Vas Nunes Jonathan, Wassill Lars, Mönnink Giulia, Falama Abdul-Mac, Mathéron Hanna, Conteh Amara, Sesay Maxwell, Sesay Aminata, Bolkan Håkon, Grobusch Martin P, Schaumburg Frieder
Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone.
Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam, The Netherlands.
Infection. 2025 May 21. doi: 10.1007/s15010-025-02548-2.
There is a high burden of chronic ulcers in Sierra Leone. However, (early) diagnosis and treatment are challenging. Data on endemicity of Mycobacterium ulcerans is limited to WHO reports from 2008 to 2011.
Patients presenting with wounds at Masanga Teaching Hospital were included in a prospective cohort study and scored following the WHO clinical list for Buruli ulcer (BU). Wounds were screened for M. ulcerans by selective culture on solid and liquid media and loop-mediated isothermal amplification (LAMP) of the M. ulcerans specific IS2404.
Between July 2019 and November 2020, 159 patients were included. The median age was 41 years (range: 2-92), 34% (54/159) were female and 56% (89/159) were literate. The median duration of a wound before admission was 12 months (range: 0-720 months), 87% (137/159) of lesions were below the knee. Wounds of 37% (58/159) of the patients were clinically scored as '(very) likely to be Buruli ulcer'. Seven out of 72 patients tested by LAMP were positive for IS2404, two showed specific melting curves. None of the wound swabs yielded a positive culture for M. ulcerans. Ninety-eight (62%) patients had a wound-related surgery during this study, 101 (63%) of patients were improving or healed at the time of discharge.
The prevalence of BU based on the WHO scoring system is high in Sierra Leone. National and international awareness, training of healthcare workers, development of in-country bacteriology as well as the furthering of robust molecular and immunological assays could reduce the burden of this neglected tropical disease.
在塞拉利昂，慢性溃疡负担沉重。然而，（早期）诊断和治疗具有挑战性。溃疡分枝杆菌的地方性流行数据仅限于世界卫生组织2008年至2011年的报告。
在马桑加教学医院出现伤口的患者被纳入一项前瞻性队列研究，并根据世界卫生组织布鲁里溃疡（BU）临床清单进行评分。通过在固体和液体培养基上进行选择性培养以及对溃疡分枝杆菌特异性IS2404进行环介导等温扩增（LAMP）来筛查伤口中的溃疡分枝杆菌。
2019年7月至2020年11月期间，纳入了159名患者。中位年龄为41岁（范围：2 - 92岁），34%（54/159）为女性，56%（89/159）有读写能力。入院前伤口的中位持续时间为12个月（范围：0 - 720个月），87%（137/159）的病变位于膝盖以下。37%（58/159）患者的伤口临床评分被判定为“（非常）可能是布鲁里溃疡”。在72名接受LAMP检测的患者中，7人IS2404呈阳性，2人显示出特异性熔解曲线。伤口拭子均未培养出溃疡分枝杆菌阳性。在本研究期间，98名（62%）患者接受了与伤口相关的手术，101名（63%）患者在出院时病情好转或已愈合。
基于世界卫生组织评分系统，布鲁里溃疡在塞拉利昂的患病率很高。提高国家和国际层面的认识、培训医护人员、发展国内细菌学以及推进强大的分子和免疫检测方法，可能会减轻这种被忽视热带病的负担。
