Global and local environmental changes as drivers of Buruli ulcer emergence

Floristic Diversity as an Indicator in Low and High Endemic Buruli Ulcer Areas in Côte d'Ivoire

Mycobacterium ulcerans is an environmental bacterium responsible for Buruli ulcer. This disease has a high frequency index in humid tropical regions, with a high incidence in Sub-Saharan Africa. The ecology and mode of transmission of this disease is not well established. Based on dilution effect hypothesis, acting as lowering disease transmission due to greater biodiversity, floristic inventory was carried out in the Health Districts of Daloa and Bouaké in Côte d'Ivoire. In each district, high and low endemic sites were investigated. A total of 169 plant species were inventoried for both low and high endemicity of Buruli ulcer sites in the districts. The Indval index revealed that 13 plant species were good indicators for Buruli ulcer highly endemic areas. The plants which correlate with high endemicity area were Leersia hexandra, Panicum laxum, Mimosa pudica, Paspalum distichum, Persicaria senegalensis, Calopogonium mucunoides, Echinochloa colona, Ipomoea sagittata, and Eichhornia crassipes. For low endemic sites, a strong relationship was recorded for 37 plants. The indices revealed low similarity between high and low endemicity sites. Low endemicity sites expressed the highest plant species diversity. These results suggest the hypothesis that floristic richness is more important in sites of low endemicity than in those of high endemicity. Moreover, we observed a co-occurrence of some plant species and Buruli ulcer endemicity. This finding may lead to the fact that it is important to care about the biodiversity to prevent outbreak of Buruli ulcer cases.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41742-023-00520-2.

Separation of Different Blogs from Skin Disease Data using Artificial Intelligence

A combination of environmental conditions may cause skin illness everywhere on the earth, and it is one of the most dangerous diseases that can develop as a result. A major goal in the selection of characteristics is to produce predictions about skin disease instances in connection with influencing variables, which is one of the most important tasks. As a consequence of the widespread usage of sensors, the amount of data collected in the health industry is disproportionately large when compared to data collected in other sectors. In the past, researchers have used a variety of machine learning algorithms to determine the relationship between illnesses and other disorders. Forecasting is a procedure that involves many steps, the most important of which are the preprocessing of any scenario and the selection of forecasting features. A major disadvantage of doing business in the health industry is a lack of data availability, which is particularly problematic when data is provided in an unstructured format. Filling in missing numbers and converting between various types of data take somewhat more than 70% of the total time. When dealing with missing data in machine learning applications, the mean, average, and median, as well as the stand mechanism, may all be employed to solve the problem. Previous research has shown that the characteristics chosen for a model's overall performance may have an influence on the overall performance of the model's overall performance. One of the primary goals of this study is to develop an intelligent algorithm for identifying relevant traits in models while simultaneously eliminating nonsignificant attributes that have an impact on model performance. To present a full view of the data, artificial intelligence techniques such as SVM, decision tree, and logistic regression models were used in conjunction with three separate feature combination methodologies, each of which was developed independently. As a consequence of this, their accuracy, F-measure, and precision are all raised by a factor of ten, respectively. We then have a list of the most important features, together with the weights that have been allocated to each of them.

Understanding the transmission of Mycobacterium ulcerans: A step towards controlling Buruli ulcer

Mycobacterium ulcerans is the causative agent of Buruli ulcer, a rare but chronic debilitating skin and soft tissue disease found predominantly in West Africa and Southeast Australia. While a moderate body of research has examined the distribution of M. ulcerans, the specific route(s) of transmission of this bacterium remain unknown, hindering control efforts. M. ulcerans is considered an environmental pathogen given it is associated with lentic ecosystems and human-to-human spread is negligible. However, the pathogen is also carried by various mammals and invertebrates, which may serve as key reservoirs and mechanical vectors, respectively. Here, we examine and review recent evidence from these endemic regions on potential transmission pathways, noting differences in findings between Africa and Australia, and summarising the risk and protective factors associated with Buruli ulcer transmission. We also discuss evidence suggesting that environmental disturbance and human population changes precede outbreaks. We note five key research priorities, including adoption of One Health frameworks, to resolve transmission pathways and inform control strategies to reduce the spread of Buruli ulcer.

Buruli ulcer is a debilitating skin and soft tissue disease characterised by large ulcerative wounds that are treated with antibiotics or with adjunctive surgery for advanced cases. Found predominantly in West Africa and Southeast Australia, the causative agent is the environmental bacterial pathogen Mycobacterium ulcerans. Lack of understanding of transmission pathways, combined with the absence of a vaccine, has hindered efforts to control the spread of M. ulcerans. Here, in order to identify probable transmission pathways and inform future studies, we review literature linking M. ulcerans to environmental reservoirs, mammalian hosts, and potential invertebrate vectors. We also summarise factors and behaviours that reduce the risk of developing Buruli ulcer, to inform effective prevention strategies and further shed light on transmission pathways.

Climate change and pediatric skin health

Children are known to disproportionately bear the health impacts of climate change, particularly children living in impoverished areas. Owing to their developing physiology and immature metabolism, distinct exposure behaviors, and reliance on adults for care and protection, children are uniquely susceptible to the adverse effects of our warming planet. Herein, we summarize the known impacts of climate change on pediatric skin health, including its effects on atopic dermatitis, vector-borne and other infectious diseases, nutritional deficiencies, and psychodermatoses.

Emerging human infectious diseases of aquatic origin: a comparative biogeographic approach using Bayesian spatial modelling

BACKGROUND

With the increase in unprecedented and unpredictable disease outbreaks due to human-driven environmental changes in recent years, we need new analytical tools to map and predict the spatial distribution of emerging infectious diseases and identify the biogeographic drivers underpinning their emergence. The aim of the study was to identify and compare the local and global biogeographic predictors such as landscape and climate that determine the spatial structure of leptospirosis and Buruli Ulcer (BU).

METHODS

We obtained 232 hospital-confirmed leptospirosis (2007-2017) cases and 236 BU cases (1969-2017) in French Guiana. We performed non-spatial and spatial Bayesian regression modeling with landscape and climate predictor variables to characterize the spatial structure and the environmental drivers influencing the distribution of the two diseases.

RESULTS

Our results show that the distribution of both diseases is spatially dependent on environmental predictors such as elevation, topological wetness index, proximity to cropland and increasing minimum temperature at the month of potential infection. However, the spatial structure of the two diseases caused by bacterial pathogens occupying similar aquatic niche was different. Leptospirosis was widely distributed across the territory while BU was restricted to the coastal riverbeds.

CONCLUSIONS

Our study shows that a biogeographic approach is an effective tool to identify, compare and predict the geographic distribution of emerging diseases at an ecological scale which are spatially dependent to environmental factors such as topography, land cover and climate.

Environmental Variations in Mycobacterium ulcerans Transcriptome: Absence of Mycolactone Expression in Suboptimal Environments

Buruli ulcer is a neglected tropical infectious disease, produced by the environmentally persistent pathogen Mycobacterium ulcerans (MU). Neither the ecological niche nor the exact mode of transmission of MU are completely elucidated. However, some environmental factors, such as the concentration in chitin and pH values, were reported to promote MU growth in vitro. We pursued this research using next generation sequencing (NGS) and mRNA sequencing to investigate potential changes in MU genomic expression profiles across in vitro environmental conditions known to be suitable for MU growth. Supplementing the growth culture medium in either chitin alone, calcium alone, or in both chitin and calcium significantly impacted the MU transcriptome and thus several metabolic pathways, such as, for instance, those involved in DNA synthesis or cell wall production. By contrast, some genes carried by the virulence plasmid and necessary for the production of the mycolactone toxin were expressed neither in control nor in any modified environments. We hypothesized that these genes are only expressed in stressful conditions. Our results describe important environmental determinants playing a role in the pathogenicity of MU, helping the understanding of its complex natural life cycle and encouraging further research using genomic approaches.

Mycobacterium ulcerans infection (Buruli ulcer) in French Guiana, South America, 1969-2013: an epidemiological study

BACKGROUND

Mycobacterium ulcerans infection is the third most common mycobacterial disease in the world after tuberculosis and leprosy. To date, transmission pathways from its environmental reservoir to humans are still unknown. In South America, French Guiana has the highest reported number of M ulcerans infections across the continent. This empirical study aimed to characterise the epidemiology of M ulcerans infection in French Guiana between 1969 and 2013.

METHODS

Data were collected prospectively mainly by two dermatologists at Cayenne Hospital's dermatology department between Jan 1, 1969, and Dec 31, 2013, for age, date of diagnosis, sex, residence, location of the lesion, type of lesion, associated symptoms, and diagnostic method (smear, culture, PCR, or histology) for all confirmed and suspected cases of M ulcerans. We obtained population data from censuses. We calculated mean M ulcerans infection incidences, presented as the number of cases per 100 000 person-years.

FINDINGS

245 patients with M ulcerans infections were reported at Cayenne Hospital's dermatology department during the study period. M ulcerans infection incidence decreased over time, from 6·07 infections per 100 000 person-years (95% CI 4·46-7·67) in 1969-83 to 4·77 infections per 100 000 person-years (3·75-5·79) in 1984-98 and to 3·49 infections per 100 000 person-years (2·83-4·16) in 1999-2013. The proportion of children with infections also declined with time, from 42 (76%) of 55 patients in 1969-83 to 26 (31%) of 84 in 1984-98 and to 22 (21%) of 106 in 1999-2013. Most cases occurred in coastal areas surrounded by marshy savannah (incidence of 21·08 per 100 000 person-years in Sinnamary and 21·18 per 100 000 person-years in Mana). Lesions mainly affected limbs (lower limbs 161 [66%] patients; upper limbs 60 [24%] patients). We diagnosed no bone infections.

INTERPRETATION

The decrease of M ulcerans infection incidence and the proportion of children with infections over a 45 year period in this ultra-peripheral French territory might have been mostly driven by improving living conditions, prophylactic recommendations, and access to health care.

FUNDING

Agence Nationale de la Recherche.