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Providing insight into the incubation period of Mycobacterium ulcerans disease: two case reports.

Amoako, YA; Frimpong, M; Awuah, DO; Plange-Rhule, G; Boakye-Yiadom, E; Agbavor, B; Sarpong, F; Ahor, H; Adu, E; Danso, KG; et al. Amoako, YA; Frimpong, M; Awuah, DO; Plange-Rhule, G; Boakye-Yiadom, E; Agbavor, B; Sarpong, F; Ahor, H; Adu, E; Danso, KG; Abass, MK; Asiedu, K; Wansbrough-Jones, M; Phillips, RO (2019) Providing insight into the incubation period of Mycobacterium ulcerans disease: two case reports. J Med Case Rep, 13 (1). p. 218. ISSN 1752-1947 https://doi.org/10.1186/s13256-019-2144-2
SGUL Authors: Wansbrough-Jones, Mark Harding

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Abstract

BACKGROUND: Buruli ulcer caused by Mycobacterium ulcerans is endemic in parts of West Africa and is most prevalent among the 5-15 years age group; Buruli ulcer is uncommon among neonates. The mode of transmission and incubation period of Buruli ulcer are unknown. We report two cases of confirmed Buruli ulcer in human immunodeficiency virus-unexposed, vaginally delivered term neonates in Ghana. CASE PRESENTATION: Patient 1: Two weeks after hospital delivery, a baby born to natives of the Ashanti ethnic group of Ghana was noticed by her mother to have a papule with associated edema on the right anterior chest wall and neck that later ulcerated. There was no restriction of neck movements. The diagnosis of Buruli ulcer was confirmed on the basis of a swab sample that had a positive polymerase chain reaction result for the IS2404 repeat sequence of M. ulcerans. Patient 2: This patient, from the Ashanti ethnic group in Ghana, had the mother noticing a swelling in the baby's left gluteal region 4 days after birth. The lesion progressively increased in size to involve almost the entire left gluteal region. Around the same time, the mother noticed a second, smaller lesion on the forehead and left side of neck. The diagnosis of Buruli ulcer was confirmed by polymerase chain reaction when the child was aged 4 weeks. Both patients 1 and 2 were treated with oral rifampicin and clarithromycin at recommended doses for 8 weeks in addition to appropriate daily wound dressing, leading to complete healing. Our report details two cases of polymerase chain reaction-confirmed Buruli ulcer in children whose lesions appeared at ages 14 and 4 days, respectively. The mode of transmission of M. ulcerans infection is unknown, so the incubation period is difficult to estimate and is probably dependent on the infective dose and the age of exposure. In our study, lesions appeared 4 days after birth in patient 2. Unless the infection was acquired in utero, this would be the shortest incubation period ever recorded. CONCLUSIONS: Buruli ulcer should be included in the differential diagnosis of neonates who present with characteristic lesions. The incubation period of Buruli ulcer in neonates is probably shorter than is reported for adults.

Item Type: Article
Additional Information: © The Author(s). 2019Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Buruli ulcer, Ghana, Incubation period, Neonate, Buruli ulcer, Ghana, Incubation period, Neonate, 1199 Other Medical And Health Sciences, General & Internal Medicine
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: J Med Case Rep
ISSN: 1752-1947
Language: eng
Dates:
DateEvent
18 July 2019Published
4 June 2019Accepted
PubMed ID: 31315637
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111050
Publisher's version: https://doi.org/10.1186/s13256-019-2144-2

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