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Fukaura R, Koizumi H, Akashi N, Imai S, Murase C, Miyamoto Y, Ishii N, Yotsu R, Muro Y, Akiyama M. Buruli ulcer with satellite lesions: A case report from Japan. J Dermatol 2024. [PMID: 39018184 DOI: 10.1111/1346-8138.17274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/03/2024] [Indexed: 07/19/2024]
Affiliation(s)
- Ryo Fukaura
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Haruka Koizumi
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Norika Akashi
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoko Imai
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Chiaki Murase
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuji Miyamoto
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Rie Yotsu
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Muhi S, Porter JL, Stinear TP. A Mycobacterium ulcerans vaccine pilot trial using an accurate low-dose challenge. Microbiol Spectr 2024:e0055524. [PMID: 38916323 DOI: 10.1128/spectrum.00555-24] [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: 02/28/2024] [Accepted: 05/21/2024] [Indexed: 06/26/2024] Open
Abstract
A Mycobacterium ulcerans human challenge model has the potential to fundamentally advance our understanding of early human immune responses to infection, while rapidly evaluating vaccines and other therapeutic interventions. Here, using a murine tail infection model, we tested a very well-characterized working cell bank of the proposed challenge isolate M. ulcerans JKD8049 in naïve and Mycobacterium bovis bacille Calmette-Guérin (BCG)-vaccinated BALB/c mice. All 10 naïve mice were successfully infected with 20 colony-forming units (CFU) of M. ulcerans [95% confidence interval (CI) 17-22 CFU] with a mean time to visible lesion of 86 days (95% CI 79-92 days). In the 10 vaccinated mice, there was a significant delay in the mean time to lesion compared to the naïve controls of 24 days (P = 0.0003), but all mice eventually developed ulcerative lesions. This study informs a future human infection model by demonstrating the successful application of the challenge agent in this in vivo model and highlights both the promise and the problems with trying to induce protective immunity against M. ulcerans. IMPORTANCE In preparation for its proposed use in a controlled human infection model (CHIM), this study reports the successful infection of BALB/c mice using a carefully characterized, low-dose inoculum of Mycobacterium ulcerans JKD8049 (our proposed CHIM strain). We also demonstrate that Mycobacterium bovis bacille Calmette-Guérin delays the onset of disease but cannot alter the course of illness once a lesion becomes apparent. We also validate the findings of previous low-dose challenges that used less accurate methods to determine the inoculum, but our presented methodology is practical, accurate, and anticipated to be reproducible.
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Affiliation(s)
- Stephen Muhi
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jessica L Porter
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Mycobacterium ulcerans, Victorian Infectious Disease Reference Laboratory (VIDRL), Doherty Institute, Melbourne, Victoria, Australia
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Briand M, Boccarossa A, Rieux A, Jacques MA, Ganlanon L, Johnson C, Eveillard M, Marsollier L, Marion E. Emergence and spread of Mycobacterium ulcerans at different geographic scales. Microbiol Spectr 2024; 12:e0382723. [PMID: 38441471 PMCID: PMC10986537 DOI: 10.1128/spectrum.03827-23] [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: 11/10/2023] [Accepted: 02/10/2024] [Indexed: 04/06/2024] Open
Abstract
The classical lineage of Mycobacterium ulcerans is the most prevalent clonal group associated with Buruli ulcer in humans. Its reservoir is strongly associated with the environment. We analyzed together 1,045 isolates collected from 13 countries on two continents to define the evolutionary history and population dynamics of this lineage. We confirm that this lineage spread over 7,000 years from Australia to Africa with the emergence of outbreaks in distinct waves in the 18th and 19th centuries. In sharp contrast with its global spread over the last century, transmission chains are now mostly local, with little or no dissemination between endemic areas. This study provides new insights into the phylogeography and population dynamics of M. ulcerans, highlighting the importance of comparative genomic analyses to improve our understanding of pathogen transmission. IMPORTANCE Mycobacterium ulcerans is an environmental mycobacterial pathogen that can cause Buruli ulcer, a severe cutaneous infection, mostly spread in Africa and Australia. We conducted a large genomic study of M. ulcerans, combining genomic and evolutionary approaches to decipher its evolutionary history and pattern of spread at different geographic scales. At the scale of villages in an endemic area of Benin, the circulating genotypes have been introduced in recent decades and are not randomly distributed along the river. On a global scale, M. ulcerans has been spreading for much longer, resulting in distinct and compartmentalized endemic foci across Africa and Australia.
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Affiliation(s)
- Martial Briand
- Univ Angers, Institut Agro, INRAE, IRHS, SFR QUASAV, Angers, France
| | | | - Adrien Rieux
- CIRAD, UMR PVBMT, Saint Pierre, La Réunion, France
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Phillips RO, Owusu L, Koka E, Ocloo EK, Simpson H, Agbanyo A, Okyere D, Tuwor RD, Fokuoh-Boadu A, Akuffo RA, Novignon J, Oppong MN, Mosweu I, Asante-Poku A, Cobbinah J, Mtuy TB, Palmer J, Ahorlu C, Amoako YA, Walker SL, Yeboah-Manu D, Marks M, Pitt C, Pullan R. Development of an integrated and decentralised skin health strategy to improve experiences of skin neglected tropical diseases and other skin conditions in Atwima Mponua District, Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002809. [PMID: 38241242 PMCID: PMC10798462 DOI: 10.1371/journal.pgph.0002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
Integrated strategies are recommended to tackle neglected tropical diseases of the skin (skin NTDs), which pose a substantial health and economic burden in many countries, including Ghana. We describe the development of an integrated and decentralised skin health strategy designed to improve experiences of skin NTDs in Atwima Mponua district in Ashanti Region. A multidisciplinary research team led an iterative process to develop an overall strategy and specific interventions, based on a theory of change informed by formative research conducted in Atwima Mponua district. The process involved preparatory work, four co-development workshops (August 2021 to November 2022), collaborative working groups to operationalise intervention components, and obtaining ethical approval. Stakeholders including affected individuals, caregivers, other community members and actors from different levels of the health system participated in co-development activities. We consulted these stakeholders at each stage of the research process, including discussion of study findings, development of our theory of change, identifying implementable solutions to identified challenges, and protocol development. Participants determined that the intervention should broadly address wounds and other skin conditions, rather than only skin NTDs, and should avoid reliance on non-governmental organisations and research teams to ensure sustainable implementation by district health teams and transferability elsewhere. The overall strategy was designed to focus on a decentralised model of care for skin conditions, while including other interventions to support a self-care delivery pathway, community engagement, and referral. Our theory of change describes the pathways through which these interventions are expected to achieve the strategy's aim, the assumptions, and problems addressed. This complex intervention strategy has been designed to respond to the local context, while maximising transferability to ensure wider relevance. Implementation is expected to begin in 2023.
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Affiliation(s)
- Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Lucy Owusu
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Eric Koka
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Edmond Kwaku Ocloo
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Hope Simpson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abigail Agbanyo
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Daniel Okyere
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ruth Dede Tuwor
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Adelaide Fokuoh-Boadu
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Richard Adjei Akuffo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jacob Novignon
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Iris Mosweu
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jojo Cobbinah
- Atwima Mponua District Health Directorate, Nhinahin, Ghana
| | - Tara B. Mtuy
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Jennifer Palmer
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Stephen L. Walker
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Catherine Pitt
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Suzuki T, Boonyaleka K, Okano T, Iida T, Yoshida M, Fukano H, Hoshino Y, Iwakura Y, Ablordey AS, Ashida H. Inflammasome-triggered IL-18 controls skin inflammation in the progression of Buruli ulcer. PLoS Pathog 2023; 19:e1011747. [PMID: 37910490 PMCID: PMC10619818 DOI: 10.1371/journal.ppat.1011747] [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: 07/10/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023] Open
Abstract
Buruli ulcer is an emerging chronic infectious skin disease caused by Mycobacterium ulcerans. Mycolactone, an exotoxin produced by the bacterium, is the only identified virulence factor so far, but the functions of this toxin and the mechanisms of disease progression remain unclear. By interfering Sec61 translocon, mycolactone inhibits the Sec61-dependent co-translational translocation of newly synthesized proteins, such as induced cytokines and immune cell receptors, into the endoplasmic reticulum. However, in regard to IL-1β, which is secreted by a Sec61-independent mechanism, mycolactone has been shown to induce IL-1β secretion via activation of inflammasomes. In this study, we clarified that cytokine induction, including that of IL-1β, in infected macrophages was suppressed by mycolactone produced by M. ulcerans subsp. shinshuense, despite the activation of caspase-1 through the inflammasome activation triggered in a manner independent of mycolactone. Intriguingly, mycolactone suppressed the expression of proIL-1β as well as TNF-α at the transcriptional level, suggesting that mycolactone of M. ulcerans subsp. shinshuense may exert additional inhibitory effect on proIL-1β expression. Remarkably, constitutively produced IL-18 was cleaved and mature IL-18 was actually released from macrophages infected with the causative mycobacterium. IL-18-deficient mice infected subcutaneously with M. ulcerans exhibited exacerbated skin inflammation during the course of disease progression. On the other hand, IL-1β controls bacterial multiplication in skin tissues. These results provide information regarding the mechanisms and functions of the induced cytokines in the pathology of Buruli ulcer.
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Affiliation(s)
- Toshihiko Suzuki
- Department of Bacterial Pathogenesis, Infection and Host Response, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kotchakorn Boonyaleka
- Department of Bacterial Pathogenesis, Infection and Host Response, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tokuju Okano
- Department of Bacterial Pathogenesis, Infection and Host Response, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tamako Iida
- Department of Bacterial Pathogenesis, Infection and Host Response, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Mitsunori Yoshida
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hanako Fukano
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshihiko Hoshino
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoichiro Iwakura
- Research Institute for Biomedical Sciences, Tokyo University of Science, Noda, Chiba, Japan
| | - Anthony S. Ablordey
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Hiroshi Ashida
- Department of Bacterial Pathogenesis, Infection and Host Response, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Velink A, Porter JL, Stinear TP, Johnson PDR. Mycobacterium ulcerans not detected by PCR on human skin in Buruli ulcer endemic areas of south eastern Australia. PLoS Negl Trop Dis 2023; 17:e0011272. [PMID: 37824578 PMCID: PMC10597473 DOI: 10.1371/journal.pntd.0011272] [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: 03/31/2023] [Revised: 10/24/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Mycobacterium ulcerans (MU) causes Buruli ulcer (Buruli), a geographically restricted infection that can result in skin loss, contracture and permanent scarring. Lesion-location maps compiled from more than 640 cases in south eastern Australia suggest biting insects are likely involved in transmission, but it is unclear whether MU is brought by insects to humans or if MU is already on the skin and inoculation is an opportunistic event that need not be insect dependent. METHODS We validated a PCR swab detection assay and defined its dynamic range using laboratory cultured M. ulcerans and fresh pigskin. We invited volunteers in Buruli-endemic and non-endemic areas to sample their skin surfaces with self-collected skin swabs tested by IS2404 quantitative PCR. RESULTS Pigskin validation experiments established a limit-of-detection of 0.06 CFU/cm2 at a qPCR cycle threshold (Ct) of 35. Fifty-seven volunteers returned their self-collected kits of 4 swabs (bilateral ankles, calves, wrists, forearms), 10 from control areas and 47 from endemic areas. Collection was timed to coincide with the known peak-transmission period of Buruli. All swabs from human volunteers tested negative (Ct ≥35). CONCLUSIONS M. ulcerans was not detected on the skin of humans from highly Buruli endemic areas.
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Affiliation(s)
- Anita Velink
- North Eastern Public Health Unit (NEPHU) and Infectious Diseases Department, Austin Health, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Victoria, Australia
| | - Jessica L. Porter
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Victoria, Australia
| | - Timothy P. Stinear
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Victoria, Australia
| | - Paul D. R. Johnson
- North Eastern Public Health Unit (NEPHU) and Infectious Diseases Department, Austin Health, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Victoria, Australia
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Cherif MS, Keita M, Dahal P, Guilavogui T, Beavogui AH, Diassy L, Conde M, Touré A, Delamou A. Neglected tropical diseases in Republic of Guinea: disease endemicity, case burden and the road towards the 2030 target. Int Health 2023; 15:490-504. [PMID: 37232124 PMCID: PMC10472893 DOI: 10.1093/inthealth/ihad036] [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: 07/07/2022] [Revised: 03/02/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023] Open
Abstract
Neglected tropical diseases (NTDs) predominantly affect vulnerable and marginalized populations in tropical and subtropical areas and globally affect more than one billion people. In Guinea, the burden of NTDs is estimated to be >7.5 disability-adjusted life years per million inhabitants. Currently the Guinea NTDs master plan (2017-2020) has identified eight diseases as public health problems: onchocerciasis, lymphatic filariasis, trachoma, schistosomiasis and soil-transmitted helminthiasis, leprosy, human African trypanosomiasis and Buruli ulcer. In this review we discuss the past and the current case burden of the priority NTDs in Guinea, highlight the major milestones and discuss current and future areas of focus for achieving the 2030 target outlined by the World Health Organization.
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Affiliation(s)
- Mahamoud Sama Cherif
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Direction Regionale de la Santé de Faranah, Ministère de la santé et de l'hygiène publique, Faranah, Guinea
- Service de Pediatrie, Hospital National Ignace Deen, Ministère de la santé et de l'Hygiène Publique, Conakry, Guinea
| | - Mory Keita
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Prabin Dahal
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Timothé Guilavogui
- Management and Programmes Coordination, Ministry of Health, Conakry, Guinea
| | - Abdoul Habib Beavogui
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Centre National de Formation et Recherche en Sante Rurale de Maferinyah, Maferinyah, Guinea
| | - Lamine Diassy
- World Health Organization, Guinea office, Landreah, Corniche Nord, Boîte postale 817, Conakry, Guinea
| | - Mohamed Conde
- Service de Pediatrie, Hospital National Ignace Deen, Ministère de la santé et de l'Hygiène Publique, Conakry, Guinea
| | - Abdoulaye Touré
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Institut National de Santé Publique, Ministère de la Santé et de l'Hygiène Publique, Conakry, Guinea
| | - Alexandre Delamou
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Centre National de Formation et Recherche en Sante Rurale de Maferinyah, Maferinyah, Guinea
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Kim D, Crippen TL, Dhungel L, Delclos PJ, Tomberlin JK, Jordan HR. Behavioral interplay between mosquito and mycolactone produced by Mycobacterium ulcerans and bacterial gene expression induced by mosquito proximity. PLoS One 2023; 18:e0289768. [PMID: 37535670 PMCID: PMC10399876 DOI: 10.1371/journal.pone.0289768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023] Open
Abstract
Mycolactone is a cytotoxic lipid metabolite produced by Mycobacterium ulcerans, the environmental pathogen responsible for Buruli ulcer, a neglected tropical disease. Mycobacterium ulcerans is prevalent in West Africa, particularly found in lentic environments, where mosquitoes also occur. Researchers hypothesize mosquitoes could serve as a transmission mechanism resulting in infection by M. ulcerans when mosquitoes pierce skin contaminated with M. ulcerans. The interplay between the pathogen, mycolactone, and mosquito is only just beginning to be explored. A triple-choice assay was conducted to determine the host-seeking preference of Aedes aegypti between M. ulcerans wildtype (MU, mycolactone active) and mutant (MUlac-, mycolactone inactive). Both qualitative and quantitative differences in volatile organic compounds' (VOCs) profiles of MU and MUlac- were determined by GC-MS. Additionally, we evaluated the interplay between Ae. aegypti proximity and M. ulcerans mRNA expression. The results showed that mosquito attraction was significantly greater (126.0%) to an artificial host treated with MU than MUlac-. We found that MU and MUlac produced differential profiles of VOCs associated with a wide range of biological importance from quorum sensing (QS) to human odor components. RT-qPCR assays showed that mycolactone upregulation was 24-fold greater for MU exposed to Ae. aegypti in direct proximity. Transcriptome data indicated significant induction of ten chromosomal genes of MU involved in stress responses and membrane protein, compared to MUlac- when directly having access to or in near mosquito proximity. Our study provides evidence of possible interkingdom interactions between unicellular and multicellular species that MU present on human skin is capable of interreacting with unrelated species (i.e., mosquitoes), altering its gene expression when mosquitoes are in direct contact or proximity, potentially impacting the production of its VOCs, and consequently leading to the stronger attraction of mosquitoes toward human hosts. This study elucidates interkingdom interactions between viable M. ulcerans bacteria and Ae. aegypti mosquitoes, which rarely have been explored in the past. Our finding opens new doors for future research in terms of disease ecology, prevalence, and pathogen dispersal outside of the M. ulcerans system.
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Affiliation(s)
- Dongmin Kim
- Department of Entomology, Texas A&M University, College Station, Texas, United States of America
| | - Tawni L Crippen
- Southern Plains Agricultural Research Center, Agricultural Research Service, USDA, College Station, Texas, United States of America
| | - Laxmi Dhungel
- Department of Biological Sciences, Mississippi State University, Starkville, Mississippi, United States of America
| | - Pablo J Delclos
- Department of Natural Sciences, University of Houston-Downtown, Houston, Texas, United States of America
| | - Jeffery K Tomberlin
- Department of Entomology, Texas A&M University, College Station, Texas, United States of America
| | - Heather R Jordan
- Department of Biological Sciences, Mississippi State University, Starkville, Mississippi, United States of America
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Keita ML, Kaba A, Telly Diallo I, Kesso Bah M, Sagno M, Goumane A, Bouam A, Drancourt M. Gold Panning-Related Chronic Cutaneous Ulcers in Guinea, West Africa. Am J Trop Med Hyg 2023; 108:221-226. [PMID: 36509061 PMCID: PMC9833079 DOI: 10.4269/ajtmh.22-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/29/2022] [Indexed: 12/15/2022] Open
Abstract
Chronic cutaneous ulcers caused potentially by several pathogens are of increasing concern in endemic tropical countries, including Guinea in West Africa, in rural populations exposed to aquatic environments during recreational, domestic, or agricultural activities. By plotting 1,011 cases of chronic cutaneous ulcers classified under the name Buruli ulcer in 24 of 33 Guinea health districts (72%) between 2018 and 2020 against the gold map and gold-panning map of Guinea, we revealed a significant spatial association between chronic cutaneous ulcer foci and gold-panning foci (P < 0.05), but not with nongold-panning foci (P = 0.12) in Guinea. Gold panning should be listed as an additional economic activity exposing populations to chronic cutaneous ulcers. Further research may aim to clarify whether any geological and biologic factors underlie such an association, besides the possibility that the unprotected skin of gold panners may be exposed to opportunistic, pathogen-contaminated environments in gold-panning areas.
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Affiliation(s)
- Mohamed L. Keita
- Aix Marseille University, Institut National pour le Developpement, Microbes, Evolution, Phylogénie et Infection, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Abdoulaye Kaba
- Bureau of Stratégies and Dévelopment, Ministère de la Santé, Conakry, République de Guinée
| | - Ibrahima Telly Diallo
- Bureau of Stratégies and Dévelopment, Ministère de la Santé, Conakry, République de Guinée
| | - Mariama Kesso Bah
- Programme National de Lutte Contre les Maladies Tropicales Negligées, Ministère de la Santé, Conakry, République de Guinée
| | - Michel Sagno
- Programme National de Lutte Contre les Maladies Tropicales Negligées, Ministère de la Santé, Conakry, République de Guinée
| | - Aboubacar Goumane
- Centre Régional de Dépistage et de Traitement de l’Ulcère de Buruli, Ministère de la Santé, N’zerekoré, République de Guinée
| | - Amar Bouam
- Aix Marseille University, Institut National pour le Developpement, Microbes, Evolution, Phylogénie et Infection, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Michel Drancourt
- Aix Marseille University, Institut National pour le Developpement, Microbes, Evolution, Phylogénie et Infection, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
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Leuenberger A, Koné BV, N’krumah RTAS, Koffi DY, Bonfoh B, Utzinger J, Pluschke G. Perceived water-related risk factors of Buruli ulcer in two villages of south-central Côte d'Ivoire. PLoS Negl Trop Dis 2022; 16:e0010927. [PMID: 36516125 PMCID: PMC9750022 DOI: 10.1371/journal.pntd.0010927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Buruli ulcer, caused by Mycobacterium ulcerans, is a neglected tropical skin disease that is primarily endemic in West and Central Africa, including Côte d'Ivoire. Studies indicate that M. ulcerans infections are caused by contact with an environmental reservoir of the bacteria, governed by specific human biological conditions. Yet, the nature of this reservoir and the exact mode of transmission remain unknown. METHODOLOGY To identify ecologic risk factors of Buruli ulcer in south-central Côte d'Ivoire, we pursued a qualitative study matched with geo-referencing inquiry. Embedded in a broader integrated wound management research project, we (i) mapped households and water sources of laboratory confirmed Buruli ulcer cases and (ii) interviewed 12 patients and four health care workers to assess exposure to surface water and to deepen the understanding of perceived transmission pathways. PRINCIPAL FINDINGS Water availability, accessibility, and affordability were reported as key determinants for choosing water resources. Furthermore, perceived risks were related to environmental, structural, and individual factors. Despite the presence of improved water sources (e.g., drilled wells), communities heavily relied on unprotected surface water for a multitude of activities. The nearby Bandama River and seasonal waterbodies were frequently used for washing, bathing, and collection of water for drinking and cooking. Many residents also reported to cross the river on a daily basis for agricultural chores, and hence, are exposed to stagnant water during farming activities. CONCLUSIONS/SIGNIFICANCE Our study in two Buruli ulcer endemic villages in south-central Côte d'Ivoire revealed a wide range of water-related domestic activities that might expose people to an increased risk of contracting the disease. Environmental, biological, social, and cultural risk factors are closely interlinked and should be considered in future investigations of Buruli ulcer transmission. Active participation of the communities is key to better understand their circumstances to advance research and fight against Buruli ulcer and other neglected tropical diseases.
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Affiliation(s)
- Andrea Leuenberger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Bognan V. Koné
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Raymond T. A. S. N’krumah
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Université Peleforo Gon Coulibaly de Korhogo, Korhogo, Côte d’Ivoire
| | - Didier Y. Koffi
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Programme National de Lutte contre l’Ulcère de Buruli, Abidjan, Côte d’Ivoire
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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11
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Manilal A, Tadesse D, Sabu KR. Buruli Ulcer and Medical Geo-Microbiology. Infect Drug Resist 2022; 15:6811-6814. [PMID: 36458199 PMCID: PMC9707318 DOI: 10.2147/idr.s388005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/18/2022] [Indexed: 09/29/2023] Open
Abstract
Buruli ulcer is a chronic debilitating infectious disease caused by the pathogen Mycobacterium ulcerans, which can be cured if diagnosed and treated in an early stage. However, advanced cases need antibiotic treatment followed by surgical interventions. In this context, an extremely effective and less expensive treatment modality can be developed by means of an extended topical application of certain selected natural clay minerals, most of the time containing illite-smectite having some iron content. There is a scope for developing the speciality, medical geo-microbiology, which is truly a multidisciplinary one, for finding a cure for the severe and advanced cases of BU.
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Affiliation(s)
- Aseer Manilal
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Dagimawie Tadesse
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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12
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Ishwarlall TZ, Adeleke VT, Maharaj L, Okpeku M, Adeniyi AA, Adeleke MA. Identification of potential candidate vaccines against Mycobacterium ulcerans based on the major facilitator superfamily transporter protein. Front Immunol 2022; 13:1023558. [PMID: 36426350 PMCID: PMC9679648 DOI: 10.3389/fimmu.2022.1023558] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2023] Open
Abstract
Buruli ulcer is a neglected tropical disease that is characterized by non-fatal lesion development. The causative agent is Mycobacterium ulcerans (M. ulcerans). There are no known vectors or transmission methods, preventing the development of control methods. There are effective diagnostic techniques and treatment routines; however, several socioeconomic factors may limit patients' abilities to receive these treatments. The Bacillus Calmette-Guérin vaccine developed against tuberculosis has shown limited efficacy, and no conventionally designed vaccines have passed clinical trials. This study aimed to generate a multi-epitope vaccine against M. ulcerans from the major facilitator superfamily transporter protein using an immunoinformatics approach. Twelve M. ulcerans genome assemblies were analyzed, resulting in the identification of 11 CD8+ and 7 CD4+ T-cell epitopes and 2 B-cell epitopes. These conserved epitopes were computationally predicted to be antigenic, immunogenic, non-allergenic, and non-toxic. The CD4+ T-cell epitopes were capable of inducing interferon-gamma and interleukin-4. They successfully bound to their respective human leukocyte antigens alleles in in silico docking studies. The expected global population coverage of the T-cell epitopes and their restricted human leukocyte antigens alleles was 99.90%. The population coverage of endemic regions ranged from 99.99% (Papua New Guinea) to 21.81% (Liberia). Two vaccine constructs were generated using the Toll-like receptors 2 and 4 agonists, LprG and RpfE, respectively. Both constructs were antigenic, non-allergenic, non-toxic, thermostable, basic, and hydrophilic. The DNA sequences of the vaccine constructs underwent optimization and were successfully in-silico cloned with the pET-28a(+) plasmid. The vaccine constructs were successfully docked to their respective toll-like receptors. Molecular dynamics simulations were carried out to analyze the binding interactions within the complex. The generated binding energies indicate the stability of both complexes. The constructs generated in this study display severable favorable properties, with construct one displaying a greater range of favorable properties. However, further analysis and laboratory validation are required.
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Affiliation(s)
- Tamara Z. Ishwarlall
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Victoria T. Adeleke
- Department of Chemical Engineering, Mangosuthu University of Technology, Durban, South Africa
| | - Leah Maharaj
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Moses Okpeku
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Adebayo A. Adeniyi
- Department of Chemistry, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa
- Department of Industrial Chemistry, Federal University Oye Ekiti, Oye-Ekiti, Ekiti State, Nigeria
| | - Matthew A. Adeleke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
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13
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Marion E, Marsollier L. Mycobacterium ulcerans. Trends Microbiol 2022; 30:1116-1117. [PMID: 36163220 DOI: 10.1016/j.tim.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Estelle Marion
- Université d'Angers, Nantes Université, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR, 1302, Angers, France.
| | - Laurent Marsollier
- Université d'Angers, Nantes Université, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR, 1302, Angers, France
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14
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Alo C, Okedo-Alex IN, Akamike IC, Agu AP, Okeke IM, Amuzie CI, Alo NC. Utilising community volunteers can increase the detection and referral of Buruli ulcer cases in endemic communities in Southeast, Nigeria. Trop Dis Travel Med Vaccines 2022; 8:24. [PMID: 36316742 PMCID: PMC9623928 DOI: 10.1186/s40794-022-00181-7] [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: 04/27/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Buruli ulcer (BU) is a debilitating neglected tropical disease which causes disability and mostly affects inhabitants in impoverished settings where access to medical care is challenging. This study aims to determine the effect of training community members as volunteers for or in the detection and referral of people who have Buruli ulcer to the hospital. METHODS The following study is a before and after study in the BU-endemic Local Government Areas (LGA) of Ebonyi State. A cluster random sampling technique was used to select 90 volunteers from three LGAs (30 from each LGA). In each LGA, the volunteers underwent a one-day training and six months field work to identify all those who have any form of ulcer on any part of their bodies. A short questionnaire was used to capture socio-demographic characteristics of the patient, site of the ulcer, duration of the ulcer, initial appearance of the ulcer, referral to hospital, result of laboratory investigation, and treatment received. The data was analysed using the Statistical Package for Social Sciences (SPSS) for Microsoft Windows version 20 software. The Z test statistic was used to compare the number of referred BU patients before and after the intervention by LGA. The Chi square test was used to examine the association between the dependent and independent variables. RESULTS The mean age of volunteers was 39 ± 9.5 while mean age of the patients was 42.3 ± 17.1. Most of the ulcers were on the legs (79.4%) and lasted 1-5 years (65.6%). There was a significant increase in the proportion of BU suspects identified by the community volunteers in all 3 LGAs (Afikpo north (p = < 0.001), Abakaliki (p = 0.02), Ikwo (p = 0.001). The duration of the ulcer was associated with the detection and referral of the patients with higher levels of detection and referral among those whose ulcer had lasted 1-5 years in two of the LGAs (P < 0.001). CONCLUSION We recommend that program managers and stakeholders integrate and scale up the services of trained community health volunteers for the rapid detection of Buruli ulcer cases in rural endemic communities. Awareness and sensitization campaigns on BU preventive measures should be intensified.
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Affiliation(s)
- Chihurumnanya Alo
- grid.412141.30000 0001 2033 5930Department of Community Medicine, Faculty of Medicine, Ebonyi State University, Ebonyi State, Abakaliki, Nigeria ,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State Nigeria
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State Nigeria ,grid.412141.30000 0001 2033 5930African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU) Abakaliki, Abakaliki,, Nigeria
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State Nigeria ,grid.412141.30000 0001 2033 5930African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU) Abakaliki, Abakaliki,, Nigeria
| | - Adaoha Pearl Agu
- grid.412141.30000 0001 2033 5930Department of Community Medicine, Faculty of Medicine, Ebonyi State University, Ebonyi State, Abakaliki, Nigeria ,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State Nigeria ,grid.412141.30000 0001 2033 5930Department of Community Medicine, Ebonyi State University Abakaliki, Abakaliki, Ebonyi State Nigeria
| | - Ifeyinwa Maureen Okeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State Nigeria
| | - Chidinma Ihuoma Amuzie
- grid.414819.1Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State Nigeria ,Nigeria Field Epidemiology Training Program, Abuja, Nigeria
| | - Nneamaka C. Alo
- Department of Family Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakalik, Ebonyi State Nigeria
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15
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Rouse WB, Gart J, Peysakhova L, Moss WN. Analysis of key genes in Mycobacterium ulcerans reveals conserved RNA structural motifs and regions with apparent pressure to remain unstructured. FRONTIERS IN TROPICAL DISEASES 2022; 3. [PMID: 37006713 PMCID: PMC10062443 DOI: 10.3389/fitd.2022.1009362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Buruli Ulcer is a neglected tropical disease that results in disfiguring and dangerous lesions in affected persons across a wide geographic area, including much of West Africa. The causative agent of Buruli Ulcer is Mycobacterium ulcerans, a relative of the bacterium that causes tuberculosis and leprosy. Few therapeutic options exist for the treatment of this disease beyond antibiotics in the early stages, which are frequently ineffective, and surgical removal in the later stage. In this study we analyze six genes in Mycobacterium ulcerans that have high potential of therapeutic targeting. We focus our analysis on a combined in silico and comparative sequence study of potential RNA secondary structure across these genes. The result of this work was the comprehensive local RNA structural landscape across each of these significant genes. This revealed multiple sites of ordered and evolved RNA structure interspersed between sequences that either have no bias for structure or, indeed, appear to be ordered to be unstructured and (potentially) accessible. In addition to providing data that could be of interest to basic biology, our results provide guides for efforts aimed at targeting this pathogen at the RNA level. We explore this latter possibility through the in silico analysis of antisense oligonucleotides that could potentially be used to target pathogen RNA.
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Affiliation(s)
- Warren B. Rouse
- Roy J. Carver Department of Biochemistry, Biophysics, and Molecular Biology, Iowa State University, Ames, IA, United States
| | - Jessica Gart
- Science and Engineering Research Program (SERP), Staten Island Technical High School, Staten Island, NY, United States
| | - Lauren Peysakhova
- Science and Engineering Research Program (SERP), Staten Island Technical High School, Staten Island, NY, United States
| | - Walter N. Moss
- Roy J. Carver Department of Biochemistry, Biophysics, and Molecular Biology, Iowa State University, Ames, IA, United States
- CORRESPONDENCE: Walter N. Moss,
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16
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Fukano H, Nakanaga K, Goto M, Yoshida M, Ishii N, Hoshino Y. Therapeutic efficacy of rifalazil (KRM-1648) in a M. ulcerans-induced Buruli ulcer mouse model. PLoS One 2022; 17:e0274742. [PMID: 36201529 PMCID: PMC9536621 DOI: 10.1371/journal.pone.0274742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 09/05/2022] [Indexed: 11/07/2022] Open
Abstract
Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans infection that requires long-term antibiotic treatment and/or surgical excision. In this study, we investigated the therapeutic efficacy of the rifamycin derivative, rifalazil (RLZ) (also known as KRM-1648), in an advanced M. ulcerans infection model. Six-week-old female BALB/c mice were infected with 3.25 x 104 colony-forming units (CFU) of M. ulcerans subcutaneously into the bilateral hind footpads. At 33 days post-infection, when the footpads exhibited significant redness and swelling, mice were treated orally with 5 or 10 mg/kg of RLZ for up to 15 weeks. Mice were followed for an additional 15 weeks following treatment cessation. Untreated mice exhibited a progressive increase in footpad redness, swelling, and erosion over time, and all untreated mice reached to endpoint within 5–8 weeks post-bacterial injection. In the RLZ-treated mice, footpad redness and swelling and general condition improved or completely healed, and no recurrence occurred following treatment cessation. After 3 weeks of treatment, the CFU counts from the footpads of recovered RLZ-treated mice showed a 104 decrease compared with those of untreated mice. We observed a further reduction in CFU counts to the detection limit following 6 to 15 weeks of treatment, which did not increase 15 weeks after discontinuing the treatment. Histopathologically, bacteria in the treated mice became fragmented one week after RLZ-treatment. At the final point of the experiment, all the treated mice (5mg/kg/day; n = 6, 10mg/kg/day; n = 7) survived and had no signs of M. ulcerans infection. These results indicate that the rifamycin analogue, RLZ, is efficacious in the treatment of an advanced M. ulcerans infection mouse model.
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Affiliation(s)
- Hanako Fukano
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazue Nakanaga
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masamichi Goto
- Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Mitsunori Yoshida
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norihisa Ishii
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- National Sanatorium Tamazenshoen, Tokyo, Japan
| | - Yoshihiko Hoshino
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- * E-mail:
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17
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Timothy JWS, Rogers E, Halliday KE, Mulbah T, Marks M, Zaizay Z, Giddings R, Kempf M, Marion E, Walker SL, Kollie KK, Pullan RL. Quantifying Population Burden and Effectiveness of Decentralized Surveillance Strategies for Skin-Presenting Neglected Tropical Diseases, Liberia. Emerg Infect Dis 2022; 28:1755-1764. [PMID: 35997318 PMCID: PMC9423900 DOI: 10.3201/eid2809.212126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated programmatic approaches for skin neglected tropical disease (NTD) surveillance and completed a robust estimation of the burden of skin NTDs endemic to West Africa (Buruli ulcer, leprosy, lymphatic filariasis morbidity, and yaws). In Maryland, Liberia, exhaustive case finding by community health workers of 56,285 persons across 92 clusters identified 3,241 suspected cases. A total of 236 skin NTDs (34.0 [95% CI 29.1–38.9]/10,000 persons) were confirmed by midlevel healthcare workers trained using a tailored program. Cases showed a focal and spatially heterogeneous distribution. This community health worker‒led approach showed a higher skin NTD burden than prevailing surveillance mechanisms, but also showed high (95.1%) and equitable population coverage. Specialized training and task-shifting of diagnoses to midlevel health workers led to reliable identification of skin NTDs, but reliability of individual diagnoses varied. This multifaceted evaluation of skin NTD surveillance strategies quantifies benefits and limitations of key approaches promoted by the 2030 NTD roadmap of the World Health Organization.
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18
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Chavda VP, Haritopoulou-Sinanidou M, Bezbaruah R, Apostolopoulos V. Vaccination efforts for Buruli Ulcer. Expert Rev Vaccines 2022; 21:1419-1428. [PMID: 35962475 DOI: 10.1080/14760584.2022.2113514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Buruli ulcer is one of the most common mycobacterial diseases usually affecting poorer populations in tropical and subtropical environments. This disease, caused by M. ulcerans infection, has devastating effects for patients, with significant health and economic burden. Antibiotics are often used to treat affected individuals, but in most cases, surgery is necessary. AREA COVERED We present progress on Buruli ulcer vaccines and identify knowledge gaps in this neglected tropical disease. EXPERT OPINION The lack of appropriate infrastructure in endemic areas, as well as the severity of symptoms and lack of non-invasive treatment options, highlights the need for an effective vaccine to combat this disease. In terms of humoral immunity, it is vital to consider its significance and the magnitude to which it inhibits or slowdowns the progression of the disease. Only by answering these key questions will it be possible to tailor more appropriate vaccination and preventative provisions.
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Affiliation(s)
- Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Ahmedabad, India
| | | | - Rajashri Bezbaruah
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, Assam, India
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Immunology and Translational Research Group, Victoria University, Melbourne VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Immunology Program, Melbourne VIC, Australia
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19
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Gyamfi E, Dogbe MA, Quaye C, Affouda AA, Kyei-Baffour E, Awuku-Asante D, Sarpong-Duah M, Mosi L. Variable Number Tandem Repeat Profiling of Mycobacterium ulcerans Reveals New Genotypes in Buruli Ulcer Endemic Communities in Ghana and Côte d’Ivoire. Front Microbiol 2022; 13:872579. [PMID: 35814673 PMCID: PMC9262091 DOI: 10.3389/fmicb.2022.872579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Buruli ulcer (BU), a necrotic skin disease caused by Mycobacterium ulcerans, 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 M. ulcerans from different geographical locations has not been clearly elucidated, and some studies seem to suggest genetic differences between M. ulcerans in humans and in the environment. This study aimed at identifying genetic differences among M. ulcerans 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 via acid fast staining and PCR targeting the 16S rRNA, IS2404, IS2606, and ER domain genes present on M. ulcerans. Heterogeneity among M. ulcerans was determined through VNTR profiling targeting 10 loci. Eleven M. ulcerans genotypes were identified within the clinical samples in both Ghana and Côte d’Ivoire, whiles six M. ulcerans genotypes were found among the environmental samples. Clinical M. ulcerans 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 M. ulcerans from the environment, particularly water bodies and biofilms from aquatic plants, to humans through open lesions on the skin.
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20
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Kurcheid J, Gordon CA, Clarke NE, Wangdi K, Kelly M, Lal A, Mutombo PN, Wang D, Mationg ML, Clements ACA, Muhi S, Bradbury RS, Biggs B, Page W, Williams G, McManus DP, Gray D. Neglected tropical diseases in Australia: a narrative review. Med J Aust 2022; 216:532-538. [DOI: 10.5694/mja2.51533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Johanna Kurcheid
- Australian National University Canberra ACT
- Swiss Tropical and Public Health Institute Basel Switzerland
| | | | - Naomi E Clarke
- Australian National University Canberra ACT
- Kirby Institute University of New South Wales Sydney NSW
| | | | | | - Aparna Lal
- Australian National University Canberra ACT
| | - Polydor N Mutombo
- National Centre for Naturopathic Medicine Southern Cross University Lismore NSW
| | | | | | | | - Stephen Muhi
- Victorian Infectious Diseases Service Royal Melbourne Hospital Melbourne VIC
| | | | - Beverley‐Ann Biggs
- Victorian Infectious Diseases Service Royal Melbourne Hospital Melbourne VIC
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21
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Timothy JWS, Pullan RL, Yotsu RR. Methods and Approaches for Buruli Ulcer Surveillance in Africa: Lessons Learnt and Future Directions. Methods Mol Biol 2022; 2387:87-102. [PMID: 34643905 DOI: 10.1007/978-1-0716-1779-3_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Over 95% of the global burden of Buruli ulcer disease (BU) caused by Mycobacterium ulcerans occurs in equatorial Africa. National and sub-national programs have implemented various approaches to improve detection and reporting of incident cases over recent decades. Regional incidence rates are currently in decline; however, surveillance targets outlined in 2012 by WHO have been missed and detection bias may contribute to these trends. In light of the new 2030 NTD roadmap and disease-specific targets, BU programs are required to strengthen case detection and begin a transition towards integration with other skin-NTDs. This transition comes with new opportunities to enhance existing BU surveillance systems and develop novel approaches for implementation and evaluation.In this review, we present a breakdown and assessment of the methods and approaches that have been the pillars of BU surveillance systems in Africa: (1) Passive case detection, (2) Data systems, (3) Clinical training, (4) Active case finding, (5) Burden estimation, and (6) Laboratory confirmation pathways. We discuss successes, challenges, and relevant case studies before highlighting opportunities for future development and evaluation including novel data collection tools, risk-based surveillance, and integrated skin-NTD surveillance. We draw on both experience and available literature to critically evaluate methods of BU surveillance in Africa and highlight new approaches to help achieve 2030 roadmap targets.
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Affiliation(s)
- Joseph W S Timothy
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rie R Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, USA.
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22
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Chronic wounds in Sierra Leone: Searching for Buruli ulcer, a NTD caused by Mycobacterium ulcerans, at Masanga Hospital. PLoS Negl Trop Dis 2021; 15:e0009862. [PMID: 34644298 PMCID: PMC8544828 DOI: 10.1371/journal.pntd.0009862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/25/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background Chronic wounds pose a significant healthcare burden in low- and middle-income countries. Buruli ulcer (BU), caused by Mycobacterium ulcerans infection, causes wounds with high morbidity and financial burden. Although highly endemic in West and Central Africa, the presence of BU in Sierra Leone is not well described. This study aimed to confirm or exclude BU in suspected cases of chronic wounds presenting to Masanga Hospital, Sierra Leone. Methodology Demographics, baseline clinical data, and quality of life scores were collected from patients with wounds suspected to be BU. Wound tissue samples were acquired and transported to the Swiss Tropical and Public Health Institute, Switzerland, for analysis to detect Mycobacterium ulcerans using qPCR, microscopic smear examination, and histopathology, as per World Health Organization (WHO) recommendations. Findings Twenty-one participants with wounds suspected to be BU were enrolled over 4-weeks (Feb-March 2019). Participants were predominantly young working males (62% male, 38% female, mean 35yrs, 90% employed in an occupation or as a student) with large, single, ulcerating wounds (mean diameter 9.4cm, 86% single wound) exclusively of the lower limbs (60% foot, 40% lower leg) present for a mean 15 months. The majority reported frequent exposure to water outdoors (76%). Self-reports of over-the-counter antibiotic use prior to presentation was high (81%), as was history of trauma (38%) and surgical interventions prior to enrolment (48%). Regarding laboratory investigation, all samples were negative for BU by microscopy, histopathology, and qPCR. Histopathology analysis revealed heavy bacterial load in many of the samples. The study had excellent participant recruitment, however follow-up proved difficult. Conclusions BU was not confirmed as a cause of chronic ulceration in our cohort of suspected cases, as judged by laboratory analysis according to WHO standards. This does not exclude the presence of BU in the region, and the definitive cause of these treatment-resistance chronic wounds is uncertain. Chronic wounds constitute a significant surgical burden to low- and middle-income countries; however, their aetiology often remains poorly understood. This study improves our understanding of wound aetiology through tissue analysis of chronic leg wounds suspected to be caused by Buruli ulcer (BU). BU is a neglected tropical disease caused by infection with Mycobacterium ulcerans, and remains severely under-researched. There is a lack of testing facilities in regions surrounding endemic countries which makes prevalence difficult to determine, with a particular paucity of data from Sierra Leone (SL). This study identified twenty-one patients with wounds suspected to be caused by BU who presented to Masanga Hospital (Tonkonili District, Sierra Leone) between February and March 2019. Tissue samples were acquired from the wounds and transported to a European tropical health laboratory for analysis. Significant bacterial loads were demonstrated in the samples. However, the gold-standard molecular tests recommended by World Health Organisation (WHO) revealed no cases of BU. These results suggest that BU is not a major cause of chronic wounds in the Northern Province of Sierra Leone. Our conclusions cannot necessarily be generalised to other regions of Sierra Leone, therefore further studies in other geographical districts are required.
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Llibre A, Dedicoat M, Burel JG, Demangel C, O’Shea MK, Mauro C. Host Immune-Metabolic Adaptations Upon Mycobacterial Infections and Associated Co-Morbidities. Front Immunol 2021; 12:747387. [PMID: 34630426 PMCID: PMC8495197 DOI: 10.3389/fimmu.2021.747387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
Mycobacterial diseases are a major public health challenge. Their causative agents include, in order of impact, members of the Mycobacterium tuberculosis complex (causing tuberculosis), Mycobacterium leprae (causing leprosy), and non-tuberculous mycobacterial pathogens including Mycobacterium ulcerans. Macrophages are mycobacterial targets and they play an essential role in the host immune response to mycobacteria. This review aims to provide a comprehensive understanding of the immune-metabolic adaptations of the macrophage to mycobacterial infections. This metabolic rewiring involves changes in glycolysis and oxidative metabolism, as well as in the use of fatty acids and that of metals such as iron, zinc and copper. The macrophage metabolic adaptations result in changes in intracellular metabolites, which can post-translationally modify proteins including histones, with potential for shaping the epigenetic landscape. This review will also cover how critical tuberculosis co-morbidities such as smoking, diabetes and HIV infection shape host metabolic responses and impact disease outcome. Finally, we will explore how the immune-metabolic knowledge gained in the last decades can be harnessed towards the design of novel diagnostic and therapeutic tools, as well as vaccines.
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Affiliation(s)
- Alba Llibre
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Martin Dedicoat
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Julie G. Burel
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, United States
| | - Caroline Demangel
- Immunobiology of Infection Unit, Institut Pasteur, INSERM U1224, Paris, France
| | - Matthew K. O’Shea
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Claudio Mauro
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Atchoglo PK, Amponsah IK, Fokou PVT, Harley BK, Baah MK, Armah FA, Adjei S. Anti-mycobacterium ulcerans activity and pharmacognostic standardisation of Pycnanthus angolensis (Welw) Warb. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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25
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Muleta AJ, Lappan R, Stinear TP, Greening C. Understanding the transmission of Mycobacterium ulcerans: A step towards controlling Buruli ulcer. PLoS Negl Trop Dis 2021; 15:e0009678. [PMID: 34437549 PMCID: PMC8389476 DOI: 10.1371/journal.pntd.0009678] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Anthony J. Muleta
- Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Rachael Lappan
- Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Timothy P. Stinear
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Chris Greening
- Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
- Centre to Impact AMR, Monash University, Melbourne, Australia
- * E-mail:
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26
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Amoako YA, Ackam N, Omuojine JP, Oppong MN, Owusu-Ansah AG, Boateng H, Abass MK, Amofa G, Ofori E, Okyere PB, Frimpong M, Bailey F, Molyneux DH, Phillips RO. Mental health and quality of life burden in Buruli ulcer disease patients in Ghana. Infect Dis Poverty 2021; 10:109. [PMID: 34404483 PMCID: PMC8367773 DOI: 10.1186/s40249-021-00891-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/02/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Buruli ulcer disease (BUD) is a necrotic skin neglected tropical disease (NTD) that has both a mental and physical health impact on affected individuals. Although there is increasing evidence suggesting a strong association between neglected tropical diseases (NTDs) and mental illness, there is a relative lack of information on BUD's impact on the mental health and quality of life (QoL) of affected individuals in Ghana. This study is to assess the impact of BUD on mental health and quality of life of patients with active and past BUD infection, and their caregivers. METHODS We conducted a case control study in 3 BUD endemic districts in Ghana between August and November 2019. Face-to-face structured questionnaire-based interviews were conducted on BUD patients with active and past infection, as well as caregivers of BUD patients using WHO Quality of Life scale, WHO Disability Assessment Schedule, Self-Reporting Questionnaire, Buruli Ulcer Functional Limitation Score and Hospital Anxiety and Depression Scale data tools. Descriptive statistics were used to summarize the characteristics of the study participants. Participant groups were compared using student t test and chi-square (χ2) or Fisher's exact tests. Mean quality of life scores are reported with their respective 95% confidence intervals. Data was analysed using STATA statistical software. RESULTS Our results show that BUD patients with active and past infection, along with their caregivers, face significant levels of distress and mental health sequelae compared to controls. Depression (P = 0.003) was more common in participants with active (27%) and past BU infection (17%), compared to controls (0%). Anxiety was found in 42% (11/26) and 20% (6/29) of participants with active and past BUD infection compared to 14% (5/36) of controls. Quality of life was also significantly diminished in active BUD infection, compared to controls. In the physical health domain, mean QoL scores were 54 ± 11.1 and 56 ± 11.0 (95% CI: 49.5‒58.5 and 52.2‒59.7) respectively for participants with active infection and controls. Similarly in the psychological domain, scores were lower for active infection than controls [57.1 ± 15.2 (95% CI: 50.9‒63.2) vs 64.7 ± 11.6 (95% CI: 60.8‒68.6)]. Participants with past infection had high QoL scores in both physical [61.3 ± 13.5 (95% CI: 56.1‒66.5)] and psychological health domains [68.4 ± 14.6 (95% CI: 62.7‒74.0)]. CONCLUSIONS BUD is associated with significant mental health distress and reduced quality of life in affected persons and their caregivers in Ghana. There is a need for integration of psychosocial interventions in the management of the disease.
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Affiliation(s)
- Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Nancy Ackam
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abena Gyawu Owusu-Ansah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Harriet Boateng
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | - Portia Boakye Okyere
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Frimpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Freddie Bailey
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - David Hurst Molyneux
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
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27
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Fevereiro J, Fraga AG, Pedrosa J. Genetics in the Host-Mycobacterium ulcerans interaction. Immunol Rev 2021; 301:222-241. [PMID: 33682158 DOI: 10.1111/imr.12958] [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: 01/05/2021] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
Buruli ulcer is an emerging infectious disease associated with high morbidity and unpredictable outbreaks. It is caused by Mycobacterium ulcerans, a slow-growing pathogen evolutionarily shaped by the acquisition of a plasmid involved in the production of a potent macrolide-like cytotoxin and by genome rearrangements and downsizing. These events culminated in an uncommon infection pattern, whereby M. ulcerans is both able to induce the initiation of the inflammatory cascade and the cell death of its proponents, as well as to survive within the phagosome and in the extracellular milieu. In such extreme conditions, the host is sentenced to rely on a highly orchestrated genetic landscape to be able to control the infection. We here revisit the dynamics of M. ulcerans infection, drawing parallels from other mycobacterioses and integrating the most recent knowledge on its evolution and pathogenicity in its interaction with the host immune response.
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Affiliation(s)
- João Fevereiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexandra G Fraga
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jorge Pedrosa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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28
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Demangel C. Immunity against Mycobacterium ulcerans: The subversive role of mycolactone. Immunol Rev 2021; 301:209-221. [PMID: 33607704 DOI: 10.1111/imr.12956] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022]
Abstract
Mycobacterium ulcerans causes Buruli ulcer, a neglected tropical skin disease manifesting as chronic wounds that can leave victims with major, life-long deformity and disability. Differently from other mycobacterial pathogens, M ulcerans produces mycolactone, a diffusible lipid factor with unique cytotoxic and immunomodulatory properties. Both traits result from mycolactone targeting Sec61, the entry point of the secretory pathway in eukaryotic cells. By inhibiting Sec61, mycolactone prevents the host cell's production of secreted proteins, and most of its transmembrane proteins. This molecular blockade dramatically alters the functions of immune cells, thereby the generation of protective immunity. Moreover, sustained inhibition of Sec61 triggers proteotoxic stress responses leading to apoptotic cell death, which can stimulate vigorous immune responses. The dynamics of bacterial production of mycolactone and elimination by infected hosts thus critically determine the balance between its immunostimulatory and immunosuppressive effects. Following an introduction summarizing the essential information on Buruli ulcer disease, this review focuses on the current state of knowledge regarding mycolactone's regulation and biodistribution. We then detail the consequences of mycolactone-mediated Sec61 blockade on initiation and maintenance of innate and adaptive immune responses. Finally, we discuss the key questions to address in order to improve immunity to M ulcerans, and how increased knowledge of mycolactone biology may pave the way to innovative therapeutics.
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Affiliation(s)
- Caroline Demangel
- Immunobiology of Infection Unit, INSERM U1221, Institut Pasteur, Paris, France
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29
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Fevereiro J, Fraga AG, Capela C, Sopoh GE, Dossou A, Ayelo GA, Peixoto MJ, Cunha C, Carvalho A, Rodrigues F, Pedrosa J. Genetic variants in human BCL2L11 ( BIM) are associated with ulcerative forms of Buruli ulcer. Emerg Microbes Infect 2021; 10:223-225. [PMID: 33467983 PMCID: PMC7889264 DOI: 10.1080/22221751.2021.1878936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Buruli ulcer (BU) is a devastating skin mycobacterial infection characterized by extensive cell death, which was previously suggested to be mediated by Bcl2-like protein 11 (BIM, encoded by the BCL2L11 gene). We here report the association of genetic variants in BCL2L11 with ulcerative forms of the disease in a cohort of 618 Beninese individuals. Our results show that regulation of apoptosis in humans contributes to BU lesions associated with worse prognosis, prompting for further investigation on the implementation of novel methods for earlier identification of at-risk patients.
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Affiliation(s)
- João Fevereiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexandra G Fraga
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Carlos Capela
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ghislain E Sopoh
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministry of Health, Allada, Bénin.,Institut Régional de Santé Publique, University of Abomey-Calavi, Ouidah, Bénin
| | - Ange Dossou
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministry of Health, Allada, Bénin
| | - Gilbert Adjimon Ayelo
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministry of Health, Allada, Bénin
| | - Maria João Peixoto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Cristina Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Fernando Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jorge Pedrosa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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30
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G-Beiras C, Ubals M, Corbacho-Monné M, Vall-Mayans M, Mitjà O. Yaws, Haemophilus ducreyi, and Other Bacterial Causes of Cutaneous Ulcer Disease in the South Pacific Islands. Dermatol Clin 2020; 39:15-22. [PMID: 33228858 DOI: 10.1016/j.det.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cutaneous ulcers in the tropics are a painful and debilitating condition that anchors people into poverty. In rural regions of the South Pacific, infectious cutaneous ulcers are caused mainly by bacteria, including Treponema pallidum pertenue (yaws), Haemophilus ducreyi, and polymicrobial ulcers. For this group of infections the term cutaneous ulcer disease (CUD) is proposed. Some infections can cause malformations on the bone that have a permanent impact on lives in endemic communities. Better characterization of CUD may help design diagnostic tools and more effective antimicrobial therapies. This review updates the knowledge of CUD and discusses optimized terminology and syndromic management.
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Affiliation(s)
- Camila G-Beiras
- Fight AIDS and Infectious Diseases Foundation, Badalona, Catalonia, Spain.
| | - Maria Ubals
- Fight AIDS and Infectious Diseases Foundation, Badalona, Catalonia, Spain; Hospital Universitari Germans Trias i Pujol, Barcelona, Catalonia, Spain
| | | | - Martí Vall-Mayans
- Fight AIDS and Infectious Diseases Foundation, Badalona, Catalonia, Spain; Hospital Universitari Germans Trias i Pujol, Barcelona, Catalonia, Spain
| | - Oriol Mitjà
- Fight AIDS and Infectious Diseases Foundation, Badalona, Catalonia, Spain; Hospital Universitari Germans Trias i Pujol, Barcelona, Catalonia, Spain
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31
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Mangas KM, Tobias NJ, Marion E, Babonneau J, Marsollier L, Porter JL, Pidot SJ, Wong CY, Jackson DC, Chua BY, Stinear TP. High antibody titres induced by protein subunit vaccines using Mycobacterium ulcerans antigens Hsp18 and MUL_3720 with a TLR-2 agonist fail to protect against Buruli ulcer in mice. PeerJ 2020; 8:e9659. [PMID: 32844063 PMCID: PMC7416718 DOI: 10.7717/peerj.9659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/14/2020] [Indexed: 12/26/2022] Open
Abstract
Background Mycobacterium ulcerans is the causative agent of a debilitating skin and soft tissue infection known as Buruli ulcer (BU). There is no vaccine against BU. The purpose of this study was to investigate the vaccine potential of two previously described immunogenic M. ulcerans proteins, MUL_3720 and Hsp18, using a mouse tail infection model of BU. Methods Recombinant versions of the two proteins were each electrostatically coupled with a previously described lipopeptide adjuvant. Seven C57BL/6 and seven BALB/c mice were vaccinated and boosted with each of the formulations. Vaccinated mice were then challenged with M. ulcerans via subcutaneous tail inoculation. Vaccine performance was assessed by time-to-ulceration compared to unvaccinated mice. Results The MUL_3720 and Hsp18 vaccines induced high titres of antigen-specific antibodies that were predominately subtype IgG1. However, all mice developed ulcers by day-40 post-M. ulcerans challenge. No significant difference was observed in the time-to-onset of ulceration between the experimental vaccine groups and unvaccinated animals. Conclusions These data align with previous vaccine experiments using Hsp18 and MUL_3720 that indicated these proteins may not be appropriate vaccine antigens. This work highlights the need to explore alternative vaccine targets and different approaches to understand the role antibodies might play in controlling BU.
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Affiliation(s)
- Kirstie M Mangas
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas J Tobias
- Johann Wolfgang Goethe Universität Frankfurt am Main, Frankfurt, Germany.,LOEWE Centre for Translational Biodiversity in Genomics (TBG), Frankfurt, Germany
| | - Estelle Marion
- Université de Nantes, Nantes, France.,Université de Nantes, Nantes, France.,Université d'Angers, Angers, France
| | - Jérémie Babonneau
- Université de Nantes, Nantes, France.,Université d'Angers, Angers, France
| | - Laurent Marsollier
- Université de Nantes, Nantes, France.,Université d'Angers, Angers, France
| | - Jessica L Porter
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Sacha J Pidot
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Chinn Yi Wong
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - David C Jackson
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Brendon Y Chua
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
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32
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The diversity of mycolactone-producing mycobacteria. Microb Pathog 2020; 149:104362. [PMID: 32702376 DOI: 10.1016/j.micpath.2020.104362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/22/2020] [Indexed: 02/08/2023]
Abstract
Mycolactone-producing mycobacteria (MPM) form an intriguing group of environmental opportunistic pathogens of mammals and human patients in whom they cause cutaneous and subcutaneous ulcers known as "Buruli ulcer" when they occur in humans. We reviewed whole genome sequence data and ecological and phenotypic characteristics from 44 MPMs and closely related Mycobacterium marinum. This analysis indicated that all the 24 M. marinum isolates were delineated into seven taxa and our comprehensive, polyphasic taxonomic approach led to the proposal of delineating M. marinum genomospecies, 01-07. Likewise, 20 MPMs isolates were delineated into seven additional M. ulcerans genomospecies, 01-07. A taxonomic card explaining the ecology, hosts of isolation and the plasmid harboured is provided for each taxon.
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Van Der Werf TS, Barogui YT, Converse PJ, Phillips RO, Stienstra Y. Pharmacologic management of Mycobacterium ulcerans infection. Expert Rev Clin Pharmacol 2020; 13:391-401. [PMID: 32310683 DOI: 10.1080/17512433.2020.1752663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Pharmacological treatment of Buruli ulcer (Mycobacterium ulcerans infection; BU) is highly effective, as shown in two randomized trials in Africa. AREAS COVERED We review BU drug treatment - in vitro, in vivo and clinical trials (PubMed: '(Buruli OR (Mycobacterium AND ulcerans)) AND (treatment OR therapy).' We also highlight the pathogenesis of M. ulcerans infection that is dominated by mycolactone, a secreted exotoxin, that causes skin and soft tissue necrosis, and impaired immune response and tissue repair. Healing is slow, due to the delayed wash-out of mycolactone. An array of repurposed tuberculosis and leprosy drugs appears effective in vitro and in animal models. In clinical trials and observational studies, only rifamycins (notably, rifampicin), macrolides (notably, clarithromycin), aminoglycosides (notably, streptomycin) and fluoroquinolones (notably, moxifloxacin, and ciprofloxacin) have been tested. EXPERT OPINION A combination of rifampicin and clarithromycin is highly effective but lesions still take a long time to heal. Novel drugs like telacebec have the potential to reduce treatment duration but this drug may remain unaffordable in low-resourced settings. Research should address ulcer treatment in general; essays to measure mycolactone over time hold promise to use as a readout for studies to compare drug treatment schedules for larger lesions of Buruli ulcer.
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Affiliation(s)
- Tjip S Van Der Werf
- Departments of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, University of Groningen , Groningen, Netherlands.,Pulmonary Diseases & Tuberculosis, University Medical Centre Groningen, University of Groningen , Groningen, Netherlands
| | - Yves T Barogui
- Ministère De La Sante ́, Programme National Lutte Contre La Lèpre Et l'Ulcère De Buruli , Cotonou, Benin
| | - Paul J Converse
- Department of Medicine, Johns Hopkins University Center for Tuberculosis Research , Baltimore, Maryland, USA
| | - Richard O Phillips
- Kumasi, Ghana And Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital , Kumasi, Ghana
| | - Ymkje Stienstra
- Departments of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, University of Groningen , Groningen, Netherlands
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34
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Affiliation(s)
- Paul D R Johnson
- Infectious Diseases Department, Austin Health, and University of Melbourne, Heidelberg, VIC 3084, Australia.
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