Epidemiological Profile of Buruli Ulcer and its Management at the Buruli Ulcer Detection and Treatment Center (CDTUB) in Pobè, Republic of BENIN

Background: The first clinical description of a new necrotizing skin disease appeared in 1948 with the work of Peter MacCallum. In fact, the latter described the causative agent for the first time by discovering acid-fast bacilli (AFB) in a biopsy taken from a leg ulcer in a child from Bairnsdale (Australia) in 1940. He would also publish eight years later his detailed report on six patients with ulcers on their arms or legs due to this new mycobacterial infection. However, the bacteria responsible for this necrotizing skin disease was not named in the original publication; the name Mycobacterium ulcerans would not be proposed until 1950 by Frank Johannes Fenner [1]. However, this disease was already known in Africa before 1948: suspected cases of Mycobacterium ulcerans infections were reported as early as the middle of the 19th century. The detailed description of the infection mentioned by the explorer James Augustus Grant in his book "A walk across Africa" in 1864 is currently considered the first reported case of Buruli ulcer. Sir Robert Cook had also described extensive ulcers in patients in Uganda as early as 1897, almost certainly caused by M. ulcerans [2]. In addition, between 1923 and 1935, a missionary doctor in northeastern Congo (formerly Zaire), named Kleinschmidt, also observed skin lesions with sunken edges containing numerous acid-fast bacilli [3]. In 1960, numerous cases occurred in Buruli County in Uganda (now Nakasongola District), hence the most commonly used name for this disease, Buruli ulcer [4]. Currently, Buruli ulcer is reported in at least 33 countries in tropical, subtropical and temperate regions of Africa, South America and the Western Pacific. Very recently, a first case of Mycobacterium ulcerans infection was also reported in Jordan [5]. It is noteworthy that West and Central African countries, such as Benin, Cameroon, Côte d'Ivoire, Ghana and the Democratic Republic of Congo, account for most of the reported cases (Figure 1). On the other hand, cases reported in Australia and Japan, countries with moderate non-tropical climates, have raised the interest of scientists in the biology of the bacteria responsible for the disease: different strains of M. ulcerans in different continents have been identified [6]. Every year, more than 7,000 people are infected with Buruli ulcer, making it the third most common mycobacterial infection [7] the most common in humans after tuberculosis (Mycobacterium tuberculosis) and leprosy (Mycobacterium leprae).