Complete Healing of a Laboratory-Confirmed Buruli Ulcer Lesion after Receiving Only Herbal Household Remedies

OnMarch 7, 2011, an 11-year-old boy from the town of Bankim in the Adamaoua Region of Cameroon—a known endemic focus of Buruli ulcer (BU) [1]—was accompanied by his father to the district hospital in Bankim. The patient presented with a BU lesion classified as Category II, according to the classifications of the World Health Organization (WHO). The partially ulcerated plaque lesion, which was approximately 14 x 6 cm in size, had undermined edges characteristic of BU (Fig 1A) [2,3]. Following clinical examination and sample collection for diagnosis, the patient’s family refused the standard WHO-recommended treatment for BU, which consists of daily rifampicin (10 mg/kg orally) and streptomycin (15mg/kg intramuscularly) for eight weeks [4], and the patient left the hospital. Wound exudates collected from the patient tested positive in theMycobacterium ulcerans-specific IS2404 quantitative polymerase chain reaction (qPCR) assay [5] with threshold cycle (Ct) values ranging from 20.0 to 28.6, indicating a high mycobacterial load. Swab exudates were also used for the initiation of aM. ulcerans primary culture on Löwenstein-Jensen medium, as previously described [6]. After 8.5 weeks of incubation at 30°C, mycobacterial growth was observed, and the cultured mycobacteria were reconfirmed asM. ulcerans by IS2404 colony PCR [6]. Whole genome sequencing of the isolate reconfirmed that it belongs to the local clonal complex ofM. ulcerans [7]. One week after reporting to the hospital, the patient was visited at the family farm in proximity to the Mbam River, south of Bankim. Between the initial consultation and this encounter, the patient did not consult with any other health centre or traditional healer. However, the father of the patient applied herbal household remedies, derived from the barks of two trees, onto the lesion (Fig 2). Using standard tools in botany, the trees from which the herbal remedies were obtained could be identified as Erythrophleum suaveolens [(Guill. & Perr.), Brenan] and Stemonocoleus micranthus [Harms] [8]. The application of the household remedies involved the washing of the lesion, at least once per day, with a decoction obtained by boiling the bark of E. suaveolens. In addition, a mixture of salt and powdered bark of S.micranthus and the E. suaveolens decoction was applied onto the open lesion daily, over a period of three months (Fig 1B). In May 2013, more than two years after the first encounter, the patient was examined again. At this point, the lesion had completely healed and no reduction in movement of the joint was observed (Fig 1C). At an additional follow-up visit in January 2014, the scar was found in good