title: Mycobacterium ulcerans disease in the middle belt of Ghana: An eight-year review from six endemic districts.
abstract: BACKGROUND
  Mycobacterium ulcerans (MU) produces mycolactone toxin when infected with a plasmid. Toxin is cytotoxic and immunosuppressive, causing extensive destruction of tissues, leading to large ulcers on exposed parts of the body. Spontaneous healing by secondary intention leads to contractures, subluxation of joints, disuse atrophy, distal lymphedema and other complications. The disease is endemic in some communities within the middle belt of Ghana.
  
  
  OBJECTIVE
  To document the clinical and epidemiological features of MU disease in the middle belt of Ghana and the outcome of treatment.
  
  
  METHODS
  Patients with lesions suspected to MU disease were screened by community workers. Lesions were confirmed by any of the following: direct smear examination, culture, polymerase chain reaction (PCR), or histopathology. Patients were treated with rifampicin (10mg/kg orally) and streptomycin (15 mg/kg IM) combination for eight weeks. Patients selected for surgical treatment included cases where medical treatment had failed, cases where medical treatment is contraindicated, cases presenting late with complications and recurrent cases.
  
  
  RESULTS
  258 patients were seen in the Ahafo Ano, Amansie Central, Amansie West, Asunafo, Asutifi, and Upper Denkyira districts of Ghana between 2005 and 2012. Their ages ranged from 1 year 3 months to 98 years, with a mean age of 29.8 (SD 20.4). The clinical forms of MU disease seen were: papule (0.5%), nodule (1.5%), chronic osteomyelitis (1.5%), contracture (1.5%), edematous lesion (3%), and ulcer (92%). Uncommon complications include subluxation of knee joint, salivary gland fistula and Marjolin's ulcer. The lesions were distributed as follows: head and neck (6.8%), upper limb (20.3%), trunk (1.7%), and lower limb (71.2%).
  
  
  CONCLUSIONS
  MU disease in the middle belt of Ghana can be controlled by early case detection and adequate curative treatment.
authors.affiliation: Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Electronic address: aduemmanuel@hotmail.com.
authors.forename: Emmanuel J K
authors.initials: EJ
authors.lastname: Adu
authors.affiliation: National Buruli Ulcer Control Programme, Korle Bu, Accra, Ghana.
authors.forename: Edwin
authors.initials: E
authors.lastname: Ampadu
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D054312:Buruli Ulcer / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D019353:Endemic Diseases; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008297:Male; D019911:Mycobacterium ulcerans / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D012293:Rifampin / Q000008:administration & dosage; D013307:Streptomycin / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin; D013307:Streptomycin
keywords: Antibiotics; Contractures; Middle belt; Mycobacterium ulcerans; Skin grafting