lunes, 29 de marzo de 2010

Buruli Ulcer, Central African Republic

EID Journal Home > Volume 16, Number 4–April 2010

Volume 16, Number 4–April 2010
Buruli Ulcer, Central African Republic
Fanny Minime-Lingoupou, Narcisse Beyam, Germain Zandanga, Alexandre Manirakiza, Alain N'Domackrah, Siméon Njuimo, Sara Eyangoh, Jane Cottin, Laurent Marsollier, Estelle Marion, Francoise Portaels, Alain Le Faou, and Raymond Bercion
Author affiliations: Pasteur Institute, Bangui, Central African Republic (F. Minime-Lingoupou, N. Beyam, G. Zandanga, A. Manirakiza, A. N'Domackrah, S. Njuimo, A. Le Faou, R. Bercion); Pasteur Center, Yaounde, Cameroon (S. Eyangoh); Central Hospitalier universitaire, Angers, France (J. Cottin, E. Marion); Université d'Angers, Angers (J. Cottin, L. Marsollier, E. Marion); and Institute for Tropical Medicine, Anvers, Belgium (F. Portaels)

Suggested citation for this article

To the Editor: Buruli ulcer, the third most common mycobacterial disease of humans after tuberculosis and leprosy, is an important disfiguring and disabling cutaneous infection disease caused by Mycobacterium ulcerans. Buruli ulcer was declared an emerging skin disease of public health concern by the World Health Organization (WHO) in 1998. Although the disease is known to be associated with swampy areas and environmental changes, the mode of transmission is not yet clearly understood. A possible role for water bugs in the transmission has been postulated in the last 10 years. In this direction, several researchers have proposed that biting water bugs could be vectors for M. ulcerans (1). M. ulcerans produces a potent toxin known as mycolactone (2), which lyses dermal cells, leading to the development of continuously expanding ulcers with undermined edges. Surgery is the only treatment for late lesions, which involves excision of necrotic tissues, followed by skin grafting. After such treatment, patients suffer from functional limitations, social stigmatization, and the loss of livelihood (3). Antimicrobial drug treatment is available (a combination of rifampin and streptomycin), but it is effective only for early lesions (4).

The disease is endemic in rural wetlands of tropical countries of Africa, the Americas, and Asia. Over the past decade, the prevalence of Buruli ulcer was highest in western Africa (3,5), with an alarming increase in detected cases. In central Africa, foci of Buruli ulcer have been reported in Gabon, Equatorial Guinea, Cameroon, Congo, the Democratic Republic of Congo, and Sudan (6), which are all neighboring countries of the Central African Republic (CAR). Surprisingly, in CAR, no cases of Buruli ulcer have been reported so far, even though its presence in this country was suspected in 2006, although not confirmed. This situation motivated us to begin a passive survey in the hospitals of Bangui, the capital of CAR. We report here 2 confirmed cases of Buruli ulcer that were found through this survey. The 2 patients were admitted in April 2007 to Hôpital de l'Amitié, Bangui, CAR, with extensive skin ulcers, which might correspond to Buruli ulcer according to WHO guidelines (7). Both patients were farmers from the Ombella M'poko region. They lived on the border of the M'poko River and carried out daily activities in an aquatic environment.

Suggested Citation for this Article
Minime-Lingoupou F, Beyam N, Zandanga G, Manirakiza A, N'Domackrah A, Juimo S, et al. Buruli ulcer, Central African Republic [letter]. Emerg Infect Dis [serial on the Internet]. 2010 Apr [date cited]. Available from

DOI: 10.3201/eid1604.090195

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