Mycobacterium ulcerans disease in the Middle Belt of Ghana: An 8-year review from six endemic districts

BackgroundMycobacterium ulcerans (MU) produces mycolactone toxin when infected with a plasmid. The toxin is cytotoxic and immunosuppressive, causing extensive destruction of tissues, leading to large ulcers on exposed parts of the body. Spontaneous healing by secondary intention leads to contractures, subluxation of joints, disuse atrophy, distal lymphedema and other complications. The objective of this study is to document the clinical and epidemiological features of MU disease in the Middle Belt of Ghana and the outcome of the treatment.Aims and objectivesThe aim is to document the clinical and epidemiological features of Mycobacterium ulcerans disease in the Middle Belt of Ghana, and the outcome of treatment.Patients and methodsPatients with lesions suspected to be MU disease were screened by community workers. Lesions were confirmed by any of the following: direct smear examination, culture, polymerase chain reaction (PCR), or histopathology.Patients were treated with rifampicin (10mg/kg orally) and streptomycin (15mg/kg im) combination for 8weeks. Patients selected for surgical treatment included cases where medical treatment had failed, cases presenting late with complications, and recurrent cases.Results258 patients were seen in the Ahafo Ano, Amansie Central, Amansie West, Asunafo, Asutifi, and Upper Denkyira districts of Ghana between 2005 and 2012. Their ages ranged from 1year 3months to 98years, with a mean age of 29.8 (SD 20.4).The clinical forms of MU disease seen were: papule (0.74%), nodule (1.48%), chronic osteomyelitis (1.48%), contracture (1.48%), oedematous lesion (2.69%), and ulcer (91.85%). Uncommon complications include subluxation of knee joint, salivary gland fistula and Marjolin’s ulcer.The lesions were distributed as follows: head and neck (6.2%), upper limb (23.1%), trunk (1.5%), and lower limb (69.2%).ConclusionThe use of antibiotics for MU disease has controlled most lesions; however, rare complications requiring reconstructive surgery are emerging