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Ahortor EK, Gwira TM, Mahazu S, Erber AC, Ablordey A. Evaluation of an electricity-independent method for IS2404 Loop-mediated isothermal amplification (LAMP) diagnosis of Buruli ulcer in resource-limited settings. PLoS Negl Trop Dis 2024; 18:e0012338. [PMID: 39141676 PMCID: PMC11346967 DOI: 10.1371/journal.pntd.0012338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 08/26/2024] [Accepted: 07/04/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Buruli ulcer (BU) caused by Mycobacterium ulcerans (MU) is a devastating necrotic skin disease. PCR, recommended for confirmation of BU by WHO, requires an adequately equipped laboratory, therefore often delaying timely diagnosis and treatment of BU patients in remote settings. Loop-mediated isothermal amplification (LAMP) is a PCR-based protocol for isothermal amplification of DNA that has been suggested for diagnosis of BU in low-resource settings. STUDY AIMS AND METHODS This is an exploratory diagnostic test evaluation study, with an embedded qualitative sub-study. Its aims are two-fold: First, to evaluate a simple rapid syringe-based DNA extraction method (SM) in comparison with a more elaborate conventional DNA extraction method (CM), followed by a LAMP assay targeting IS2404 for the detection of MU, either using a commercially available pocket warmer (pw) or a heat block (hb) for incubation. Second, to complement this by exploring the diagnostic workflow for BU at a community-based health centre in an endemic area in rural Ghana as an example of a potential target setting, using interviews with researchers and health care workers (HCWs). Diagnostic test evaluation results are discussed in relation to the requirements of a target product profile (TPP) for BU diagnosis and the target setting. RESULTS A protocol using SM for DNA extraction followed by IS2404 PCR (IS2404 PCRSM) was able to identify MU DNA in 73 out of 83 BU clinical specimens submitted for diagnosis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IS2404 PCRSM were 90.12%, 100%, 100% and 65.21% respectively, as compared to the reference standard IS2404 PCR in combination with a standard extraction protocol for mycobacterial DNA. Evaluation of the LAMP assay on 64 SM DNA extracts showed a sensitivity, specificity, PPV and NPV of 83.6%, 100%, 100% and 50%, respectively, using either pocket warmer (pwLAMPSM) or heat block (hbLAMPSM) for incubation of the reaction, as compared to the same reference standard. The limit of detection of pwLAMPSM was found to be 30 copies of the IS2404 target. Interview findings explored barriers to BU diagnosis and treatment, including perceptions of the disease, costs, and availability of transport. Participants confirmed that a diagnosis at the PoC, in addition to screening based on clinical criteria, would be advantageous in order to prevent delays and loss to follow-up. DISCUSSION AND CONCLUSIONS The high diagnostic and analytic accuracy of the pwLAMP, evaluated by us in combination with a syringe-based DNA extraction method, supports its potential use for the rapid detection of MU in suspected BU samples at the community or primary health care level without reliable electricity supply. Further optimization needs include a lysis buffer, evaluation directly at the PoC and/or other sites, assessing staff training requirements and quality control.
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Affiliation(s)
- Evans K. Ahortor
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, Wales, United Kingdom
| | - Theresa Manful Gwira
- Department of Biochemistry, Cell and Molecular Biology & West African Centre for Cell Biology of Infectious Pathogens, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
| | - Samiratu Mahazu
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- Department of Molecular Microbiology and Immunology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Astrid C. Erber
- Department of Epidemiology, Centre for Public Health, Medical University of Vienna, Vienna, Austria
- Infectious Diseases Data Observatory, Oxford, United Kingdom
| | - Anthony Ablordey
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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Ukwaja KN, Alphonsus C, Eze CC, Lehman L, Ekeke N, Nwafor CC, Ikebudu J, Anyim MC, Chukwu JN. Investigating barriers and challenges to the integrated management of neglected tropical skin diseases in an endemic setting in Nigeria. PLoS Negl Trop Dis 2020; 14:e0008248. [PMID: 32352967 PMCID: PMC7217480 DOI: 10.1371/journal.pntd.0008248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/12/2020] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a dearth of experience in and evidence for cost-effective integrated community-based management of skin neglected tropical diseases (NTDs). The objective of this study was to assess the knowledge, attitude and care-seeking practices including self-care with a view to introducing appropriate community-based interventions for skin NTDs in an endemic setting in Southern Nigeria. METHODS/PRINCIPAL FINDINGS This exploratory study adopted a mixed-methods design consisting of cross-sectional surveys of community members and health workers using interviewer-administered questionnaires; and focus group discussions (FGDs) with community members, health care workers and patients with NTDs in Anambra State, Nigeria. The survey was completed by 353 community members (61.8% female) and 15 health care workers (100.0% female). A total of 52 individuals participated in six FGDs. Of the community members, 236 (66.9%) had heard or seen a case of leprosy; 324 (91.8%) and 131 (37.5%) had heard or seen a case of Buruli ulcer and lymphatic filariasis, respectively. Again, 213 (60.3%) of the respondents reported that the diseases were caused by witchcraft or curse. As regards prevention, 241 (68.3%) suggested avoiding handshake with affected persons. Up to 223 (63.2%) of respondents strongly agreed to the seriousness of skin NTDs in their community. Meanwhile, 272 (77.1%) of the respondents believed that the transmission of these skin NTDs can be prevented. Furthermore, 324 (91.7%) desired active community engagement for control of skin NTDs. Regarding community care seeking practices, 197 (55.8%) would first visit the health centre/hospital, followed by 91 (25.8%) traditional healer/herbalist and 35 (9.9%) pharmacy/patent medicine vendor if they develop a skin NTD. Overall, 332 (94.1%) of respondents expressed interest in being taught self-care practices for skin NTDs. Out of 15 healthcare workers, 13 (86.7%) were able to correctly diagnose two of these skin NTDs and 10 (66.7%) would encourage patients to practice self-care. Prominent themes in the FGDs were belief in witchcraft and herbal remedies; as well as the occurrence of physical, social and economic distress. CONCLUSIONS Our study helped quantify the information gaps that need to be addressed in order to create demand for integrated skin NTDs services in an endemic setting in Nigeria. Individual, structural and socioeconomic challenges to access and delivery of services were identified. Community and health care workers' empowerment and engagement through outreach and regular training, respectively may alleviate these challenges.
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Affiliation(s)
- Kingsley N. Ukwaja
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- * E-mail:
| | - Chukwuka Alphonsus
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Chinwe C. Eze
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Linda Lehman
- American Leprosy Missions, Greenville, South Carolina, United States of America
| | - Ngozi Ekeke
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Charles C. Nwafor
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Joy Ikebudu
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Moses C. Anyim
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Joseph N. Chukwu
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
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Aquatic Hemiptera in Southwest Cameroon: Biodiversity of Potential Reservoirs of Mycobacterium ulcerans and Multiple Wolbachia Sequence Types Revealed by Metagenomics. DIVERSITY 2019. [DOI: 10.3390/d11120225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical disease associated with freshwater habitats. A variety of limnic organisms harbor this pathogen, including aquatic bugs (Hemiptera: Heteroptera), which have been hypothesized to be epidemiologically important reservoirs. Aquatic Hemiptera exhibit high levels of diversity in the tropics, but species identification remains challenging. In this study, we collected aquatic bugs from emerging foci of BU in the Southwest Region of Cameroon, which were identified using morphological and molecular methods. The bugs were screened for mycobacterial DNA and a selection of 20 mycobacteria-positive specimens from the families Gerridae and Veliidae were subjected to next-generation sequencing. Only one individual revealed putative M. ulcerans DNA, but all specimens contained sequences from the widespread alpha-proteobacterial symbiont, Wolbachia. Phylogenetic analysis placed the Wolbachia sequences into supergroups A, B, and F. Circularized mitogenomes were obtained for seven gerrids and two veliids, the first from these families for the African continent. This study suggests that aquatic Hemiptera may have a minor role (if any) in the spread of BU in Southwest Cameroon. Our metagenomic analysis provides new insights into the incursion of Wolbachia into aquatic environments and generated valuable resources to aid molecular taxonomic studies of aquatic Hemiptera.
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Nwafor CC, Meka A, Chukwu JN, Ekeke N, Alphonsus C, Mbah O, Madichie NO, Aduh U, Ogbeifo M, IseOluwa-Adelokiki BO, Edochie JE, Ushaka J, Ukwaja KN. Assessment of community knowledge, attitude, and stigma of Buruli ulcer disease in Southern Nigeria. Afr Health Sci 2019; 19:2100-2111. [PMID: 31656494 PMCID: PMC6794545 DOI: 10.4314/ahs.v19i2.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Poor knowledge can influence timely care-seeking among persons with Buruli ulcer disease (BUD). Objectives To assess community knowledge, attitude and stigma towards persons with BUD in endemic settings of Southern Nigeria. Methods This was a cross-sectional survey conducted among adult community members in four States of Southern Nigeria. A semi-structured interviewer-administered questionnaire was administered to all participants. Results Of 491 adults who completed the survey, 315 (64.2%) belonged to the ≤40 years age group, 257 (52.3%) were males and 415 (84.5%) had some formal education. The overall mean (SD) knowledge score was 5.5±2.3 (maximum 10). Only 172 (35.0%) of the participants had a good knowledge of BUD. A total of 327 (66.6%) considered BUD as a very serious illness. Also, there was a high-level of stigma against BUD patients; 372 (75.8%) of the participants felt compassion for and desire to help them, 77 (15.7%) felt compassion but tended to stay away from them, and 53 (10.8%) feared them because they may infect them with the disease. Having a formal education and ethnicity were independent predictors of good knowledge of BUD. Conclusion There is poor community knowledge of BUD in endemic settings of Southern Nigeria which influenced the attitude and perceptions of community members towards persons with BUD
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Affiliation(s)
| | - Anthony Meka
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | - Joseph Ngozi Chukwu
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | - Ngozi Ekeke
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | - Chukwuka Alphonsus
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | - Obinna Mbah
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | | | - Ufuoma Aduh
- Delta State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Delta State, Nigeria
| | - Matthew Ogbeifo
- Delta State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Delta State, Nigeria
| | | | | | - Joseph Ushaka
- Cross River State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Cross River State, Nigeria
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Nsai FS, Cumber SN, Nkfusai NC, Viyoff VZ, Afutendem NB, Cumber RY, Tsoka-Gwegweni JM, Akoachere JFTK. Knowledge and practices of health practitioners on treatment of Buruli ulcer in the Mbonge, Ekondo Titi and Muyuka Health Districts, South West Region, Cameroon. Pan Afr Med J 2018; 31:228. [PMID: 31452829 PMCID: PMC6693786 DOI: 10.11604/pamj.2018.31.228.17420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/19/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION After tuberculosis and leprosy, Buruli ulcer (BU) is the third most common mycobacterial infection. Buruli ulcer begins as a localized skin lesion that progresses to extensive ulceration thus leading to functional disability, loss of economic productivity and social stigma. This study is aimed at assessing the knowledge and practices among health practitioners on the treatment of BU in the Mbonge, Ekondo Titi and Muyuka Health Districts of the South West Region of Cameroon. METHODS This is a cross-sectional study that investigates participants' knowledge and practices on the treatment of BU. The study uses a qualitative method of structured questionnaires in the process of data collection. RESULTS Seventy percent (70%) of the participants acknowledged they encounter cases of BU in their respective Hospitals or Health centers. Among these, 48% agreed they managed BU in their facilities and up to 91.7% noted that their community members are aware that BU is managed in their facility while seventy percent of the medical practitioners indicated they cannot identify the various stages of BU. Eighty-one percent of the practitioners from Muyuka HD indicated they could not identify the various stages of BU. More than 63% of the practitioners regarded BU patients as normal people in their communities however, practitioners that practiced for less than 5 years were likely not to admit BU patients in the same room with other patients. Beliefs such as being cursed (47.06%) and being possessed (29.41%) were reported by practitioners that acknowledged the existence of traditional beliefs in the community. CONCLUSION Despite the fact that a majority of the health practitioners knew what BU is, most of them demonstrated lack of knowledge on the identification of the various stages and management of the illness. Practitioners demonstrated positive attitude towards patients although they would not admit them in the same room with other patients. Considering the poor knowledge on identification and management demonstrated by most of the practitioners, management of the disease would be inadequate and may even aggravate the patient's situation. Training and onsite mentorship on screening, identification and management of BU is therefore highly recommended amongst health personnel practicing in endemic areas.
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Affiliation(s)
| | - Samuel Nambile Cumber
- Section for Epidemiology and Social Medicine, Department of Public Health, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Ngwayu Claude Nkfusai
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Vecheusi Zennobia Viyoff
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | | | | | - Joyce Mahlako Tsoka-Gwegweni
- Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Yeboah-Manu D, Aboagye SY, Asare P, Asante-Poku A, Ampah K, Danso E, Owusu-Mireku E, Nakobu Z, Ampadu E. Laboratory confirmation of Buruli ulcer cases in Ghana, 2008-2016. PLoS Negl Trop Dis 2018; 12:e0006560. [PMID: 29870529 PMCID: PMC6003692 DOI: 10.1371/journal.pntd.0006560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/15/2018] [Accepted: 05/24/2018] [Indexed: 11/21/2022] Open
Abstract
Background 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. Buruli ulcer (BU), a necrotizing skin disease caused by Mycobacterium ulcerans, is currently reported in 33 countries, with the greatest disease burden mostly in West African countries along the gulf of Guinea. The lack of pain associated with BU disease enhances delay in seeking medical treatment that could result to complications. The current existing control strategy is early case detection. Previously BU diagnosis was based solely on clinical evidence by a healthcare worker, however, since other skin conditions present similar clinical signs as BU there is the need for further laboratory diagnosis. We microbiological confirmed all clinically diagnosed cases by IS2404 PCR, and Ziehl-Neelsen. We found that over 50% of the clinically diagnosed cases were not BU, thereby averting any unnecessary antimycobacterial treatment with the associated side effects.
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Affiliation(s)
- Dorothy Yeboah-Manu
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Sammy Yaw Aboagye
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- * E-mail:
| | - Prince Asare
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Adwoa Asante-Poku
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kobina Ampah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Emelia Danso
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Evelyn Owusu-Mireku
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Zuleihatu Nakobu
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Edwin Ampadu
- National Buruli Ulcer Control Program, Ghana Health Service, Accra, Ghana
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