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Abstracts of Poster and e-Poster Presentations
PA-817 Relationship between microbiome and clinical outcome in Buruli ulcer disease
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  1. Nancy Ackam1,2,
  2. Abigail Opoku-Boadi1,
  3. Bernadette Agbavor1,2,
  4. Jonathan K Adjei1,
  5. Abigail Agbanyo1,
  6. Evans A Asamoah1,
  7. Charity Wiafe-Akenten1,2,
  8. Augustina Sylverken1,2,
  9. Kwasi O Danso2,
  10. Mark Wansbrough-Jones3,
  11. Yaw A Amoako1,4,5,
  12. Richard O Phillips1,4,5
  1. 1Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana
  2. 2Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Ghana
  3. 3Institute of Infection and Immunity, St. George’s University of London, UK
  4. 4School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Ghana
  5. 5Komfo Anokye Teaching Hospital, Ghana

Abstract

Background Previous studies have demonstrated secondary microbial infection of Buruli ulcer (BU) lesions before, during and after treatment. However, there is limited data on the resistance profile of these organisms and their influence on the development of paradoxical reactions. The present study aimed to investigate the microbiome and resistance profile in BU lesions during therapy and at the onset of a paradoxical reaction (PR).

Methods We investigated the bacteria diversity in patients with PCR confirmed BU from 5 endemic districts within central Ghana. Samples were collected longitudinally from lesions and compared to normal skin flora in literature. Microbiological analyses including isolation of bacteria, species identification and antibiotic susceptibility testing (AST) were performed using the VITEK 2 system.

Results Of the 38 participants, 66 bacteria (Actinobacteria – 2.5%, Firmicutes – 48.1%, Proteobacteria – 49.4%) were isolated from BU lesions relative to healthy skin. Staphylococcus spp was dominant at baseline. There was a marked reduction in the number of isolates after treatment with Pseudomonas spp and Staphylococcus spp being the dominant bacterial isolates. Baseline AST profile revealed organisms in BU lesions were highly resistant to tetracycline (55%), benzylpenicillin (52%), and trimethoprim-sulfamethoxazole (26%). Organisms isolated after treatment completion showed high level of resistance to tetracycline (79%), benzylpenicillin (65%) and rifampicin (59%). Of note, 4/8isolates were Methicillin Resistant Staphylococcus aureus (MRSA). Opportunistic pathogens including Staphylococcus spp, Enterococcus spp and Klebsiella pneumoniae were isolated from 6/38 patients that developed PR.

Conclusion Infection with BU alters the skin microbiome of patients. Most BU lesions are colonized by polymicrobial organisms resistant to commonly used antibiotics in Ghana. Our study demonstrated the presence of opportunistic pathogens in BU lesions that developed paradoxical reaction, suggesting a possible relationship.

Funding: Presenter is supported from the Senior Fellowship Grant under EDCTP2 Program supported by the European Union awarded to Richard Phillips

https://doi.org/10.1136/bmjgh-2023-EDC.310

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