Clinical Epidemiology of Buruli Ulcer from Benin (2005-2013): Effect of Time-Delay to Diagnosis on Clinical Forms and Severe Phenotypes
| Autor: | Jean Gabin Houezo, Fernando Rodrigues, Carlos Capela, Jorge Pedrosa, Rita Silva-Gomes, Alexandra G. Fraga, Edgard M. Ouendo, Ghislain Emmanuel Sopoh, Patrício Costa, René Fiodessihoue, Ange Dodji Dossou, João F. Menino |
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| Přispěvatelé: | Faculdade de Psicologia e de Ciências da Educação, Universidade do Minho |
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Buruli ulcer
Adult Male medicine.medical_specialty lcsh:Arctic medicine. Tropical medicine Delayed Diagnosis Time Factors Adolescent lcsh:RC955-962 030231 tropical medicine Severity of Illness Index 03 medical and health sciences Young Adult 0302 clinical medicine Edema Psychology [Social sciences] Epidemiology Severity of illness Psicologia [Ciências sociais] medicine Psychology Benin Humans 030212 general & internal medicine Child Buruli Ulcer Retrospective Studies Science & Technology biology business.industry Osteomyelitis lcsh:Public aspects of medicine Public Health Environmental and Occupational Health Retrospective cohort study lcsh:RA1-1270 biology.organism_classification medicine.disease Dermatology 3. Good health Surgery Infectious Diseases Psicologia Mycobacterium ulcerans Cohort Female medicine.symptom business Research Article |
| Zdroj: | PLoS Neglected Tropical Diseases PLoS Neglected Tropical Diseases, Vol 9, Iss 9, p e0004005 (2015) Repositório Científico de Acesso Aberto de Portugal Repositório Científico de Acesso Aberto de Portugal (RCAAP) instacron:RCAAP |
| ISSN: | 1935-2735 1935-2727 |
| Popis: | Buruli Ulcer (BU) is a neglected infectious disease caused by Mycobacterium ulcerans that is responsible for severe necrotizing cutaneous lesions that may be associated with bone involvement. Clinical presentations of BU lesions are classically classified as papules, nodules, plaques and edematous infiltration, ulcer or osteomyelitis. Within these different clinical forms, lesions can be further classified as severe forms based on focality (multiple lesions), lesions' size (>15 cm diameter) or WHO Category (WHO Category 3 lesions). There are studies reporting an association between delay in seeking medical care and the development of ulcerative forms of BU or osteomyelitis, but the effect of time-delay on the emergence of lesions classified as severe has not been addressed. To address both issues, and in a cohort of laboratory-confirmed BU cases, 476 patients from a medical center in Allada, Benin, were studied. In this laboratory-confirmed cohort, we validated previous observations, demonstrating that time-delay is statistically related to the clinical form of BU. Indeed, for non-ulcerated forms (nodule, edema, and plaque) the median time-delay was 32.5 days (IQR 30.0-67.5), while for ulcerated forms it was 60 days (IQR 20.0-120.0) (p = 0.009), and for bone lesions, 365 days (IQR 228.0-548.0). On the other hand, we show here that time-delay is not associated with the more severe phenotypes of BU, such as multi-focal lesions (median 90 days; IQR 56-217.5; p = 0.09), larger lesions (diameter >15 cm) (median 60 days; IQR 30-120; p = 0.92) or category 3 WHO classification (median 60 days; IQR 30-150; p = 0.20), when compared with unifocal (median 60 days; IQR 30-90), small lesions (diameter =15 cm) (median 60 days; IQR 30-90), or WHO category 1+2 lesions (median 60 days; IQR 30-90), respectively. Our results demonstrate that after an initial period of progression towards ulceration or bone involvement, BU lesions become stable regarding size and focal/multi-focal progression. Therefore, in future studies on BU epidemiology, severe clinical forms should be systematically considered as distinct phenotypes of the same disease and thus subjected to specific risk factor investigation. The research leading to these results received funding from the Health Services of the Fundacao Calouste Gulbenkian under the grant Proc. No94776 LJ; from the Fundacao para a Ciecia e Tecnologia (FCT), cofunded by Programa Operacional Regional do Norte (ON.2-O Novo Norte); from the Quadro de Referencia Estrategico Nacional (QREN) through the Fundo Europeu de Desenvolvimento Regional (FEDER) and from the Projeto Estrategico - LA 26 - 2013-2014 (PEst-C/SAU/LA0026/2013). A. G. Fraga received an individual FCT fellowship (SFRH/BPD/68547/2010) and J. Menino received an individual QREN fellowship (UMINHO/BPD/14/2014). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. |
| Databáze: | OpenAIRE |
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