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A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer
Eddyani, M. Vandelannoote, K. Meehan, Conor J. Bhuju, S. Porter, J.L. Aguiar, J. Seemann, T. Jarek, M. Singh, M. Portaels, F.
Eddyani, M.
Vandelannoote, K.
Meehan, Conor J.
Bhuju, S.
Porter, J.L.
Aguiar, J.
Seemann, T.
Jarek, M.
Singh, M.
Portaels, F.
Publication Date
30/11/2015
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© 2015 Eddyani et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License 4.0, https://creativecommons.org/licenses/by/4.0/, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
credited.
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openAccess
Accepted for publication
22/09/2015
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Abstract
Background.
Increased availability of Next Generation Sequencing (NGS) techniques allows, for the first time,
to distinguish relapses from reinfections in patients with multiple Buruli ulcer (BU) episodes.
Methodology.
We compared the number and location of single nucleotide polymorphisms (SNPs) identified by genomic screening between four pairs of Mycobacterium ulcerans isolates collected
at the time of first diagnosis and at recurrence, derived from a collection of almost 5000 well
characterized clinical samples from one BU treatment center in Benin.
Principal Findings.
The findings suggest that after surgical treatment—without antibiotics—the second episodes were due to relapse rather than reinfection. Since specific antibiotics were introduced
for the treatment of BU, the one patient with a culture available from both disease episodes
had M. ulcerans isolates with a genomic distance of 20 SNPs, suggesting the patient was
most likely reinfected rather than having a relapse.
Conclusions.
To our knowledge, this study is the first to study recurrences in M. ulcerans using NGS, and
to identify exogenous reinfection as causing a recurrence of BU. The occurrence of reinfection highlights the contribution of ongoing exposure to M. ulcerans to disease recurrence,
and has implications for vaccine development.
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Published version
Citation
Eddyani M, Vandelannoote K, Meehan CJ et al (2015) A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer. PLoS Neglected Tropical Diseases, 9 (11): e0004158.
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Article