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Background  Buruli Ulcer (BU) is a neglected tropical skin infection caused by  Mycobacterium ulcerans . Residence near aquatic areas has been identified as an important source of transmission of  M .  ulcerans  with increased risk of contracting Buruli ulcer. However, the reservoir and the mode of transmission are not yet well known. The aim of this study was to identify the presence of  M .  ulcerans  in the environment and its relationship with Buruli ulcer occurrence in Zio and Yoto districts of the maritime region in south Togo.    Methods  A total of 219 environmental samples including soil (n = 119), water (n = 65), biofilms/plants (n = 29) and animals’ feces (n = 6) were collected in 17 villages of Zio and Yoto districts of the maritime region in Togo. DNA of  M .  ulcerans  including  IS2404  and  IS2606  insertions sequences and mycolactone ketoreductase-B gene (KR-B) was detected using real time PCR amplification (qPCR) technique. In parallel, clinical samples of patients were tested to establish a comparison of the genetic profile of  M .  ulcerans  between the two types of samples. A calibration curve was generated for  IS2404  from a synthetic gene of  M .  ulcerans  Transposase pMUM001, the plasmid of virulence.    Results  In the absence of inhibition of the qPCR, 6/219 (2.7%) samples were tested positive for  M .  ulcerans  DNA containing three sequences ( IS2404/IS2606/ KR-B). Positive samples of  M .  ulcerans  were consisting of biofilms/plants (3/29; 10.3%), water (1/65; 1.7%) and soil (2/119; 1.5%). Comparative analysis between DNA detected in environmental and clinical samples from BU patients showed the same genetic profile of  M .  ulcerans  in the same environment. All these samples were collected in the environment of Haho and Zio rivers in the maritime region.    Conclusion  This study confirms the presence of  M .  ulcerans  in the environment of the Zio and Yoto districts of the maritime region of Togo. This may explain partially, the high rates of Buruli ulcer patients in this region. Also, water, plants and soil along the rivers could be possible reservoirs of the bacterium. Therefore, Haho and Zio rivers could be potential sources of infection with  M .  ulcerans  in humans in these districts.

plos neglected tropical diseases

Molecular detection of Mycobacterium ulcerans in the environment and its relationship with Buruli ulcer occurrence in Zio and Yoto districts of maritime region in Togo