{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T07:43:49Z","timestamp":1781077429821,"version":"3.54.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009862","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000}}],"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T00:00:00Z","timestamp":1634083200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"national institute for health research","doi-asserted-by":"publisher","award":["16\/137\/44"],"award-info":[{"award-number":["16\/137\/44"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Chronic wounds pose a significant healthcare burden in low- and middle-income countries. Buruli ulcer (BU), caused by <jats:italic>Mycobacterium ulcerans<\/jats:italic> infection, causes wounds with high morbidity and financial burden. Although highly endemic in West and Central Africa, the presence of BU in Sierra Leone is not well described. This study aimed to confirm or exclude BU in suspected cases of chronic wounds presenting to Masanga Hospital, Sierra Leone.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>Demographics, baseline clinical data, and quality of life scores were collected from patients with wounds suspected to be BU. Wound tissue samples were acquired and transported to the Swiss Tropical and Public Health Institute, Switzerland, for analysis to detect <jats:italic>Mycobacterium ulcerans<\/jats:italic> using qPCR, microscopic smear examination, and histopathology, as per World Health Organization (WHO) recommendations.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>Twenty-one participants with wounds suspected to be BU were enrolled over 4-weeks (Feb-March 2019). Participants were predominantly young working males (62% male, 38% female, mean 35yrs, 90% employed in an occupation or as a student) with large, single, ulcerating wounds (mean diameter 9.4cm, 86% single wound) exclusively of the lower limbs (60% foot, 40% lower leg) present for a mean 15 months. The majority reported frequent exposure to water outdoors (76%). Self-reports of over-the-counter antibiotic use prior to presentation was high (81%), as was history of trauma (38%) and surgical interventions prior to enrolment (48%). Regarding laboratory investigation, all samples were negative for BU by microscopy, histopathology, and qPCR. Histopathology analysis revealed heavy bacterial load in many of the samples. The study had excellent participant recruitment, however follow-up proved difficult.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>BU was not confirmed as a cause of chronic ulceration in our cohort of suspected cases, as judged by laboratory analysis according to WHO standards. This does not exclude the presence of BU in the region, and the definitive cause of these treatment-resistance chronic wounds is uncertain.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0009862","type":"journal-article","created":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T19:07:43Z","timestamp":1634152063000},"page":"e0009862","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Chronic wounds in Sierra Leone: Searching for Buruli ulcer, a NTD caused by Mycobacterium ulcerans, at Masanga Hospital"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8758-6889","authenticated-orcid":true,"given":"Helen R.","family":"Please","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4012-4177","authenticated-orcid":true,"given":"Jonathan H.","family":"Vas Nunes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7908-9161","authenticated-orcid":true,"given":"Rashida","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1957-2925","authenticated-orcid":true,"given":"Gerd","family":"Pluschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Tholley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Ther\u00e9s\u00e8","family":"Ruf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8451-9595","authenticated-orcid":true,"given":"William","family":"Bolton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian A.","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin P.","family":"Grobusch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9609-4093","authenticated-orcid":true,"given":"H\u00e5kon A.","family":"Bolkan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia M.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Jayne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,13]]},"reference":[{"issue":"9993","key":"pntd.0009862.ref001","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S0140-6736(15)60160-X","article-title":"Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development","volume":"386","author":"JG Meara","year":"2015","journal-title":"The Lancet"},{"issue":"6","key":"pntd.0009862.ref002","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.surg.2014.12.028","article-title":"Met and unmet needs for surgery in Sierra Leone: a comprehensive, retrospective, countrywide survey from all health care facilities performing operations in 2012","volume":"157","author":"HA Bolkan","year":"2015","journal-title":"Surgery"},{"issue":"1","key":"pntd.0009862.ref003","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1093\/heapol\/czaa131","article-title":"Staff recognition and its importance for surgical service delivery: a qualitative study in Freetown, Sierra Leone","volume":"36","author":"C Willott","year":"2021","journal-title":"Health Policy and Planning."},{"issue":"3","key":"pntd.0009862.ref004","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1001\/jamasurg.2015.3431","article-title":"Self-reported determinants of access to surgical care in 3 developing countries","volume":"151","author":"JD Forrester","year":"2016","journal-title":"JAMA surgery"},{"issue":"2","key":"pntd.0009862.ref005","first-page":"92","article-title":"Global initiative for wound and lymphoedema care (GIWLC).","volume":"4","author":"J MacDonald","year":"2009","journal-title":"Journal of Lymphoedema"},{"key":"pntd.0009862.ref006","first-page":"1","volume-title":"BBuruli Ulcer","author":"K R\u00f6ltgen","year":"2019"},{"key":"pntd.0009862.ref007","unstructured":"World Health Organisation, Global Health Observatory data repository, Buruli Ulcer, Number of New Reported Cases, Data by Country updated Dec 2018 [Internet]. 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