbiological confirmed rates over the years and therefore call for intensive education on case recognition to prevent over-diagnosis as BU cases decline.
由溃疡分枝杆菌引起的坏死性皮肤感染——布鲁里溃疡（BU），是免疫功能正常个体中除结核和麻风以外的第三大重要分枝杆菌病。本研究报告了对加纳 75 个卫生机构中经微生物学证实的布鲁里溃疡（BU）病例的回顾性分析。
方法/主要发现：从 BU 病变中采集病理样本，通过快递服务或汽车直接运送到实验室。样本通过 IS2404PCR、培养和齐-尼染色进行分析，以检测抗酸杆菌。2008 年至 2016 年，我们分析了来自加纳七个地区（阿散蒂、布隆阿哈福、中部、东部、大阿克拉、北部和沃尔特）75 个卫生机构的 2203 例 2287 份样本，PCR 阳性率平均为 46.2%，范围为 14.6%至 76.2%。2008 年至 2016 年的阳性率分别为 52.3%、76.2%、56.7%、53.8%、41.2%、41.5%、22.9%、28.5%和 14.6%。在 1020 例确诊病例中，男女比例分别为 518 比 502。15 岁及以下患者占所有病例的 39.8%。中位年龄为 20 岁（IQR=10-43）。溃疡性病变占 69.2%，结节（9.6%），斑块（2.9%），水肿（2.5%），骨髓炎（1.1%），溃疡/水肿（9.5%）和溃疡/斑块（5.2%）。病变常发生于下肢（57%），其次是上肢（38%），颈部和头部（3%），腹部最少（2%）。
结论/意义：我们的发现表明，多年来微生物学确诊率有所下降，因此需要加强对病例识别的教育，以防止 BU 病例减少导致的过度诊断。
