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Persistence of Mycobacterium ulcerans Disease (Buruli Ulcer) in the Historical Focus of Kasongo Territory, the Democratic Republic of Congo

Fifty years after the last report of Mycobacterium ulcerans infections (Buruli ulcer [BU]) in Kasongo Territory, Maniema Province, Democratic Republic of Congo (DRC), we conducted a small-scale cross-sectional survey to assess if this historical BU focus was still active and if so to explore the disease epidemiology. Seventy-five active and inactive BU cases were identified on clinical grounds of which two of 28 BU active cases were laboratory confirmed. We used a modified BU02 form to reconstruct the local disease dynamics and we believe that the horrific conflict in eastern DRC and exceptional flooding were the most likely causes of the re-emergence of the disease. There is a need in the DRC to decentralize and integrate surveillance and control activities at local level to increase the effectiveness of patient management.

Received January 27, 2009. Accepted for publication June 10, 2009.

Acknowledgments: We thank the BU patients for their input; Dr. Maarten Desmet (Belgian Embassy, DRC), Professor Vincent De Brouwere and Professor Bart Criel (Public Health Department, ITM), Dr. Didier Molisho Sadi (Deputy, DRC), and Dr. Raphaël Ngongo (Coordination Provinciale Lèpre-Tuberculose, Maniema Province) for their constant interest in this work and sharing their experience and introduction of important contacts in Kasongo Rural Health Zone; Father Luc Vansina (Memisa and Order of Friars Minor Capuchin, DRC), Dr. Diana Van Daele (Deutsche Gesellschaft für Technische Zusammenarbeit, GTZ, DRC), Albert Ongombe Utchudi (CARE International, Kasongo), and Dr. Arthur Nondo (Projet TIDC, Kasongo) for their logistic support, as well as ECHO flight for transport from Kinshasa to Kasongo; Nasibu Baraka (CARE International, Kasongo) for excellent coordination of logistic and administrative support; the technical staff of the Mycobacteriology Unit, ITM for excellent technical assistance; and Conor Cahill, a professional medical writer, for providing technical assistance for the last draft of the manuscript. We dedicate this work to the memory of two inspiring pioneers of BU research in the DRC, Professor Pieter Gustaaf Janssens and Professor Stefaan Rogier Pattyn (ITM).

Financial support: This study was supported by the European Commission (International Science and Technology Cooperation Development Program), project no. INCO-CT-2005-051476-BURULICO. Patrick Suykerbuyk is currently supported by a PhD grant (no. NDOC2005UA0006) of the Flemish Interuniversity Council (VLIR). Julie Wambacq was supported by a research travel grant of VLIR.

^* Address correspondence to Françoise Portaels, Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerpen, Belgium. E-mail: portaels{at}itg.be

Authors’ addresses: Patrick Suykerbuyk, Pieter Stragier, and Françoise Portaels, Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium. Julie Wambacq and Eric De Herdt, Group T, Leuven Engineering College (Association K. U. Leuven), Andreas Vesaliusstraat 13, B-3000 Leuven, Belgium. Delphin M. Phanzu, Institut Médical Evangélique, Kimpese Hospital, PO Box 68, Projet UB, Kimpese, Bas-Congo Province, Democratic Republic of Congo. Hemedi Haruna, Zone de Santé Rural Kasongo, Maniema Province, Democratic Republic of Congo. Yoshinori Nakazawa, Natural History Museum and Biodiversity Research Center, Department of Ecology and Evolutionary Biology, University of Kansas, 1345 Jayhawk Boulevard, Dyche Hall, Lawrence, KS 66045. Kristien Ooms and Philippe De Maeyer, Department of Geography, Ghent University, Krijgslaan 281 (S8), B-9000 Gent, Belgium. Kalambo Kamango, Leprosy, Tuberculosis and Buruli Ulcer Supervision, Zone de Santé Rural Kasongo, Maniema Province, Democratic Republic of Congo. Jackie N. Singa, Programme Nationale de Lutte Contre l’Ulcère de Buruli, Institut National de Recherche Biomédicale, Avenue des Huileries, Kinshasa-Gombe, Democratic Republic of Congo. Florent Ekwanzala, World Health Organization Representation in Democratic Republic of Congo, Bureau du Représentant de l’Organisation Mondiale de la Santé–République Démocratique du Congo, Diseases Control and Prevention Program, Avenue des Cliniques 42, PO Box 1899, Kinshasa-Gombe, Democratic Republic of Congo. Luc Kestens, Immunology Unit, Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium.