1
|
Spiliopoulos O, Solomos Z, Puchner KP. Buruli ulcer, tuberculosis and leprosy: Exploring the One Health dimensions of three most prevalent mycobacterial diseases: A narrative review. Trop Med Int Health 2024; 29:657-667. [PMID: 38994702 DOI: 10.1111/tmi.14024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
ΟBJECTIVES: Although Buruli ulcer, tuberculosis, and leprosy are the three most common mycobacterial diseases, One Health dimensions of these infections remain poorly understood. This narrative review aims at exploring the scientific literature with respect to the presence of animal reservoir(s) and other environmental sources for the pathogens of these infections, their role in transmission to humans and the research on/practical implementation of One Health relevant control efforts. METHODS The literature review was conducted using the online databases PubMed, Scopus, ProQuest and Google Scholar, reviewing articles that were written in English in the last 15 years. Grey literature, published by intergovernmental agencies, was also reviewed. RESULTS For the pathogen of Buruli ulcer, evidence suggests possums as a possible animal reservoir and thus having an active role in disease transmission to humans. Cattle and some wildlife species are deemed as established animal reservoirs for tuberculosis pathogens, with a non-negligible proportion of infections in humans being of zoonotic origin. Armadillos constitute an established animal reservoir for leprosy pathogens with the transmission of the disease from armadillos to humans being deemed possible. Lentic environments, soil and other aquatic sources may represent further abiotic reservoirs for viable Buruli ulcer and leprosy pathogens infecting humans. Ongoing investigation and implementation of public health measures, targeting (sapro)zoonotic transmission can be found in all three diseases. CONCLUSION Buruli ulcer, tuberculosis and leprosy exhibit important yet still poorly understood One Health aspects. Despite the microbiological affinity of the respective causative mycobacteria, considerable differences in their animal reservoirs, potential environmental sources and modes of zoonotic transmission are being observed. Whether these differences reflect actual variations between these diseases or rather knowledge gaps remains unclear. For improved disease control, further investigation of zoonotic aspects of all three diseases and formulation of One Health relevant interventions is urgently needed.
Collapse
Affiliation(s)
- Orestis Spiliopoulos
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Zisimangelos Solomos
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Karl Philipp Puchner
- Laboratory of Primary Health Care, General Medicine and Health Services Research, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
2
|
Mee PT, Buultjens AH, Oliver J, Brown K, Crowder JC, Porter JL, Hobbs EC, Judd LM, Taiaroa G, Puttharak N, Williamson DA, Blasdell KR, Tay EL, Feldman R, Muzari MO, Sanders C, Larsen S, Crouch SR, Johnson PDR, Wallace JR, Price DJ, Hoffmann AA, Gibney KB, Stinear TP, Lynch SE. Mosquitoes provide a transmission route between possums and humans for Buruli ulcer in southeastern Australia. Nat Microbiol 2024; 9:377-389. [PMID: 38263454 PMCID: PMC10847040 DOI: 10.1038/s41564-023-01553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024]
Abstract
Buruli ulcer, a chronic subcutaneous infection caused by Mycobacterium ulcerans, is increasing in prevalence in southeastern Australia. Possums are a local wildlife reservoir for M. ulcerans and, although mosquitoes have been implicated in transmission, it remains unclear how humans acquire infection. We conducted extensive field survey analyses of M. ulcerans prevalence among mosquitoes in the Mornington Peninsula region of southeastern Australia. PCR screening of trapped mosquitoes revealed a significant association between M. ulcerans and Aedes notoscriptus. Spatial scanning statistics revealed overlap between clusters of M. ulcerans-positive Ae. notoscriptus, M. ulcerans-positive possum excreta and Buruli ulcer cases, and metabarcoding analyses showed individual mosquitoes had fed on humans and possums. Bacterial genomic analysis confirmed shared single-nucleotide-polymorphism profiles for M. ulcerans detected in mosquitoes, possum excreta and humans. These findings indicate Ae. notoscriptus probably transmit M. ulcerans in southeastern Australia and highlight mosquito control as a Buruli ulcer prevention measure.
Collapse
Affiliation(s)
- Peter T Mee
- Centre for AgriBioscience, AgriBio, Agriculture Victoria, Bundoora, Victoria, Australia.
| | - Andrew H Buultjens
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Oliver
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Brown
- Centre for AgriBioscience, AgriBio, Agriculture Victoria, Bundoora, Victoria, Australia
| | - Jodie C Crowder
- Centre for AgriBioscience, AgriBio, Agriculture Victoria, Bundoora, Victoria, Australia
| | - Jessica L Porter
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Emma C Hobbs
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Louise M Judd
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - George Taiaroa
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Natsuda Puttharak
- Centre for AgriBioscience, AgriBio, Agriculture Victoria, Bundoora, Victoria, Australia
| | - Deborah A Williamson
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute for Infection and Immunity, Melbourne Health, Melbourne, Victoria, Australia
| | - Kim R Blasdell
- Australian Centre for Disease Preparedness, CSIRO, Geelong, Victoria, Australia
| | - Ee Laine Tay
- Department of Health, Melbourne, Victoria, Australia
| | | | - Mutizwa Odwell Muzari
- Medical Entomology, Tropical Public Health Services Cairns, Cairns and Hinterland Hospital and Health Services, Cairns, Queensland, Australia
| | - Chris Sanders
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart Larsen
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon R Crouch
- South East Public Health Unit, Monash Health, Clayton, Victoria, Australia
| | - Paul D R Johnson
- North East Public Health Unit, Austin Health, Heidelberg, Victoria, Australia
| | - John R Wallace
- Department of Biology, Millersville University, Millersville, PA, USA
| | - David J Price
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Ary A Hoffmann
- Pest and Environmental Adaptation Research Group, School of BioSciences, Bio21 Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine B Gibney
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.
- WHO Collaborating Centre for Mycobacterium ulcerans, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
| | - Stacey E Lynch
- Centre for AgriBioscience, AgriBio, Agriculture Victoria, Bundoora, Victoria, Australia
- Australian Centre for Disease Preparedness, CSIRO, Geelong, Victoria, Australia
| |
Collapse
|
3
|
Malhotra AM, Arias M, Backx M, Gadsby J, Goodman A, Gourlay Y, Milburn H, Moncayo-Nieto OL, Shimmin D, Dedicoat M, Kunst H. Extrapulmonary nontuberculous mycobacterial infections: a guide for the general physician. Clin Med (Lond) 2024; 24:100016. [PMID: 38350409 PMCID: PMC11024835 DOI: 10.1016/j.clinme.2024.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Non-tuberculous mycobacteria (NTM) infections predominantly present as pulmonary disease. Although relatively rare, 20-30 % originate from extrapulmonary sites resulting in a wide range of clinical syndromes. Immunocompromised individuals are particularly susceptible. Clinical manifestations include skin and soft-tissue infections, lymphadenitis, musculoskeletal infections and disseminated disease. Diagnosing extrapulmonary NTM is challenging, and management is complex, often involving multiple radiological and microbiological investigations, long courses of combination antibiotic regimens and may require adjuvant surgical interventions. We highlight both the importance of involving NTM experts at an early stage and the role of a multidisciplinary approach in the diagnosis and management of these infections.
Collapse
Affiliation(s)
- Akanksha Mimi Malhotra
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | | | | | - Jessica Gadsby
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Anna Goodman
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| |
Collapse
|
4
|
O'Brien DP, Blasdell K, Muhi S, Marais BJ, Buddle B, McNamara B, Athan E. Is BCG vaccination of possums the solution to the Buruli ulcer epidemic in south-eastern Australia? Med J Aust 2023; 219:520-522. [PMID: 37679050 DOI: 10.5694/mja2.52096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Daniel P O'Brien
- University Hospital Geelong, Geelong, VIC
- Department of Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC
| | - Kim Blasdell
- Australian Centre for Disease Preparedness, Commonwealth Scientific and Industrial Research Organisation, Geelong, VIC
| | - Stephen Muhi
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC
| | - Ben J Marais
- Sydney Institute of Infectious Diseases, University of Sydney, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Bryce Buddle
- Hopkirk Research Institute, Palmerston North, New Zealand
| | | | - Eugene Athan
- Barwon Health, Geelong, VIC
- Centre for Innovation in Infectious Diseases and Immunology Research, Deakin University, Geelong, VIC
| |
Collapse
|
5
|
McNamara BJ, Blasdell KR, Yerramilli A, Smith IL, Clayton SL, Dunn M, Tay EL, Gibney KB, Waidyatillake NT, Hussain MA, Muleme M, O'Brien DP, Athan E. Comprehensive Case-Control Study of Protective and Risk Factors for Buruli Ulcer, Southeastern Australia. Emerg Infect Dis 2023; 29:2032-2043. [PMID: 37735741 PMCID: PMC10521623 DOI: 10.3201/eid2910.230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
To examine protective and risk factors for Buruli ulcer (BU), we conducted a case-control study of 245 adult BU cases and 481 postcode-matched controls across BU-endemic areas of Victoria, Australia. We calculated age- and sex-adjusted odds ratios for socio-environmental, host, and behavioral factors associated with BU by using conditional logistic regression. Odds of BU were >2-fold for persons with diabetes mellitus and persons working outdoors who had soil contact in BU-endemic areas (compared with indoor work) but were lower among persons who had bacillus Calmette-Guérin vaccinations. BU was associated with increasing numbers of possums and with ponds and bore water use at residences. Using insect repellent, covering arms and legs outdoors, and immediately washing wounds were protective; undertaking multiple protective behaviors was associated with the lowest odds of BU. Skin hygiene/protection behaviors and previous bacillus Calmette-Guérin vaccination might provide protection against BU in BU-endemic areas.
Collapse
|
6
|
Bartley B, O'Brien D. Buruli ulcer - A neglected tropical disease in the Barwon region of Victoria, Australia: An emerging public health threat with local and national ramifications. Emerg Med Australas 2023; 35:697-701. [PMID: 37454363 DOI: 10.1111/1742-6723.14235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/18/2023] [Indexed: 07/18/2023]
Abstract
Mycobacterium ulcerans (MU) is known to be endemic in heavily touristed coastal regions of Victoria and is the cause of Buruli ulcer (BU) disease. The incidence, severity and geographic spread of MU infection/BU disease is increasing, including metropolitan Victorian suburbs. While the specifics of disease transmission and effective prevention strategies remain uncertain, severe complications can be mitigated by health systems that provide vigilant population surveillance to underpin early recognition, early specialist involvement and definitive treatment for the individual. Current theories regarding disease transmission and 'best practice' (or best guess) prevention and mitigation measures are presented herein. Opportunities to improve the health system response to this emerging public health threat are identified. It is incumbent upon all healthcare providers, including ED clinicians, to contribute by familiarising themselves with the established and emerging areas of endemicity of MU infection and the array of BU clinical presentations.
Collapse
Affiliation(s)
- Bruce Bartley
- Emergency Department, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Daniel O'Brien
- Department of Infectious Diseases, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| |
Collapse
|
7
|
Vandelannoote K, Buultjens AH, Porter JL, Velink A, Wallace JR, Blasdell KR, Dunn M, Boyd V, Fyfe JAM, Tay EL, Johnson PDR, Windecker SM, Golding N, Stinear TP. Statistical modeling based on structured surveys of Australian native possum excreta harboring Mycobacterium ulcerans predicts Buruli ulcer occurrence in humans. eLife 2023; 12:e84983. [PMID: 37057888 PMCID: PMC10154024 DOI: 10.7554/elife.84983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/13/2023] [Indexed: 04/15/2023] Open
Abstract
Background Buruli ulcer (BU) is a neglected tropical disease caused by infection of subcutaneous tissue with Mycobacterium ulcerans. BU is commonly reported across rural regions of Central and West Africa but has been increasing dramatically in temperate southeast Australia around the major metropolitan city of Melbourne, with most disease transmission occurring in the summer months. Previous research has shown that Australian native possums are reservoirs of M. ulcerans and that they shed the bacteria in their fecal material (excreta). Field surveys show that locales where possums harbor M. ulcerans overlap with human cases of BU, raising the possibility of using possum excreta surveys to predict the risk of disease occurrence in humans. Methods We thus established a highly structured 12 month possum excreta surveillance program across an area of 350 km2 in the Mornington Peninsula area 70 km south of Melbourne, Australia. The primary objective of our study was to assess using statistical modeling if M. ulcerans surveillance of possum excreta provided useful information for predicting future human BU case locations. Results Over two sampling campaigns in summer and winter, we collected 2,282 possum excreta specimens of which 11% were PCR positive for M. ulcerans-specific DNA. Using the spatial scanning statistical tool SaTScan, we observed non-random, co-correlated clustering of both M. ulcerans positive possum excreta and human BU cases. We next trained a statistical model with the Mornington Peninsula excreta survey data to predict the future likelihood of human BU cases occurring in the region. By observing where human BU cases subsequently occurred, we show that the excreta model performance was superior to a null model trained using the previous year's human BU case incidence data (AUC 0.66 vs 0.55). We then used data unseen by the excreta-informed model from a new survey of 661 possum excreta specimens in Geelong, a geographically separate BU endemic area to the southwest of Melbourne, to prospectively predict the location of human BU cases in that region. As for the Mornington Peninsula, the excreta-based BU prediction model outperformed the null model (AUC 0.75 vs 0.50) and pinpointed specific locations in Geelong where interventions could be deployed to interrupt disease spread. Conclusions This study highlights the One Health nature of BU by confirming a quantitative relationship between possum excreta shedding of M. ulcerans and humans developing BU. The excreta survey-informed modeling we have described will be a powerful tool for the efficient targeting of public health responses to stop BU. Funding This research was supported by the National Health and Medical Research Council of Australia and the Victorian Government Department of Health (GNT1152807 and GNT1196396).
Collapse
Affiliation(s)
- Koen Vandelannoote
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of MelbourneMelbourneAustralia
- Bacterial Phylogenomics Group, Institut Pasteur du CambodgePhnom PenhCambodia
| | - Andrew H Buultjens
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of MelbourneMelbourneAustralia
| | - Jessica L Porter
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of MelbourneMelbourneAustralia
| | - Anita Velink
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of MelbourneMelbourneAustralia
| | - John R Wallace
- Department of Biology, Millersville UniversityMillersvilleUnited States
| | - Kim R Blasdell
- Health and Biosecurity, Commonwealth Scientific and Industrial Research OrganisationGeelongAustralia
| | - Michael Dunn
- Health and Biosecurity, Commonwealth Scientific and Industrial Research OrganisationGeelongAustralia
| | - Victoria Boyd
- Health and Biosecurity, Commonwealth Scientific and Industrial Research OrganisationGeelongAustralia
| | - Janet AM Fyfe
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Ee Laine Tay
- Health Protection branch, Department of HealthVictoriaAustralia
| | - Paul DR Johnson
- North Eastern Public Health Unit (NEPHU), Austin HealthMelbourneAustralia
| | - Saras M Windecker
- School of Ecosystem and Forest Sciences, University of MelbourneMelbourneAustralia
| | - Nick Golding
- Telethon Kids Institute, Perth Children’s HospitalNedlandsAustralia
- Curtin School of Population Health, Curtin UniversityBentleyAustralia
- Melbourne School of Population and Global Health, University of MelbourneMelbourneAustralia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of MelbourneMelbourneAustralia
| |
Collapse
|