Polymicrobial ulcers in Ghana (Leishmaniasis, Yaws and H. ducreyi) / Ulcères polymicrobiennes au Ghana (Leishmaniose, Pian et H. ducreyi)
Background: Cutaneous leishmaniasis (CL), Buruli ulcer, Haemophilus ducreyi, and yaws are skin ulcer diseases caused by Leishmania spp., Mycobacterium ulcerans. H. ducreyi, and Treponema pallidum sub. Sp. pertenue respectively Methodology/Principal Findings: A community based cross-sectional study was conducted in December 2021 in the Oti region of Ghana to investigate causes of undetermined skin ulcers. A total of 101 skin ulcer samples were obtained from 101 persons in 5 communities of the region. All participants were screened in the field as potential yaws cases using the Syphilis 3.0 and Dual path platform (DPP) rapid diagnostic tests (RDT). The samples from each participant were systematically
tested for Leishmania spp., Mycobacterium ulcerans, Haemophilus ducreyi, and Treponema pallidum sub species pertenue, using polymerase chain reaction (PCR) molecular methods. Two persons (2%) were suspected to have yaws via the RDT screening in the field. Of the 101 samples tested, 83(82.2%), 68 (67.3%), and 74(73.3%) were positive for Leishmania spp., Treponema pallidum sub. Sp. pertenue, and H. ducreyi respectively. None of the samples was positive for Mycobacterium ulcerans. Leishmania spp., Treponema pallidum sub. sp. pertenue, and H. ducreyi were simultaneously detected in 43 (42.6%) of the ulcers. Conclusions/Significance: This integrated skin ulcers study confirmed single and mixed occurrence of the causative organisms for CL, yaws, and H. ducreyi. This has implications for skin ulcer nomenclature and calls for the development of a comprehensive guideline for diagnosing and treating tropical ulcers in the study area. We propose a syndromic treatment algorithm for validation in the study areas.
Key words: Cutaneous leishmaniasis, Leishmania, yaws, Haemophilus ducreyi, Buruli ulcer, Oti Region, Ghana