Maylis Douine1, Rodolphe Gozlan2, Mathieu Nacher1, Julie Dufour3, Yann Reynaud4, Eric Elguero5, Marine Combe5, Camilla J Velvin5, Christine Chevillon5, Alain Berlioz-Arthaud6, Sylvain Labbé7, Dominique Sainte-Marie3, Jean-François Guégan8, Roger Pradinaud3, Pierre Couppié9. 1. Centre d'Investigation Clinique, Institut National de la Santé et de la Recherche Médicale 1424, Cayenne Hospital, Cayenne, French Guiana; Université de Guyane, EA3593 Epidémiologie des Parasitoses Tropicales, Cayenne, French Guiana. 2. Institut de Recherche pour le Développement Unité Mixte de Recherche Biologie des Organismes et Ecosystèmes Aquatiques, Université Pierre et Marie Curie, Muséum National d'Histoire Naturelle, Paris, France. 3. Service de Dermatologie, Cayenne Hospital, Cayenne, French Guiana. 4. Institut Pasteur de la Guadeloupe, Tuberculosis and Mycobacteria Unit, Morne Jolivière, Les Abymes, Guadeloupe, France. 5. Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France. 6. Institut Pasteur de la Guyane, Laboratoire de Biologie Médicale, Cayenne, French Guiana. 7. Service D'Anatomie-Pathologique, Cayenne Hospital, Cayenne, French Guiana. 8. Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France; Future Earth United Nations International Programme, OneHealth Research Initiative, Montréal, QC, Canada. 9. Service de Dermatologie, Cayenne Hospital, Cayenne, French Guiana; Université de Guyane, EA3593 Epidémiologie des Parasitoses Tropicales, Cayenne, French Guiana. Electronic address: pierre.couppie@ch-cayenne.fr.
Abstract
BACKGROUND: Mycobacterium ulcerans infection is the third most common mycobacterial disease in the world after tuberculosis and leprosy. To date, transmission pathways from its environmental reservoir to humans are still unknown. In South America, French Guiana has the highest reported number of M ulcerans infections across the continent. This empirical study aimed to characterise the epidemiology of M ulcerans infection in French Guiana between 1969 and 2013. METHODS: Data were collected prospectively mainly by two dermatologists at Cayenne Hospital's dermatology department between Jan 1, 1969, and Dec 31, 2013, for age, date of diagnosis, sex, residence, location of the lesion, type of lesion, associated symptoms, and diagnostic method (smear, culture, PCR, or histology) for all confirmed and suspected cases of M ulcerans. We obtained population data from censuses. We calculated mean M ulcerans infection incidences, presented as the number of cases per 100 000 person-years. FINDINGS: 245 patients with M ulcerans infections were reported at Cayenne Hospital's dermatology department during the study period. M ulcerans infection incidence decreased over time, from 6·07 infections per 100 000 person-years (95% CI 4·46-7·67) in 1969-83 to 4·77 infections per 100 000 person-years (3·75-5·79) in 1984-98 and to 3·49 infections per 100 000 person-years (2·83-4·16) in 1999-2013. The proportion of children with infections also declined with time, from 42 (76%) of 55 patients in 1969-83 to 26 (31%) of 84 in 1984-98 and to 22 (21%) of 106 in 1999-2013. Most cases occurred in coastal areas surrounded by marshy savannah (incidence of 21·08 per 100 000 person-years in Sinnamary and 21·18 per 100 000 person-years in Mana). Lesions mainly affected limbs (lower limbs 161 [66%] patients; upper limbs 60 [24%] patients). We diagnosed no bone infections. INTERPRETATION: The decrease of M ulcerans infection incidence and the proportion of children with infections over a 45 year period in this ultra-peripheral French territory might have been mostly driven by improving living conditions, prophylactic recommendations, and access to health care. FUNDING: Agence Nationale de la Recherche.
BACKGROUND: Mycobacterium ulcerans infection is the third most common mycobacterial disease in the world after tuberculosis and leprosy. To date, transmission pathways from its environmental reservoir to humans are still unknown. In South America, French Guiana has the highest reported number of M ulcerans infections across the continent. This empirical study aimed to characterise the epidemiology of M ulcerans infection in French Guiana between 1969 and 2013. METHODS: Data were collected prospectively mainly by two dermatologists at Cayenne Hospital's dermatology department between Jan 1, 1969, and Dec 31, 2013, for age, date of diagnosis, sex, residence, location of the lesion, type of lesion, associated symptoms, and diagnostic method (smear, culture, PCR, or histology) for all confirmed and suspected cases of M ulcerans. We obtained population data from censuses. We calculated mean M ulcerans infection incidences, presented as the number of cases per 100 000 person-years. FINDINGS: 245 patients with M ulcerans infections were reported at Cayenne Hospital's dermatology department during the study period. M ulcerans infection incidence decreased over time, from 6·07 infections per 100 000 person-years (95% CI 4·46-7·67) in 1969-83 to 4·77 infections per 100 000 person-years (3·75-5·79) in 1984-98 and to 3·49 infections per 100 000 person-years (2·83-4·16) in 1999-2013. The proportion of children with infections also declined with time, from 42 (76%) of 55 patients in 1969-83 to 26 (31%) of 84 in 1984-98 and to 22 (21%) of 106 in 1999-2013. Most cases occurred in coastal areas surrounded by marshy savannah (incidence of 21·08 per 100 000 person-years in Sinnamary and 21·18 per 100 000 person-years in Mana). Lesions mainly affected limbs (lower limbs 161 [66%] patients; upper limbs 60 [24%] patients). We diagnosed no bone infections. INTERPRETATION: The decrease of M ulcerans infection incidence and the proportion of children with infections over a 45 year period in this ultra-peripheral French territory might have been mostly driven by improving living conditions, prophylactic recommendations, and access to health care. FUNDING: Agence Nationale de la Recherche.
Authors: Hope Simpson; Earnest Njih Tabah; Richard O Phillips; Michael Frimpong; Issaka Maman; Edwin Ampadu; Joseph Timothy; Paul Saunderson; Rachel L Pullan; Jorge Cano Journal: PLoS Negl Trop Dis Date: 2021-03-03