Dataset Information

A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer.

ABSTRACT: BACKGROUND:Increased availability of Next Generation Sequencing (NGS) techniques allows, for the first time, to distinguish relapses from reinfections in patients with multiple Buruli ulcer (BU) episodes. METHODOLOGY:We compared the number and location of single nucleotide polymorphisms (SNPs) identified by genomic screening between four pairs of Mycobacterium ulcerans isolates collected at the time of first diagnosis and at recurrence, derived from a collection of almost 5000 well characterized clinical samples from one BU treatment center in Benin. PRINCIPAL FINDINGS:The findings suggest that after surgical treatment-without antibiotics-the second episodes were due to relapse rather than reinfection. Since specific antibiotics were introduced for the treatment of BU, the one patient with a culture available from both disease episodes had M. ulcerans isolates with a genomic distance of 20 SNPs, suggesting the patient was most likely reinfected rather than having a relapse. CONCLUSIONS:To our knowledge, this study is the first to study recurrences in M. ulcerans using NGS, and to identify exogenous reinfection as causing a recurrence of BU. The occurrence of reinfection highlights the contribution of ongoing exposure to M. ulcerans to disease recurrence, and has implications for vaccine development.

SUBMITTER: Eddyani M

PROVIDER: S-EPMC4664471 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer.

Eddyani Miriam M Vandelannoote Koen K Meehan Conor J CJ Bhuju Sabin S Porter Jessica L JL Aguiar Julia J Seemann Torsten T Jarek Michael M Singh Mahavir M Portaels Françoise F Stinear Timothy P TP de Jong Bouke C BC

PLoS neglected tropical diseases 20151130 11

<h4>Background</h4>Increased availability of Next Generation Sequencing (NGS) techniques allows, for the first time, to distinguish relapses from reinfections in patients with multiple Buruli ulcer (BU) episodes.<h4>Methodology</h4>We compared the number and location of single nucleotide polymorphisms (SNPs) identified by genomic screening between four pairs of Mycobacterium ulcerans isolates collected at the time of first diagnosis and at recurrence, derived from a collection of almost 5000 wel ...[more]

PMID: 26618509

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Project description:BackgroundIn the Cameroon, previous efforts to identify Buruli ulcer (BU) through the mobilization of community health workers (CHWs) yielded poor results. In this paper, we describe the successful creation of a BU community of practice (BUCOP) in Bankim, Cameroon composed of hospital staff, former patients, CHWs, and traditional healers.Methods and principle findingsAll seven stages of a well-defined formative research process were conducted during three phases of research carried out by a team of social scientists working closely with Bankim hospital staff. Phase one ethnographic research generated interventions tested in a phase two proof of concept study followed by a three- year pilot project. In phase three the pilot project was evaluated. An outcome evaluation documented a significant rise in BU detection, especially category I cases, and a shift in case referral. Trained CHW and traditional healers initially referred most suspected cases of BU to Bankim hospital. Over time, household members exposed to an innovative and culturally sensitive outreach education program referred the greatest number of suspected cases. Laboratory confirmation of suspected BU cases referred by community stakeholders was above 30%. An impact and process evaluation found that sustained collaboration between health staff, CHWs, and traditional healers had been achieved. CHWs came to play a more active role in organizing BU outreach activities, which increased their social status. Traditional healers found they gained more from collaboration than they lost from referral.Conclusion/ significanceSetting up lines of communication, and promoting collaboration and trust between community stakeholders and health staff is essential to the control of neglected tropical diseases. It is also essential to health system strengthening and emerging disease preparedness. The BUCOP model described in this paper holds great promise for bringing communities together to solve pressing health problems in a culturally sensitive manner.

Dataset Information

A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer.

Publications

A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer.

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