Variable Number Tandem Repeat Profiling of Reveals New Genotypes in Buruli Ulcer Endemic Communities in Ghana and Côte d'Ivoire.

Buruli ulcer (BU), a necrotic skin disease caused by , is mainly prevalent in West Africa, but cases have also been reported in other tropical parts of the world. It is the second most common mycobacterial disease after tuberculosis in Ghana and Côte d'Ivoire. Heterogeneity among from different geographical locations has not been clearly elucidated, and some studies seem to suggest genetic differences between in humans and in the environment. This study aimed at identifying genetic differences among strains between two BU endemic countries: Ghana and Côte d'Ivoire. Clinical samples consisting of swabs, fine needle aspirates, and tissue biopsies of suspected BU lesions and environmental samples (e.g., water, biofilms from plants, soil, and detrital material) were analyzed. BU cases were confirmed acid fast staining and PCR targeting the 16S rRNA, IS, , and ER domain genes present on . Heterogeneity among was determined through VNTR profiling targeting 10 loci. Eleven genotypes were identified within the clinical samples in both Ghana and Côte d'Ivoire, whiles six genotypes were found among the environmental samples. Clinical genotypes C, D, F, and G were common in both countries. Genotype E was unique among the Ghanaian samples, whiles genotypes A, Z, J, and K were unique to the Ivorian samples. Environmental isolates were found to be more conserved compared with the clinical isolates. Genotype W was observed only among the Ghanaian environmental samples. Genotype D was found to be prominent in both clinical and environmental samples, suggesting evidence of possible transmission of from the environment, particularly water bodies and biofilms from aquatic plants, to humans through open lesions on the skin.