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BURULI ULCER AND SCHISTOSOMIASIS: NO ASSOCIATION FOUND

Helminth infections elicit an immune response potentially enhancing susceptibility to mycobacterial diseases. Schistosomiasis and infection with Mycobacterium ulcerans show a remarkable similarity in epidemiologic characteristics in Ghana. In 2000, a case-control study was conducted in three districts in Ghana endemic for M. ulcerans. One hundred six patients with confirmed M. ulcerans disease and 106 matched community controls were included. Schistosome infection of these patients and controls was measured by an enzyme-linked immunosorbent assay that detected circulating anodic antigen in serum. Fifty percent of the participants tested positive for schistosomiasis. There was no difference in detection rates among patients and matched controls. Similarly, there were no differences in worm burden between patients and controls. These results do not support the hypothesis that susceptibility to M. ulcerans disease is driven by a co-infection with schistosomes.

Received August 22, 2003. Accepted for publication April 22, 2004.

Acknowledgments: We thank Ellen Spotts Whitney, Pratima Raghunathan, Jeanette Guarner, Jordan Tappero, and David Ashford (Centers for Disease Control and Prevention, Atlanta, GA) for their assistance. We also thank Ablordey and D. Ofori-Adjei (Noguchi Memorial Institute, Accra, Ghana) for their assistance with data and specimen collection.

Financial support: This research was supported in part by a grant from the Centers for Disease Control and Prevention (HHS U50/CCU416560), a grant from the NWO (Dutch Organization for Scientific Research), from the Dr. L. A. Buma foundation, and from the Nicolaas Mulerius foundation in the Netherlands.

Authors’ addresses: Ymkje Stienstra, Tjip S. van der Werf, and Winette T. A. van der Graaf, Department of Internal Medicine, Groningen University Hospital, PO Box 30.001, 9700 RB Groningen, The Netherlands, Telephone: 31-50-361-1501, Fax: 31-50-361-3216, E-mails: y.stienstra{at}int.azg.nl and t.s.van.der.werf{at}int.azg.nl. W. Evan Secor, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341. Stacey L Kihlstrom, Karen M. Dobos, and C. Harold King, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30303. Kwame Asamoa, Ministry of Health, National Buruli Ulcer Control Programme, Korle Bu Accra, Ghana. Eric Quarshi, Agogo Presbyterian Hospital, Agogo, Ghana. Samual N. Etuaful, St. Martin’s Catholic Hospital, Agroyesum, Ghana. Erasmus Y. Klutse, Dunkwa Governmental Hospital, Dunkwa, Ghana.