Mycobacterium ulcerans infection (Buruli ulcer) in French Guiana, South America, 1969-2013: an epidemiological study

Type Article
Date 2017-05
Language English
Author(s) Douine MaylisORCID1, 4, Gozlan Rodolphe5, Nacher Mathieu1, 4, Dufour Julie2, Reynaud Yann6, Elguero Eric7, Combe MarineORCID7, Velvin Camilla J.7, Chevillon ChristineORCID7, Berlioz-Arthaud Alain8, Labbe Sylvain3, Sainte-Marie Dominique2, Guegan Jean-FrancoisORCID7, 9, Pradinaud Roger2, Couppie Pierre2, 4
Affiliation(s) 1 : Cayenne Hosp, Ctr Invest Clin, INSERM 1424, Cayenne, French Guiana.
2 : Cayenne Hosp, Serv Dermatol, BP 6006, Cayenne 97306, French Guiana.
3 : Cayenne Hosp, Serv Anat Pathol, Cayenne, French Guiana.
4 : Univ Guyane, EA3593 Epidemiol Parasitoses Trop, Cayenne, French Guiana.
5 : Univ Paris 06, Museum Natl Hist Nat, Inst Rech Dev, Unite Mixte Rech Biol Organismes & Ecosyst Aquat, Paris, France.
6 : Inst Pasteur Guadeloupe, TB & Mycobacteria Unit, Les Abymes, Guadeloupe, France.
7 : Univ Montpellier, Ctr Inst Rech Dev Montpellier, Unite Mixte Rech Malad Infectieuses & Vecteurs Ev, Inst Rech Dev,Ctr Natl Rech Sci, Montpellier, France.
8 : Inst Pasteur, Lab Biol Med, Cayenne, French Guiana.
9 : OneHlth Res Initiat, Future Earth United Nations Int Programme, Montreal, PQ, Canada.
Source Lancet Planetary Health (2542-5196) (Elsevier Sci Ltd), 2017-05 , Vol. 1 , N. 2 , P. E65-E73
DOI 10.1016/S2542-5196(17)30009-8
WOS© Times Cited 11
Abstract Background Mycobacterium ulcerans infection is the third most common mycobacterial disease in the world after tuberculosis and leprosy. To date, transmission pathways from its environmental reservoir to humans are still unknown. In South America, French Guiana has the highest reported number of M ulcerans infections across the continent. This empirical study aimed to characterise the epidemiology of M ulcerans infection in French Guiana between 1969 and 2013. Methods Data were collected prospectively mainly by two dermatologists at Cayenne Hospital's dermatology department between Jan 1, 1969, and Dec 31, 2013, for age, date of diagnosis, sex, residence, location of the lesion, type of lesion, associated symptoms, and diagnostic method (smear, culture, PCR, or histology) for all confirmed and suspected cases of M ulcerans. We obtained population data from censuses. We calculated mean M ulcerans infection incidences, presented as the number of cases per 100 000 person-years. Findings 245 patients with M ulcerans infections were reported at Cayenne Hospital's dermatology department during the study period. M ulcerans infection incidence decreased over time, from 6.07 infections per 100 000 person-years (95% CI 4.46-7.67) in 1969-83 to 4.77 infections per 100 000 person-years (3.75-5.79) in 1984-98 and to 3.49 infections per 100 000 person-years (2.83-4.16) in 1999-2013. The proportion of children with infections also declined with time, from 42 (76%) of 55 patients in 1969-83 to 26 (31%) of 84 in 1984-98 and to 22 (21%) of 106 in 1999-2013. Most cases occurred in coastal areas surrounded by marshy savannah (incidence of 21.08 per 100 000 person-years in Sinnamary and 21.18 per 100 000 person-years in Mana). Lesions mainly affected limbs (lower limbs 161 [66%] patients; upper limbs 60 [24%] patients). We diagnosed no bone infections. Interpretation The decrease of M ulcerans infection incidence and the proportion of children with infections over a 45 year period in this ultra-peripheral French territory might have been mostly driven by improving living conditions, prophylactic recommendations, and access to health care. Copyright (C) The Author(s). Published by Elsevier Ltd.
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Douine Maylis, Gozlan Rodolphe, Nacher Mathieu, Dufour Julie, Reynaud Yann, Elguero Eric, Combe Marine, Velvin Camilla J., Chevillon Christine, Berlioz-Arthaud Alain, Labbe Sylvain, Sainte-Marie Dominique, Guegan Jean-Francois, Pradinaud Roger, Couppie Pierre (2017). Mycobacterium ulcerans infection (Buruli ulcer) in French Guiana, South America, 1969-2013: an epidemiological study. Lancet Planetary Health, 1(2), E65-E73. Publisher's official version : , Open Access version :