title: Geographic distribution, age pattern and sites of lesions in a cohort of Buruli ulcer patients from the Mapé Basin of Cameroon.
abstract: Buruli ulcer (BU), a neglected tropical disease of the skin, caused by Mycobacterium ulcerans, occurs most frequently in children in West Africa. Risk factors for BU include proximity to slow flowing water, poor wound care and not wearing protective clothing. Man-made alterations of the environment have been suggested to lead to increased BU incidence. M. ulcerans DNA has been detected in the environment, water bugs and recently also in mosquitoes. Despite these findings, the mode of transmission of BU remains poorly understood and both transmission by insects or direct inoculation from contaminated environment have been suggested. Here, we investigated the BU epidemiology in the Mapé basin of Cameroon where the damming of the Mapé River since 1988 is believed to have increased the incidence of BU. Through a house-by-house survey in spring 2010, which also examined the local population for leprosy and yaws, and continued surveillance thereafter, we identified, till June 2012, altogether 88 RT-PCR positive cases of BU. We found that the age adjusted cumulative incidence of BU was highest in young teenagers and in individuals above the age of 50 and that very young children (<5) were underrepresented among cases. BU lesions clustered around the ankles and at the back of the elbows. This pattern neither matches any of the published mosquito biting site patterns, nor the published distribution of small skin injuries in children, where lesions on the knees are much more frequent. The option of multiple modes of transmission should thus be considered. Analyzing the geographic distribution of cases in the Mapé Dam area revealed a closer association with the Mbam River than with the artificial lake.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Bratschi
authors.forename: Miriam
authors.initials: M
authors.lastname: Bolz
authors.forename: Jacques C
authors.initials: JC
authors.lastname: Minyem
authors.forename: Leticia
authors.initials: L
authors.lastname: Grize
authors.forename: Fidèle G
authors.initials: FG
authors.lastname: Wantong
authors.forename: Sarah
authors.initials: S
authors.lastname: Kerber
authors.forename: Earnest
authors.initials: E
authors.lastname: Njih Tabah
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Ruf
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mou
authors.forename: Djeunga
authors.initials: D
authors.lastname: Noumen
authors.forename: Alphonse
authors.initials: A
authors.lastname: Um Boock
authors.forename: Gerd
authors.initials: G
authors.lastname: Pluschke
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D054312:Buruli Ulcer / Q000453:epidemiology* / Q000473:pathology*; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019911:Mycobacterium ulcerans / Q000302:isolation & purification*; D012307:Risk Factors; D019371:Topography, Medical; D055815:Young Adult