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Nicol T, Declerck C, Le Gallo M, Bougeard C, Habib A, Catraye P, Adeye A, Boccarossa A, Dubée V, Marsollier L, Marion E, Johnson RC, Eveillard M. Wound colonization with methicillin-resistant Staphylococcus aureus and hypotheses about acquisition routes in rural healthcare settings in Sub-Saharan Africa: Perspective from a Center devoted to the treatment of cutaneous neglected tropical diseases. Am J Infect Control 2024:S0196-6553(24)00499-1. [PMID: 38763430 DOI: 10.1016/j.ajic.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
We identified a high prevalence (46.4%) of wound colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients hospitalized in a Center devoted to the treatment of cutaneous tropical diseases in Benin. The proportion of MRSA among S. aureus isolates was 54.3%. Thirty percent of these MRSA were identified in outpatients. Concurrently, 51% of MRSA were identified in patients for whom the time spent in the Center was between 20 days and 228 days. The analysis of pulsed-field gel electrophoresis demonstrated an important diversity of strains but also identified eight small clusters containing between two and four isolates suggesting cross-transmission. Based on these data, hypotheses about acquisition routes were suggested and measures for limiting the burden of antimicrobial resistance were envisaged.
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Affiliation(s)
- Thomas Nicol
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France; Laboratoire de bactériologie, Département de biologie des agents infectieux, CHU Angers, France
| | - Charles Declerck
- Service des Maladies infectieuses et tropicales, CHU Angers, France
| | | | - Camille Bougeard
- Laboratoire de bactériologie, Département de biologie des agents infectieux, CHU Angers, France
| | - Akimat Habib
- CDTLUB - Raoul Follereau Foundation, Pobè, Bénin
| | | | | | | | - Vincent Dubée
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France; Service des Maladies infectieuses et tropicales, CHU Angers, France
| | - Laurent Marsollier
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France
| | - Estelle Marion
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France
| | - Roch Christian Johnson
- CDTLUB - Raoul Follereau Foundation, Pobè, Bénin; Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Matthieu Eveillard
- CDTLUB - Raoul Follereau Foundation, Pobè, Bénin; Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d'Abomey-Calavi, Abomey-Calavi, Bénin.
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Briand M, Boccarossa A, Rieux A, Jacques MA, Ganlanon L, Johnson C, Eveillard M, Marsollier L, Marion E. Emergence and spread of Mycobacterium ulcerans at different geographic scales. Microbiol Spectr 2024; 12:e0382723. [PMID: 38441471 PMCID: PMC10986537 DOI: 10.1128/spectrum.03827-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/10/2024] [Indexed: 04/06/2024] Open
Abstract
The classical lineage of Mycobacterium ulcerans is the most prevalent clonal group associated with Buruli ulcer in humans. Its reservoir is strongly associated with the environment. We analyzed together 1,045 isolates collected from 13 countries on two continents to define the evolutionary history and population dynamics of this lineage. We confirm that this lineage spread over 7,000 years from Australia to Africa with the emergence of outbreaks in distinct waves in the 18th and 19th centuries. In sharp contrast with its global spread over the last century, transmission chains are now mostly local, with little or no dissemination between endemic areas. This study provides new insights into the phylogeography and population dynamics of M. ulcerans, highlighting the importance of comparative genomic analyses to improve our understanding of pathogen transmission. IMPORTANCE Mycobacterium ulcerans is an environmental mycobacterial pathogen that can cause Buruli ulcer, a severe cutaneous infection, mostly spread in Africa and Australia. We conducted a large genomic study of M. ulcerans, combining genomic and evolutionary approaches to decipher its evolutionary history and pattern of spread at different geographic scales. At the scale of villages in an endemic area of Benin, the circulating genotypes have been introduced in recent decades and are not randomly distributed along the river. On a global scale, M. ulcerans has been spreading for much longer, resulting in distinct and compartmentalized endemic foci across Africa and Australia.
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Affiliation(s)
- Martial Briand
- Univ Angers, Institut Agro, INRAE, IRHS, SFR QUASAV, Angers, France
| | | | - Adrien Rieux
- CIRAD, UMR PVBMT, Saint Pierre, La Réunion, France
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Gnimavo RS, Fajloun F, Al-Bayssari C, Sodjinou E, Habib A, Ganlonon L, Claco E, Agoundoté I, Houngbo OA, Anagonou EG, Biaou CAO, Ayélo AG, Houezo JG, Boccarossa A, Moussa EH, Gomez B, Gine A, Sopoh GE, Marion E, Johnson RC, Kempf M. Importance of consultations using mobile teams in the screening and treatment of neglected tropical skin diseases in Benin. PLoS Negl Trop Dis 2023; 17:e0011314. [PMID: 37172044 DOI: 10.1371/journal.pntd.0011314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/24/2023] [Accepted: 04/15/2023] [Indexed: 05/14/2023] Open
Abstract
CONTEXT Since 2013, the World Health Organization has recommended integrated control strategies for neglected tropical diseases (NTDs) with skin manifestations. We evaluated the implementation of an integrated approach to the early detection and rapid treatment of skin NTDs based on mobile clinics in the Ouémé and Plateau areas of Benin. METHODS This descriptive cross-sectional study was performed in Ouémé and Plateau in Benin from 2018 to 2020. Consultations using mobile teams were performed at various sites selected by reasoned choice based on the epidemiological data of the National Program for the Control of Leprosy and Buruli Ulcer. All individuals presenting with a dermatological lesion who voluntarily approached the multidisciplinary management team on the day of consultation were included. The information collected was kept strictly anonymous and was entered into an Excel 2013 spreadsheet and analyzed with Stata 11 software. RESULTS In total, 5,267 patients with various skin conditions consulted the medical team. The median age of these patients was 14 years (IQR: 7-34 years). We saw 646 (12.3%) patients presenting NTDs with skin manifestations, principally scabies, in 88.4% (571/646), followed by 37 cases of Buruli ulcer (5.8%), 22 cases of leprosy (3.4%), 15 cases of lymphatic filariasis (2.3%) and one case of mycetoma (0.2%). We detected no cases of yaws. CONCLUSION This sustainable approach could help to decrease the burden of skin NTDs in resource-limited countries.
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Affiliation(s)
- Ronald Sètondji Gnimavo
- Centre de Dépistage et de Traitement de la Lèpre et de l´Ulcère de Buruli de Pobè, Fondation Raoul Follereau, Pobè, Bénin
- Institut Régional de Santé Publique- Comlan Alfred Quenum, Université d'Abomey Calavi, Ouidah, Bénin
| | - Faraj Fajloun
- University of Angers, Nantes Université, CHU Angers, Inserm, INCIT, Angers, France
- Ecole Doctorale en Sciences et Technologie, Université Libanaise, Campus Rafic Hariri, Hadath, Liban
- Laboratoire d'Innovation Thérapeutique, Faculté de Sciences 2, Campus Pierre Gemayel, Fanar, Liban
| | - Charbel Al-Bayssari
- Departement of Medical Laboratory Sciences, Faculty of Health Sciences, University of Balamand, Tripoli, Lebanon
| | - Espoir Sodjinou
- Centre de Dépistage et de Traitement de la Lèpre et de l´Ulcère de Buruli de Pobè, Fondation Raoul Follereau, Pobè, Bénin
| | - Akimath Habib
- Centre de Dépistage et de Traitement de la Lèpre et de l´Ulcère de Buruli de Pobè, Fondation Raoul Follereau, Pobè, Bénin
| | - Line Ganlonon
- Centre de Dépistage et de Traitement de la Lèpre et de l´Ulcère de Buruli de Pobè, Fondation Raoul Follereau, Pobè, Bénin
| | - Eric Claco
- Centre de Dépistage et de Traitement de la Lèpre et de l´Ulcère de Buruli de Pobè, Fondation Raoul Follereau, Pobè, Bénin
| | - Irvine Agoundoté
- Centre de Dépistage et de Traitement de la Lèpre et de l´Ulcère de Buruli de Pobè, Fondation Raoul Follereau, Pobè, Bénin
| | - Odile Adjouavi Houngbo
- Centre de Dépistage et de Traitement de la Lèpre et de l´Ulcère de Buruli de Pobè, Fondation Raoul Follereau, Pobè, Bénin
| | - Esaï Gimatal Anagonou
- Programme National de Lutte contre la Lèpre et l'Ulcère de Buruli, Ministère de la Santé, Cotonou, Bénin
| | | | - Adjimon Gilbert Ayélo
- Programme National de Lutte contre la Lèpre et l'Ulcère de Buruli, Ministère de la Santé, Cotonou, Bénin
| | - Jean Gabin Houezo
- Programme National de Lutte contre la Lèpre et l'Ulcère de Buruli, Ministère de la Santé, Cotonou, Bénin
| | - Alexandra Boccarossa
- University of Angers, Nantes Université, CHU Angers, Inserm, INCIT, Angers, France
| | - Elie Hajj Moussa
- Laboratoire d'Innovation Thérapeutique, Faculté de Sciences 2, Campus Pierre Gemayel, Fanar, Liban
| | | | - Anna Gine
- Fondation Anesvad, Henao, Bilbao, Spain
| | - Ghislain Emmanuel Sopoh
- Institut Régional de Santé Publique- Comlan Alfred Quenum, Université d'Abomey Calavi, Ouidah, Bénin
| | - Estelle Marion
- University of Angers, Nantes Université, CHU Angers, Inserm, INCIT, Angers, France
| | | | - Marie Kempf
- University of Angers, Nantes Université, CHU Angers, Inserm, INCIT, Angers, France
- Département de Biologie des Agents Infectieux, UF de Bactériologie, Centre Hospitalier Universitaire Angers, Angers, France
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Boccarossa A, Degnonvi H, Brou TY, Robbe-Saule M, Esnault L, Boucaud Y, Eveillard M, Gnimavo R, Hounsou S, Djenontin A, Johnson CR, Fleuret S, Marion E. A combined field study of Buruli ulcer disease in southeast Benin proposing preventive strategies based on epidemiological, geographic, behavioural and environmental analyses. PLOS Glob Public Health 2022; 2:e0000095. [PMID: 36962132 PMCID: PMC10021984 DOI: 10.1371/journal.pgph.0000095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/08/2021] [Indexed: 06/18/2023]
Abstract
Buruli ulcer is a neglected tropical disease caused by M. ulcerans, an environmental mycobacterium. This cutaneous infectious disease affects populations with poor access to sanitation, safe water and healthcare living in rural areas of West and Central Africa. Stagnant open bodies of surface water and slow-running streams are the only risk factor identified in Africa, and there is no human-to-human transmission. Appropriate and effective prevention strategies are required for populations living in endemic areas. Based on a multidisciplinary approach in an area in which Buruli ulcer is endemic in South Benin, we investigated the link between all human-environment interactions relating to unprotected water and behaviors associated with Buruli ulcer risk likely to affect incidence rates. We characterised the sources of water as well as water bodies and streams used by communities, by conducting a prospective case-control study directly coupled with geographic field observations, spatial analysis, and the detection of M. ulcerans in the environment. A full list of the free surface waters used for domestic activities was generated for a set of 34 villages, and several types of human behaviour associated with a higher risk of transmission were identified: (i) prolonged walking in water to reach cultivated fields, (ii) collecting water, (iii) and swimming. Combining the results of the different analyses identified the risk factor most strongly associated with Buruli ulcer was the frequency of contact with unprotected and natural water, particularly in regularly flooded or irrigated lowlands. We confirm that the use of clean water from drilled wells confers protection against Buruli ulcer. These specific and refined results provide a broader scope for the design of an appropriate preventive strategy including certain practices or infrastructures observed during our field investigations. This strategy could be improved by the addition of knowledge about irrigation practices and agricultural work in low-lying areas.
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Affiliation(s)
- Alexandra Boccarossa
- Univ Angers, Inserm, CRCINA, Angers, France
- Univ Angers, CNRS, ESO, Angers, France
| | - Horace Degnonvi
- Univ Angers, Inserm, CRCINA, Angers, France
- University Abomey Calavi, Cifred, Benin
| | | | | | | | | | | | | | - Saturnin Hounsou
- University Abomey Calavi, Cifred, Benin
- Faculté des Sciences et Techniques, University of Abomey-Calavi, Abomey Calavi, Benin
| | - Armel Djenontin
- Faculté des Sciences et Techniques, University of Abomey-Calavi, Abomey Calavi, Benin
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Gnimavo R, Besnard A, Degnonvi H, Pipoli Da Fonseca J, Kempf M, Johnson CR, Boccarossa A, Brou YT, Marsollier L, Marion E. Molecular and epidemiological characterization of recurrent Mycobacterium ulcerans infections in Benin. PLoS Negl Trop Dis 2021; 15:e0010053. [PMID: 34962930 PMCID: PMC8746791 DOI: 10.1371/journal.pntd.0010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/10/2022] [Accepted: 12/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans, an environmental mycobacterium. Although transmission of M. ulcerans remains poorly understood, the main identified risk factor for acquiring Buruli ulcer is living in proximity of potentially contaminated water sources. Knowledge about the clinical features of Buruli ulcer and its physiopathology is increasing, but little is known about recurrence due to reinfection. METHODOLOGY/PRINCIPAL FINDINGS We describe two patients with Buruli ulcer recurrence due to reinfection with M. ulcerans, as demonstrated by comparisons of DNA from the strains isolated at the time of the first diagnosis and at recurrence. Based on the spatial distribution of M. ulcerans genotypes in this region and a detailed study of the behavior of these two patients with respect to sources of water as well as water bodies and streams, we formulated hypotheses concerning the sites at which they may have been contaminated. CONCLUSIONS/SIGNIFICANCE Second episodes of Buruli ulcer may occur through reinfection, relapse or a paradoxical reaction. We formally demonstrated that the recurrence in these two patients was due to reinfection. Based on the sites at which the patients reported engaging in activities relating to water, we were able to identify possible sites of contamination. Our findings indicate that the non-random distribution of M. ulcerans genotypes in this region may provide useful information about activities at risk.
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Affiliation(s)
- Ronald Gnimavo
- Centre de Diagnostic et de Traitement de l’ulcère de Buruli, Fondation Raoul Follereau, Pobè, Bénin
| | | | - Horace Degnonvi
- Univ Angers, Inserm, INCIT, Angers, France
- Centre Inter Facultaire de Formation et de Recherche en Environnement pour le Développement Durable (CIFRED), Université d’Abomey Calavi (UAC), Cotonou, Benin
| | | | - Marie Kempf
- Univ Angers, Inserm, CHU Angers, INCIT, Angers, France
| | - Christian Roch Johnson
- Centre Inter Facultaire de Formation et de Recherche en Environnement pour le Développement Durable (CIFRED), Université d’Abomey Calavi (UAC), Cotonou, Benin
| | - Alexandra Boccarossa
- Univ Angers, Inserm, INCIT, Angers, France
- CNRS, UMR ESO, Université d’Angers, Angers, France
| | - Yao Télesphore Brou
- UMR 228 ESPACE-DEV (IRD, UAG, UM, UR), Station SEAS-OI, Saint Pierre, Ile de la Réunion, France
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