Comparative analysis of Buruli ulcer in Ghana and Côte d'Ivoire: A cross-sectional study

Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical skin disease highly endemic in West Africa and Australia. The molecular diversity of M. ulcerans strains varies geographically within endemic regions and this directly influences the virulence of mycolactone, the lipid toxin produced by the bacterium which is responsible for disease pathogenesis. This study investigated differences in BU presentation based on various sociodemographic determinants of infection between Ghana and Côte d'Ivoire, two of the most affected countries globally. While the general epidemiology and presentation of confirmed Buruli ulcer cases were similar in both countries, distinct differences emerged in clinical manifestation, perceived transmission routes, and health-seeking behaviours. Interestingly, children in Ghana were the least affected, in direct contrast with Côte d'Ivoire where adults over 60 years had the lowest incidence. In both countries, ulcerative lesions were predominant, typically appearing on the lower limbs. A key distinction was the recall of initial symptoms: most affected individuals in Côte d'Ivoire could not remember how their lesions began, whereas the majority in Ghana reported onset as a boil or oedema or after an injury or bruise from an infected object. These crucial observations are associated with treatment seeking behaviours and have significant implications for early case diagnosis and efforts to understand disease epidemiology.