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  • Early diagnosis 'essential' in Buruli ulcer treatment

[COTONOU] Diagnosis of Buruli ulcer is needed sooner to prevent permanent disability and disfigurement from the flesh-eating bacteria, say experts.

The declaration came at a WHO meeting of Buruli ulcer specialists earlier this month (3 April) in Cotonou, Benin.

Buruli ulcer is caused by infection with Mycobacterium ulcerans, which is from the same bacteria family responsible for tuberculosis and leprosy. It leads to severe damage of skin and soft tissue, and causes large ulcers on the arms or legs.

The WHO's Second International Conference on Buruli Ulcer Control and Research — organised with the Benin health ministry and the Cotonou-based non-profit organisation Water for All Children — resolved to strengthen the capacity of national laboratories to confirm cases of the disease but warned that "efforts are still needed to develop simple diagnostic tools usable in the field as well as disability prevention methods".

It was followed by the publication of a nine-site study in Ghana, which found that separate laboratory methods are needed to first diagnose and then monitor antibiotic treatment of the infection.

The research was published this month (15 April) in Clinical Infectious Diseases.

According to co-authors Ohene Adjei and Nana-Yaa Awua-Boateng — of the Kumasi Centre for Collaborative Research, Ghana — polymerase chain reaction (PCR), which copies and amplifies the Buruli mycobacterium's DNA, was "significantly better" than other methods, such as growing bacterial cultures, at accurately diagnosing the disease.

But Pius Agbenorku — another co-author and a surgeon at the Kwame Nkrumah University of Science and Technology's Reconstructive Plastic Surgery and Burns Unit — told SciDev.Net that monitoring the effectiveness of antibiotic treatment should only be done by culturing the bacteria.

Dissou Affolabi, who set up a national referral laboratory for Buruli's ulcer in Cotonou, says that molecular diagnosis — such as PCR — was already routinely performed in Benin. And the National Buruli Ulcer Reference Laboratory and the Evangelical Medical Institute carry out PCR diagnosis in the Democratic Republic of Congo, according to Anatole Kibadi of the country's National Biomedical Research Institute.

But N'Guetta Aka of Côte d'Ivoire's National Buruli Ulcer Reference Centre noted that the shortage of laboratories and skilled staff, and the cost of chemical reagents needed in molecular biology, might hamper diagnosis efforts.

Scientists at the Benin conference said  that new antibiotics — and greater quantities of existing antibiotics — are desperately needed for what is often two months of daily treatments.

Antibiotics currently used in treating the infection can be "quite toxic" and have negative side-effects, according to Ange Dossou of the Ulcer Screening and Treatment Centre in Allada, Benin, who reported on adverse patient reactions at the conference.

Treatments have improved since the first WHO declaration on Buruli ulcer was signed in Côte d'Ivoire in 1999 — when surgery was the main option in order to remove dead skin tissue and correct deformities, according to Yves Barogui, head surgeon at the Buruli Ulcer Screening and Treatment Centre in the village of Lalo in southwest Benin.

Link to abstract in Clinical Infectious Diseases

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