# Comparative analysis of Buruli ulcer in Ghana and Côte d’Ivoire: A cross-sectional study

## TL;DR

This study compares how Buruli ulcer affects people in Ghana and Côte d’Ivoire, finding differences in who gets it and how symptoms start, which could help improve early diagnosis.

## Contribution

The study reveals distinct sociodemographic and clinical patterns of Buruli ulcer in Ghana and Côte d’Ivoire, impacting diagnosis and treatment-seeking behaviors.

## Key findings

- Children in Ghana were least affected, while adults over 60 in Côte d’Ivoire had the lowest incidence.
- In Ghana, most recalled initial symptoms like boils or injuries, whereas in Côte d’Ivoire, many couldn't recall symptom onset.
- Ulcerative lesions on lower limbs were common in both countries.

## Abstract

Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical skin disease highly endemic in West Africa and Australia. The molecular diversity of M. ulcerans strains varies geographically within endemic regions and this directly influences the virulence of mycolactone, the lipid toxin produced by the bacterium which is responsible for disease pathogenesis. This study investigated differences in BU presentation based on various sociodemographic determinants of infection between Ghana and Côte d’Ivoire, two of the most affected countries globally. While the general epidemiology and presentation of confirmed Buruli ulcer cases were similar in both countries, distinct differences emerged in clinical manifestation, perceived transmission routes, and health-seeking behaviours. Interestingly, children in Ghana were the least affected, in direct contrast with Côte d’Ivoire where adults over 60 years had the lowest incidence. In both countries, ulcerative lesions were predominant, typically appearing on the lower limbs. A key distinction was the recall of initial symptoms: most affected individuals in Côte d’Ivoire could not remember how their lesions began, whereas the majority in Ghana reported onset as a boil or oedema or after an injury or bruise from an infected object. These crucial observations are associated with treatment seeking behaviours and have significant implications for early case diagnosis and efforts to understand disease epidemiology.

Buruli ulcer (BU), a debilitating skin disease caused by Mycobacterium ulcerans, poses a significant health challenge in West Africa. This study delves into the characteristics of how this disease manifests and is perceived in Ghana and Côte d’Ivoire, two of the most heavily impacted nations. While the overall picture of BU cases is similar in both countries, interesting differences emerged in how the disease presents clinically, how people believe they contracted it, and how they sought treatment. Children in Ghana were less affected compared to Côte d’Ivoire, where adults over 60 showed the lowest incidence. In both countries, ulcers on the lower limbs were the most common type of lesion. A key finding was the difference in how people recollected the start of their symptoms: most in Côte d’Ivoire could not pinpoint the beginning of their lesions, whereas in Ghana, many recalled it starting as a boil, swelling, or after an injury. These distinctions are important because they may directly influence when and how people seek treatment, with significant implications for early diagnosis and disease surveillance strategies.