Mycobacterium ulcerans infection: control, diagnosis, and treatment.

The skin disease Buruli ulcer, caused by Mycobacterium ulcerans, is the third most common mycobacterial disease after tuberculosis and leprosy and mainly affects remote rural African communities. Although the disease is known to be linked to contaminated water, the mode of transmission is not yet understood, which makes it difficult to propose control interventions. The disease is usually detected in its later stages, when it has caused substantial damage and disability. Surgery remains the treatment of choice. Although easy and effective in the early stages of the disease, treatment requires extended excisions and long hospitalisation for the advanced forms of the disease. Currently, no antibiotic treatment has proven effective for all forms of M ulcerans infection and research into a new vaccine is urgently needed. While the scientific community works on developing non-invasive and rapid diagnostic tools, the governments of endemic countries should implement active case finding and health education strategies in their affected communities to detect the disease in its early stages. We review the diagnosis, treatment, and control of Buruli ulcer and list priorities for research and development

Support needs of people living with Mycobacterium ulcerans (Buruli ulcer) disease in a Ghana rural community: a grounded theory study

Mycobacterium Ulcerans (also known as Buruli ulcer) disease is a rare tropical skin disease which causes contracture and severe scarring and thus affect the functional activities of people who suffer from it as well as their quality of life. An assessment of the effects of BU on patients’ quality of life helps health professionals to meet the needs of such patients. Therefore the aim of this paper is to assess the quality of life of people living with the consequences of Buruli ulcer (BU). Methods This was a combination of an ethnographic in-depth study based on the grounded theory method, Dermatology Life Quality Index (DLQI) tool and functional limitation scores to assess the quality of life of people living with the consequences of BU. Findings The overall finding was that BU affects the quality of life of the participants in all the domains of the DLQI and the areas most affected were symptoms and feelings, leisure and personal relationships Conclusion The quality of life of this vulnerable group was identified from detailed analysis of the qualitative data, functional limitation scores and the Dermatology Life Quality Index (DLQI) tool. People living with the consequences of BU have low quality of life. Efforts should be made to include this in the overall assessment and treatment of these patients

Response to treatment in a prospective cohort of patients with large ulcerated lesions suspected to be Buruli Ulcer (Mycobacterium ulcerans disease)

BACKGROUND: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called "Buruli ulcer" (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of > or =10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC). METHODS: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment. FINDINGS: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%). INTERPRETATION: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed.This study was supported by the Directorate-General for Development and Cooperation (DGDC), Brussels, Belgium, the European Commission (International Science and Technology Cooperation Development Program) (project no. INCO-CT-2005-051476-BURULICO), and by a grant from the Health Services of Fundacao Calouste Gulbenkian. K.K. was supported by a grant from DGDC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

KlenTaq DNA Polymerase adopts unique recognition states when encountering matched, mismatched, and abasic template sites : an NMR Study

On the tracks of a DNA polymerase: NMR provides insights into DNA synthesis in a virtually label-free manner and under close-to-physiological conditions. Through the monitoring of the chemical-shift changes of multiple (13) C-methyl methionine residues we found unique recognition states for canonical and noncanonical cases, thus indicating enzymatic cycling through distinct paths

Tetraphenylphosphonium octahydrotriborate

The structure of the title salt, C(24)H(20)P(+)center dot H(8)B(3)(-) , at 120 (2) K has triclinic (P1) symmetry with an unusual Z = 5, although there is pseudosymmetry observedwith the tetraphenylphosphonium cations exhibiting I (4) over bar symmetry. One of the anions is disordered over two sets of sites with refined occupancies of 0.478 (11) and 0.522 (11