Volume 81, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Almost half of patients have functional limitations after treatment of Buruli ulcer disease. Antibiotic treatment (along with surgery) was introduced in the National Program for Buruli ulcer in Benin in 2005. The aim of this study was to compare functional limitations in patients who were treated by antibiotics, surgery, or both, using a validated questionnaire. One hundred seventy-nine former patients in Lalo, Benin were retrieved and interviewed in their village. Hospital records were used to gather data about size of lesion at presentation and treatment provided. No significant differences in resulting functional limitations were found between the different treatments. Larger lesions (> 15 cm cross-sectional diameter) at presentation; lesions on a joint, muscular atrophy, and amputation were all associated with a higher risk for functional limitations. Advantages of antibiotic treatment may involve other domains, like costs of treatment or a change in help-seeking behavior.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Portaels F, Meyers WM, Ablordey A, Castro AG, Chemlal K, de Rijk P, Elsen P, Fissette K, Fraga AG, Lee R, Mahrous E, Small PL, Stragier P, Torrado E, Van Aerde A, Silva MT, Pedrosa J, 2008. First cultivation and characterization of Mycobacterium ulcerans from the environment. PLoS Negl Trop Dis 2 : e178. [Google Scholar]
  2. Durnez L, Eddyani M, Mgode GF, Katakweba A, Katholi CR, Machang’u RR, Kazwala RR, Portaels F, Leirs H, 2008. First detection of mycobacteria in African rodents and insectivores, using stratified pool screening. Appl Environ Microbiol 74 : 768–773. [Google Scholar]
  3. Johnson PD, Azuolas J, Lavender CJ, Wishart E, Stinear TP, Hayman JA, Brown L, Jenkin GA, Fyfe JA, 2007. Mycobacterium ulcerans in mosquitoes captured during outbreak of Buruli ulcer, southeastern Australia. Emerg Infect Dis 13 : 1653–1660. [Google Scholar]
  4. Marsollier L, Robert R, Aubry J, Saint Andre JP, Kouakou H, Legras P, Manceau AL, Mahaza C, Carbonnelle B, 2002. Aquatic insects as a vector for Mycobacterium ulcerans. Appl Environ Microbiol 68 : 4623–4628. [Google Scholar]
  5. Portaels F, Chemlal K, Elsen P, Johnson PD, Hayman JA, Hibble J, Kirkwood R, Meyers WM, 2001. Mycobacterium ulcerans in wild animals. Rev Sci Tech 20 : 252–264. [Google Scholar]
  6. Williamson HR, Benbow ME, Nguyen KD, Beachboard DC, Kimbirauskas RK, McIntosh MD, Quaye C, Ampadu EO, Boakye D, Merritt RW, Small PL, 2008. Distribution of Mycobacterium ulcerans in Buruli ulcer endemic and non-endemic aquatic sites in Ghana. PLoS Negl Trop Dis 2 : e205. [Google Scholar]
  7. Benbow ME, Williamson H, Kimbirauskas R, McIntosh MD, Kolar R, Quaye C, Akpabey F, Boakye D, Small P, Merritt RW, 2008. Aquatic invertebrates as unlikely vectors of Buruli ulcer disease. Emerg Infect Dis 14 : 1247–1254. [Google Scholar]
  8. Debacker M, Portaels F, Aguiar J, Steunou C, Zinsou C, Meyers W, Dramaix M, 2006. Risk factors for Buruli ulcer, Benin. Emerg Infect Dis 12 : 1325–1331. [Google Scholar]
  9. Pouillot R, Matias G, Wondje CM, Portaels F, Valin N, Ngos F, Njikap A, Marsollier L, Fontanet A, Eyangoh S, 2007. Risk factors for Buruli ulcer: a case control study in Cameroon. PLoS Negl Trop Dis 1 : e101. [Google Scholar]
  10. Raghunathan PL, Whitney EA, Asamoa K, Stienstra Y, Taylor THJ, Amofah GK, Ofori-Adjei D, Dobos KM, Guarner J, Kihlstrom SL, Pathak S, Klutse E, Etuaful S, Quarshie E, van der Graaf WT, van der Werf TS, King CH, Tappero JW, Ashford DA, 2005. Risk factors for Buruli ulcer disease (Mycobacterium ulcerans infection): results from a case-control study in Ghana. Clin Infect Dis 40 : 1445–1453. [Google Scholar]
  11. van der Werf TS, Stienstra Y, Johnson RC, Phillips R, Adjei O, Fleischer B, Wansbrough-Jones MH, Johnson PD, Portaels F, van der Graaf WT, Asiedu K, 2005. Mycobacterium ulcerans disease. Bull World Health Organ 83 : 785–791. [Google Scholar]
  12. Aujoulat I, Johnson C, Zinsou C, Guédénon A, Portaels F, 2003. Psychosocial aspects of health seeking behaviours of patients with Buruli ulcer in southern Benin. Trop Med Int Health 8 : 750–759. [Google Scholar]
  13. Stienstra Y, van der Graaf WTA, Asamoa K, van der Werf TS, 2002. Beliefs and attitudes towards Buruli ulcer Ghana. Am J Trop Med Hyg 67 : 207–213. [Google Scholar]
  14. van der Werf TS, van der Graaf WTA, Tappero JW, Asiedu K, 1999. Mycobacterium ulcerans infection. Lancet 354 : 1013–1018. [Google Scholar]
  15. Aguiar J, Stenou C, 1997. Les ulcères de Buruli en zone rurale au Bénin: prise en charge de 635 cas. Med Trop 57 : 83–90. [Google Scholar]
  16. Asiedu K, Etuaful S, 1998. Socioeconomic implications of Buruli ulcer in Ghana: a three-year review. Am J Trop Med Hyg 59 : 1015–1022. [Google Scholar]
  17. Ouattara D, Meningaud JP, Kaba L, Sica A, Asse H, 2004. Traitement de l’ulcère de Buruli par excision-greffe: à propos de 118 observations. Ann Chir Plast Esthet 49 : 11–16. [Google Scholar]
  18. Etuaful S, Carbonnelle B, Grosset J, Lucas S, Horsfield C, Phillips R, Evans M, Ofori-Adjei D, Klustse E, Owusu-Boateng J, Amedofu GK, Awuah P, Ampadu E, Amofah G, Asiedu K, Wansbrough-Jones M, 2005. Efficacy of the combination rifampin-streptomycin in preventing growth of Mycobacterium ulcerans in early lesions of Buruli ulcer in humans. Antimicrob Agents Chemother 49 : 3182–3186. [Google Scholar]
  19. van der Werf TS, Stinear T, Stienstra Y, van der Graaf WT, Small PL, 2003. Mycolactones and Mycobacterium ulcerans disease. Lancet 362 : 1062–1064. [Google Scholar]
  20. George KM, Chatterjee D, Gunawardana G, Welty D, Hayman J, Lee R, Small PL, 1999. Mycolactone: a polyketide toxin from Mycobacterium ulcerans required for virulence. Science 283 : 854–857. [Google Scholar]
  21. Chauty A, Ardant MF, Adeye A, Euverte H, Guedenon A, Johnson C, Aubry J, Nuermberger E, Grosset J, 2007. Promising clinical efficacy of the combination streptomycin-rifampin for the treatment of Buruli ulcer (Mycobacterium ulcerans disease). Antimicrob Agents Chemother 51 : 4029–4035. [Google Scholar]
  22. Ellen DE, Stienstra Y, Teelken MA, Dijkstra PE, van der Graaf WT, van der Werf TS, 2003. Assessment of functional limitations caused by Mycobacterium ulcerans infection: towards a Buruli ulcer functional limitations score. Trop Med Int Health 8 : 90–96. [Google Scholar]
  23. Stienstra Y, Dijkstra PU, Guedenon A, Johnson RC, Ampadu EO, Mensah T, Klutse EY, Etuaful S, Deepak S, van der Graaf WT, van der Werf TS, 2004. Development of a questionnaire assessing Buruli ulcer-induced functional limitation. Am J Trop Med Hyg 70 : 318–322. [Google Scholar]
  24. Stienstra Y, Dijkstra PU, van Wezel MJ, van Roest MH, Beets M, Zijlstra IJ, Johnson RC, Ampadu EO, Gbovi J, Zinsou C, Etuaful S, Klutse EY, van der Graaf WT, van der Werf TS, 2005. Reliability and validity of the Buruli ulcer functional limitation score questionnaire. Am J Trop Med Hyg 72 : 449–452. [Google Scholar]
  25. Stienstra Y, van Roest MH, van Wezel MJ, Wiersma IC, Hospers IC, Dijkstra PU, Johnson RC, Ampadu EO, Gbovi J, Zinsou C, Etuaful S, Klutse EY, van der Graaf WT, van der Werf TS, 2005. Factors associated with functional limitations and subsequent employment or schooling in Buruli ulcer patients. Trop Med Int Health 10 : 1251–1257. [Google Scholar]
  26. Teelken MA, Stienstra Y, Ellen DE, Quarshie E, Klutse E, van der Graaf WT, van der Werf TS, 2003. Buruli ulcer: differences in treatment outcome between two centres in Ghana. Acta Trop 88 : 51–56. [Google Scholar]
  27. Debacker M, Aguiar J, Steunou C, Zinsou C, Meyers WM, Guedenon A, Scott JT, Dramaix M, Portaels F, 2004. Mycobacterium ulcerans disease (Buruli ulcer) in rural hospital, Southern Benin, 1997–2001. Emerg Infect Dis 10 : 1391–1398. [Google Scholar]
  28. Renzaho AM, Woods PV, Ackumey MM, Harvey SK, Kotin J, 2007. Community-based study on knowledge, attitude and practice on the mode of transmission, prevention and treatment of the Buruli ulcer in Ga West District, Ghana. Trop Med Int Health 12 : 445–458. [Google Scholar]
  29. Kassah AK, 1998. Community-based rehabilitation and stigma management by physically disabled people in Ghana. Disabil Rehabil 20 : 66–73. [Google Scholar]
  30. Tinney MJ, Chiodo A, Haig A, Wiredu E, 2007. Medical rehabilitation in Ghana. Disabil Rehabil 29 : 921–927. [Google Scholar]

Data & Media loading...

  • Received : 08 Sep 2008
  • Accepted : 15 Apr 2009

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error