Centre de Diagnostic et de Traitement de l'ulcère de Buruli, Fondation Raoul Follereau, Pobè, Bénin.
Univ Angers, Inserm, INCIT, Angers, France.
PLoS Negl Trop Dis. 2021 Dec 28;15(12):e0010053. doi: 10.1371/journal.pntd.0010053. eCollection 2021 Dec.
Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans, an environmental mycobacterium. Although transmission of M. ulcerans remains poorly understood, the main identified risk factor for acquiring Buruli ulcer is living in proximity of potentially contaminated water sources. Knowledge about the clinical features of Buruli ulcer and its physiopathology is increasing, but little is known about recurrence due to reinfection.
METHODOLOGY/PRINCIPAL FINDINGS: We describe two patients with Buruli ulcer recurrence due to reinfection with M. ulcerans, as demonstrated by comparisons of DNA from the strains isolated at the time of the first diagnosis and at recurrence. Based on the spatial distribution of M. ulcerans genotypes in this region and a detailed study of the behavior of these two patients with respect to sources of water as well as water bodies and streams, we formulated hypotheses concerning the sites at which they may have been contaminated.
CONCLUSIONS/SIGNIFICANCE: Second episodes of Buruli ulcer may occur through reinfection, relapse or a paradoxical reaction. We formally demonstrated that the recurrence in these two patients was due to reinfection. Based on the sites at which the patients reported engaging in activities relating to water, we were able to identify possible sites of contamination. Our findings indicate that the non-random distribution of M. ulcerans genotypes in this region may provide useful information about activities at risk.
溃疡分枝杆菌引起的Buruli 溃疡是一种被忽视的热带病，溃疡分枝杆菌是一种环境分枝杆菌。尽管分枝杆菌传播的机制仍不清楚，但获得 Buruli 溃疡的主要确定危险因素是生活在潜在受污染水源附近。人们对 Buruli 溃疡的临床特征及其病理生理学的了解正在增加，但由于再感染导致的复发知之甚少。
方法/主要发现： 我们描述了两例因再感染溃疡分枝杆菌而导致 Buruli 溃疡复发的患者，这是通过比较首次诊断和复发时分离的菌株的 DNA 来证明的。根据该地区溃疡分枝杆菌基因型的空间分布以及对这两名患者与水源以及水体和溪流相关行为的详细研究，我们提出了关于他们可能被污染的地点的假设。
结论/意义： Buruli 溃疡的第二发作可能是由于再感染、复发或矛盾反应引起的。我们正式证明这两名患者的复发是由于再感染。根据患者报告的与水有关的活动地点，我们能够确定可能的污染地点。我们的研究结果表明，该地区溃疡分枝杆菌基因型的非随机分布可能为危险活动提供有用信息。
