Effect of a Control Project on Clinical Profiles and Outcomes in Buruli Ulcer: A Before/After Study in Bas-Congo, Democratic Republic of Congo

Abstract

BackgroundBuruli ulcer (BU) is a necrotizing bacterial infection of skin, subcutaneous tissue and bone caused by Mycobacterium ulcerans. Although the functional impairment caused by BU results in severe suffering and in socio-economic problems, the disease remains largely neglected in Africa. The province of Bas-Congo in Democratic Republic of Congo contains one of the most important BU foci of the country, i.e. the Songololo Territory in the District of Cataractes. This study aims to assess the impact of a BU control project launched in 2004 in the Songololo Territory.MethodsWe used a comparative non-randomized study design, comparing clinical profiles and outcomes of the group of patients admitted at the General Reference Hospital (GRH) of the “Institut Médical Evangélique” (IME) of Kimpese 3 years before the start of the project (2002–2004) with those admitted during the 3 years after the start of the project (2005–2007).ResultsThe BU control project was associated with a strong increase in the number of admitted BU cases at the GRH of IME/Kimpese and a fundamental change in the profile of those patients; more female patients presented with BU, the proportion of relapse cases amongst all admissions reduced, the proportion of early lesions and simple ulcerative forms increased, more patients healed without complications and the case fatality rate decreased substantially. The median duration since the onset of first symptoms however remained high, as well as the proportion of patients with osteomyelitis or limitations of joint movement, suggesting that the diagnostic delay remains substantial.ConclusionImplementing a specialized program for BU may be effective in improving clinical profiles and outcomes in BU. Despite these encouraging results, our study highlights the need of considering new strategies to better improve BU control in a low resources setting.

Burden of Mycobacterium ulcerans Disease (Buruli Ulcer) and the Underreporting Ratio in the Territory of Songololo, Democratic Republic of Congo

“…This is consistent with studies in Côte d'Ivoire [10] and Cameroon [12], [13], while the percentage of ulcerative lesions was lower in some other studies, for example, 48.5% in Ghana [11], approximately 50% in Benin from 1997 to 2001 [26] and 57.5% in 2004 in the same country [6]. Of the 259 active cases, 62 (23.9%) were diagnosed with joint functional limitations, similar to previous findings in the same area [19], and in other African endemic regions [6], [12]. The general finding of limbs being most affected was confirmed in this study [2], [11]–[13], [23], [24].…”

The Mycetoma Knowledge Gap: Identification of Research Priorities

“…The Akonolinga district in Cameroon and the Songololo territory in DRC were found to have a high prevalence [22], [23]. Subsequently, Buruli ulcer control projects launched in these two locations resulted in an increase in the number of Buruli cases detected [22],[23]. As a result, there was a significant increase in the proportion of early lesions and simple ulcerative forms and a decrease in the proportion of relapse cases [23].…”

“…The BU02 form is used to establish the prevalence of Buruli ulcer in different districts in Cameroon and the Democratic Republic of Congo (DRC). The Akonolinga district in Cameroon and the Songololo territory in DRC were found to have a high prevalence [22], [23]. Subsequently, Buruli ulcer control projects launched in these two locations resulted in an increase in the number of Buruli cases detected [22],[23].…”

Buruli ulcer: wound care and rehabilitation

“…1,3,7 Treatment of BU disease (BUD) has evolved over the past decade, leading to the use of antibiotics as replacement to surgery. The combination of rifampicin and streptomycin daily for 8 weeks is effective in healing all forms of lesions caused by M. ulcerans, and this has reduced the…”

“…8 Despite antibiotic efficacy with healing of up to two-thirds of patients within 25 weeks after initiation of treatment, the time to healing differs significantly for similar-sized lesions, [9][10][11] and this is influenced by the quality of wound care. As ulcerative disease forms the majority of lesions in many treatment centers, [7][8][9]12 wound care plays a pivotal role in the care and treatment outcomes of patients. 13 In addition, as a result of late presentation to health facilities, scarring and contractures may complicate the healing process, particularly among patients who are not treated early, leading to long-term functional disability and occasionally amputation of affected limbs.…”