Comparison of Two Assays for Molecular Determination of Rifampin Resistance in Clinical Samples from Patients with Buruli Ulcer Disease

Abstract

This study evaluates a novel assay for detecting rifampin resistance in clinical Mycobacterium ulcerans isolates. Although highly susceptible for PCR inhibitors in 50% of the samples tested, the assay was 100% M. ulcerans specific and yielded >98% analyzable sequences with a lower limit of detection of 100 to 200 copies of the target sequence.

Susceptibility Profiles ofMycobacterium ulceransIsolates to Streptomycin and Rifampicin in Two Districts of the Eastern Region of Ghana

“…Initial challenging efforts at search for effective antibiotics warrant a more vigilant approach. In this study, there was no M. ulcerans isolate exhibiting dual resistance to rifampicin and streptomycin; this is not surprising as the low rate of M. ulcerans mutation has been reported in a study conducted by Jansson et al [14] in Ghana. That notwithstanding, there is the need for continuous vigilance/monitoring on the possible emergence of resistant M. ulcerans strains in the BU endemic communities, especially where there could be cases of coinfections with M. ulcerans and MTB, which could aggravate the current condition.…”

“…In most of these studies, the primary objective has been for drug discovery or improvement on existing regimen. Studies assessing susceptibility by clinical isolates is rare, though it is an important public health tool useful for effective disease surveillance, as it provides information on circulating resistant M. ulcerans within BU endemic communities [14]. …”

“…This was based on a recommendation by the World Health Organization (WHO), after a successful clinical trial by Etuaful et al, in Agroyesum in Ghana [10, 11]. Despite this success, new, recurrent, and unresponsive cases of Buruli ulcer are reported from endemic areas [12–14]. These challenges, coupled with the misuse, abuse of recommended doses of antibiotics, and noncompliance on the part of patients have the potential to generate mutant strains with resistant properties, as has been reported for other cases of mycobacteriosis particularly tuberculosis (TB) [14, 15].…”

“…Despite this success, new, recurrent, and unresponsive cases of Buruli ulcer are reported from endemic areas [12–14]. These challenges, coupled with the misuse, abuse of recommended doses of antibiotics, and noncompliance on the part of patients have the potential to generate mutant strains with resistant properties, as has been reported for other cases of mycobacteriosis particularly tuberculosis (TB) [14, 15]. Mycobacterium ulcerans mutation, though reportedly low (0.9%) even for rifampicin, exists and has the potential to undermine instituted interventions for the control of the disease [14].…”

In Silico Prediction of Antibiotic Resistance in Mycobacterium ulcerans Agy99 through Whole Genome Sequence Analysis

“…Very few studies has been conducted on drug resistance MU from humans. 7,41 As acquired resistance to these antibiotics might occur by single mutation in target genes during monotherapy, antibiotics combination could be the better alternative to treat BU patients. Finally, we believe that surveillance of a possible emergence of resistance to these antibiotics could be implemented by development of molecular tests easily monitoring any changes in these target genes.…”