Distribution and Risk of Mycolactone-Producing Mycobacteria Transmission within Buruli Ulcer Endemic Communities in Côte d’Ivoire

In Buruli ulcer (BU) endemic communities, most mycolactone-producing mycobacteria (MPM), including Mycobacterium ulcerans, the causative agent, are present in water bodies used by inhabitants; yet, their mode of transmission is still unclear. This study aimed to assess the distribution of MPM strains, both from human suspected cases and aquatic environments, for identifying possible transmission modes within two BU endemic districts, Daloa and Tiassalé (Taabo), in Côte d’Ivoire. Collected samples were processed using conventional polymerase chain reaction and screened for the presence of non-tuberculous mycobacteria (NTM) and MPMs using 16S rRNA, IS2404 and enoyl reductase (ER) primers. MPM-positive samples were further discriminated using variable number tandem repeat (VNTR) typing and sequencing. 16S rRNA and IS2404 sequences confirmed that 94% of the clinical samples contained MPMs. For environmental samples, 53% were contaminated with NTMs, of which 17% contained MPMs particularly M. ulcerans, suggesting that water-related activities could predispose inhabitants to BU transmission. MPM discrimination by VNTR at four M. ulcerans Agy99 loci identified genotype C, previously reported in Côte d’Ivoire as the most dominant profile. Phylogenetic clustering on the basis of genetic diversity in the MIRU 1 locus showed two main M. ulcerans lineages in Côte d’Ivoire.