Article

Buruli ulcer disease: Prospects for a vaccine

Scientific Institute of Public Health, Rue Engelandstraat 642, 1180 Brussels, Belgium.
Medical Microbiology and Immunology (Impact Factor: 3.04). 03/2009; 198(2):69-77. DOI: 10.1007/s00430-009-0109-6
Source: PubMed

ABSTRACT

Buruli ulcer disease (BUD), caused by Mycobacterium ulcerans, is a neglected bacterial infection of the poor in remote rural areas, mostly affecting children. BUD is a mutilating disease leading to severe disability; it is the third most common mycobacterial infection in immunocompetent people after tuberculosis and leprosy. It is most endemic in West Africa, but cases have been reported from more than 30 countries. Treatment with antibiotics is possible, long-lasting and requires injections; there are cases of treatment failures, and the disease is prone to resistance. A vaccine against M. ulcerans would protect persons at risk in highly endemic areas, and could be used as a therapeutic vaccine to shorten the duration of treatment and prevent relapses. There is considerable evidence supporting the notion that generation of a vaccine is feasible. This article reviews the present state of the art with special emphasis on the immunology of the infection and the prospects for development of a vaccine.

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Available from: Caroline Demangel, Apr 18, 2014
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    • "Given the deficient cross-reactive immune response elicited by BCG vaccination during M. ulcerans infection, it has been argued that an M. ulcerans-specific immunization would be more efficient at controlling infection. Indeed, there are differences in genetic and antigenic mycobacterial composition that can result in variations of immunodominant epitopes [38]. Therefore, we evaluated the efficacy of a vaccination protocol with a mycolactone-negative strain of M. ulcerans. "
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    ABSTRACT: Mycobacterium ulcerans infection is an emerging disease that causes indolent, necrotizing skin lesions known as Buruli ulcer (BU). Approximately 10% of patients develop reactive osteitis or osteomyelitis beneath skin lesions or metastatic osteomyelitis from lymphohematogenous spread of M. ulcerans. The most plausible mode of transmission is by skin trauma at sites contaminated by M. ulcerans. Pathogenesis is mediated by a necrotizing, immunosuppressive toxin produced by M. ulcerans called mycolactone. The incidence of BU is highest in children up to 15 years old and is a public health problem in countries of endemicity due to disabling scarring and bone destruction. Today, most BU occurs in West Africa, but the disease has been reported in over 30 countries. Treatment options for BU are antibiotics and surgery. BCG vaccination provides short-term protection against BU and prevents osteomyelitis. HIV seropositivity may increase the risk for BU and render BU osteomyeletis highly aggressive.
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