03353nas a2200373   4500000000100000008004100001653000900042653001700051653002700068653001700095653001800112653001800130100001300148700001300161700001300174700001300187700001400200700001400214700001200228700001400240700001600254700002200270700001300292700001900305700001300324700001600337700001500353245012300368856003100491300001100522490000600533520242700539022001302966       2017                            d10aNTDs10aBuruli ulcer10aMycobacterium ulcerans10aEpidemiology10aFrench Guiana10aSouth America1 aDouine M1 aGozlan R1 aNacher M1 aDufour J1 aReynaud Y1 aElguero E1 aCombe M1 aVelvin CJ1 aChevillon C1 aBerlioz-Arthaud A1 aLabbé S1 aSainte-Marie D1 aGuegan J1 aPradinaud R1 aCouppié P00aMycobacterium ulcerans infection (Buruli ulcer) in French Guiana, South America, 1969–2013: an epidemiological study  uhttp://tinyurl.com/myg9ldd  ae65-730 v13 a<h4><strong>Background</strong></h4>

<p><em>Mycobacterium ulcerans</em> infection is the third most common mycobacterial disease in the world after tuberculosis and leprosy. To date, transmission pathways from its environmental reservoir to humans are still unknown. In South America, French Guiana has the highest reported number of <em>M ulcerans</em> infections across the continent. This empirical study aimed to characterise the epidemiology of <em>M ulcerans</em> infection in French Guiana between 1969 and 2013.</p>

<h4><strong>Methods</strong></h4>

<p>Data were collected prospectively mainly by two dermatologists at Cayenne Hospital's dermatology department between Jan 1, 1969, and Dec 31, 2013, for age, date of diagnosis, sex, residence, location of the lesion, type of lesion, associated symptoms, and diagnostic method (smear, culture, PCR, or histology) for all confirmed and suspected cases of <em>M ulcerans</em>. We obtained population data from censuses. We calculated mean <em>M ulcerans</em> infection incidences, presented as the number of cases per 100 000 person-years.</p>

<h4><strong>Findings</strong></h4>

<p>245 patients with <em>M ulcerans</em> infections were reported at Cayenne Hospital's dermatology department during the study period. <em>M ulcerans</em> infection incidence decreased over time, from 6·07 infections per 100 000 person-years (95% CI 4·46–7·67) in 1969–83 to 4·77 infections per 100 000 person-years (3·75–5·79) in 1984–98 and to 3·49 infections per 100 000 person-years (2·83–4·16) in 1999–2013. The proportion of children with infections also declined with time, from 42 (76%) of 55 patients in 1969–83 to 26 (31%) of 84 in 1984–98 and to 22 (21%) of 106 in 1999–2013. Most cases occurred in coastal areas surrounded by marshy savannah (incidence of 21·08 per 100 000 person-years in Sinnamary and 21·18 per 100 000 person-years in Mana). Lesions mainly affected limbs (lower limbs 161 [66%] patients; upper limbs 60 [24%] patients). We diagnosed no bone infections.</p>

<h4><strong>Interpretation</strong></h4>

<p>The decrease of <em>M ulcerans</em> infection incidence and the proportion of children with infections over a 45 year period in this ultra-peripheral French territory might have been mostly driven by improving living conditions, prophylactic recommendations, and access to health care.</p>
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