Complete healing of a laboratory-confirmed Buruli ulcer lesion after receiving only herbal household remedies.
On March 7, 2011, an 11-year-old boy from the town of Bankim in the Adamaoua Region of Cameroon—a known endemic focus of Buruli ulcer (BU)—was accompanied by his father to the district hospital in Bankim. The patient presented with a BU lesion classified as Category II, according to the classifications of the World Health Organization (WHO). The partially ulcerated plaque lesion, which was approximately 14 x 6 cm in size, had undermined edges characteristic of BU. Following clinical examination and sample collection for diagnosis, the patient’s family refused the standard WHO-recommended treatment for BU, which consists of daily rifampicin (10 mg/kg orally) and streptomycin (15mg/kg intramuscularly) for eight weeks, and the patient left the hospital. Wound exudates collected from the patient tested positive in the Mycobacterium ulcerans-specific IS2404 quantitative polymerase chain reaction (qPCR) assay with threshold cycle (Ct) values ranging from 20.0 to 28.6, indicating a high mycobacterial load. Swab exudates were also used for the initiation of a M. ulcerans primary culture on Löwenstein-Jensen medium, as previously described. After 8.5 weeks of incubation at 30°C, mycobacterial growth was observed, and the cultured mycobacteria were reconfirmed as M. ulcerans by IS2404 colony PCR. Whole genome sequencing of the isolate reconfirmed that it belongs to the local clonal complex of M. ulcerans.