for Buruli ulcer in Côte d’Ivoire: Results of a case-control
study, August 2001
Laurence Ahoua1,2*, Aka N.
Guetta1, Euloge Ekaza1, Samir Bouzid1,
Raymond N’Guessan1 and Mireille Dosso1
and virological laboratory, Institut Pasteur, 01 B. P. 490,
Abidjan Côte d’Ivoire.
8 rue Saint Sabin 75011 Paris, France.
*Corresponding author. E-mail:
firstname.lastname@example.org. Phone: + 331-421-2849;
Fax: + 331-40-21-28-03.
Accepted 22 January, 2009
A case-control study was carried out in 3 highly endemic
regions of Côte d’Ivoire to study risk factors for Buruli
ulcer. A case was defined as a Buruli ulcer occurring less
than one year before the date of survey, resident in one of
the regions investigated and there was no history of Buruli
ulcer illness. Controls were selected from the general
population by a two stage cluster sampling method. A total
of 116 cases and 116 controls were included. For the cases,
the male/female sex ratio was 0.84, the median age was 19.5
years and 40.5% were children ≤ 15 years. Biological results
were obtained for 86 (74%) cases using skin exudate samples.
Positive rates were 22.0, 22.1 and 27.9% respectively for
smear examination, culture and PCR IS2404,
respectively. After adjusting for possible
confounders, no history of BCG vaccination (ORa =
5.0, CI 1.7 - 14.3), presence of a case ≤15 years (ORa
= 8.3, CI 2.8 - 24.1), having a river/lake/dam near
the housing (ORa = 4.4, CI 1.6 - 12.2) and the
type of place for fishing (p = 0.001) were associated with
illness. Young children and women having daily water related
activities were most at risk. Swab samples were not
sensitive enough for Buruli ulcer diagnosis. There is an
urgent need for a rapid field test to diagnosis Buruli Ulcer
as PCR IS2404 remains expensive for most of the
Ulcer, Mycobacterium ulcerans, Côte d’Ivoire,
case-control study, risk factors.