L'ulcère de Buruli est une maladie infectieuse tropicale présente dans des foyers endémiques. Cette infection essentiellement cutanée est causée par Mycobacterium ulcerans. M. ulcerans est un pathogène opportuniste dont le réservoir est environnemental. Notre revue de la littérature a répertorié les sources environnementales potentielles de cette mycobactérie. Seulement cinq souches de M. ulcerans ont été isolées à partir de prélèvements de l’environnement. Il existe une corrélation inverse entre réchauffement climatique et incidence de l’ulcère de Buruli, peut-être liée à la sensibilité intrinsèque de M. ulcerans aux variations de température, ou bien à des modifications de son écosystème. Dans la perspective d’améliorer les protocoles d’isolement de M. ulcerans à partir de l’environnement, nous avons entrepris une analyse phénotypique à haut débit des substrats carbonés métabolisés par M. ulcerans et le profil obtenu nous a orientés après une recherche bibliographique des principales sources environnementales de ces substrats, vers des interactions plus spécifiques de M. ulcerans avec les bactéries, algues, mollusques et champignons. Les résultats de ce premier travail ont servi de base pour la mise au point de milieux de culture innovants qui nous ont permis d’isoler pour la première fois, une microcolonie de M. ulcerans à partir de fèces d’agouti. Nous avons mis au point une méthode de lecture automatisée des échantillons colorés par la méthode de Ziehl-Neelsen. Notre travail de thèse a produit des protocoles qui ont pour objectif d’être mis en œuvre dans les pays d’endémie, pour préciser les sources et modes de transmission de M. ulcerans aux populations. / Buruli ulcer is a tropical infectious disease present in endemic foci/This mainly cutaneous infection is caused by Mycobacterium ulcerans. M. ulcerans is an opportunistic pathogen from the environment. Our literature review has listed the potential environmental sources of this mycobacterium.. However, only five strains of M. ulcerans have been isolated from environmental samples. There is an inverse correlation between global warming and incidence of Buruli ulcer, possibly related to the intrinsic sensitivity of M. ulcerans to temperature, or to changes in its ecosystem. In order to improve the isolation protocols of M. ulcerans from the environment, we conducted a high-throughput phenotypic analysis of the carbon substrates metabolized by M. ulcerans and the profile obtained oriented us afterwards a bibliographic search of the main environmental sources of these substrates, towards more specific interactions of M. ulcerans with other bacteria, algae, molluscs and fungi. The results of this first work served as a basis for the development of innovative culture media which, allowed us to isolate for the first time a microcolony of M. ulcerans from feces of agouti. We also developed a method for automated reading of samples stained by Ziehl-Neelsen staining. Our thesis work has produced protocols that are intended to be implemented in African endemic countries, in order to clarify the sources and modes of transmission of M. ulcerans to populations.

L’ulcère de Buruli est une maladie nécrotique de la peau présente dans plus de trente pays dans le monde, et affectant principalement le continent africain et l’Océanie. L’infection est due à Mycobacterium ulcerans (M. ulcerans), un micro-organisme qui sécrète une exotoxine appelée mycolactone, représentant le premier polycétide isolé d’un pathogène humain. La maladie est caractérisée par la formation progressive de lésions nécrotiques combinée à une absence de réponse immunitaire et de sensation de douleur ; la mycolactone est connue pour être directement impliquée dans ce mécanisme biologique. A ce jour, aucun traitement totalement performant et spécifique contre l’ulcère de Buruli n’a été développé, ce qui révèle le manque crucial de connaissances sur les mécanismes chimique et biologique. Dans ce contexte, le projet développé s’intéresse à l’élucidation du mécanisme d’action des mycolactones en utilisant la synthèse totale comme outil principal. Pour cela, notre équipe a mis au point une voie de synthèse modulaire permettant la préparation de la toxine naturelle et de ses différents analogues en vue de les tester biologiquement et d’affiner ainsi notre compréhension mécanistique de cette infection. / Buruli ulcer is a necrotizing skin disease present in more than thirty countries in the world, located mainly in West and Central Africa but also in Australia and in Japan. This infection is caused by Mycobacterium ulcerans (M. ulcerans) that secretes a macrolide toxin called mycolactone, which is the first polyketide isolated from a human pathogen. The disease is characterized by the formation of painless progressive necrotic lesions combined with a lack of acute inflammatory response, and mycolactone is known to be directly involved in the biological mechanism. To date no specific and completely efficient treatment of Buruli ulcer has been developed which correlates with the dramatic lack of understanding of the associated chemical and biological mechanisms. In this context, this research project aims at a better understanding of mycolactone A/B molecular interactions by using total synthesis as main tool. To this end, our research team has developed an efficient synthetic pathway allowing the preparation of the natural toxin and its differents analogues for purposes of their biological evaluation and fine-tuning our mechanical understanding of this infection.

Mycobacterium ulcerans (MU), agent causatif de l'ulcère de Buruli (UB), une maladie infectieuse humaine émergente, est associé aux milieux aquatiques tropicaux, et en particulier ceux modifiés par les activités humaines. L’écologie de cette mycobactérie est encore peu informée, et des interrogations demeurent sur son cycle de transmission au sein des écosystèmes et à l’humain. La tendance observée aujourd’hui en recherche est de montrer l’existence d’une multitude de taxa porteurs du bacille au sein des écosystèmes aquatiques mais aussi terrestres, laissant donc imaginer qu’un ou quelques facteurs en commun puissent expliquer sa présence et son développement. Dans ce contexte, nous avons développé des approches expérimentales au laboratoire pour analyser les effets de paramètres environnementaux, sélectionnés comme être importants dans la définition de la niche écologique de MU, sur le maintien et le développement des populations bactériennes. En tenant compte de gammes de valeurs rencontrées dans des régions endémiques et non endémiques, où sévit, nous avons testé dans un premier temps l'effet de deux polysaccharides très largement présents dans les écosystèmes naturels (la chitine et l’amidon) ainsi que cinq composants chimiques (le fer, le calcium, le zinc, le phosphate et le sulfate), représentant des nutriments indispensables pour les bactéries, sur la croissance de MU. Notre travail montre que la chitine augmente de manière très significative la croissance de MU. A l’inverse, la présence d’amidon ne favorise pas son développement. Le calcium est le seul élément chimique à contribuer à l’augmentation de quantité de cellules de MU avec le temps, mais ce paramètre reste toutefois très marginal. L’absence d’effet joué par le fer, le zinc, le sulfate et le phosphate sur la croissance in vitro de MU tend à indiquer que les valeurs utilisées dans nos expériences correspondent à des valeurs limites pour expliquer la distribution géographique de MU dans les écosystèmes aquatiques tropicaux. Dans un deuxième temps, eu égard au peu d‘informations existant concernant le rôle joué par le pH sur la présence et le développement de MU, nous avons reproduit des environnements pour étudier la croissance de MU en fonction de différentes valeurs de pH rencontrées dans des régions du Cameroun et de Guyane française où la mycobactérie peut être présente ou absente. Nos résultats montrent que le pH présente un effet significatif sur la dynamique de croissance de MU avec un effet plus marqué pour des valeurs de pH proches de 6,0. De plus, il existe une forte interaction entre pH et chitine puisque pour des mêmes valeurs de pH, la croissance bactérienne est 10 fois plus importante en présence de milieu avec chitine. Ces résultats suggèrent aussi que des pH trop acides, inférieurs à 5,0, sont défavorables à la croissance de la mycobactérie.Finalement, nous nous sommes intéressés à l’expression génique de différents isolats de MU générés à partir de différents environnements expérimentaux. Pour ce faire, et en nous servant d’une nouvelle approche de séquençage des ARN, nous avons étudié l’expression de MU dans différents environnements ; Nous nous sommes notamment intéressés à l’expression des gènes impliqués dans les voies métaboliques de production de la mycolactone, le peptide responsable des ulcérations chez l’humain. Des contextes environnementaux spécifiques pourraient conduire à une sur-expression de toxine peptidique traduisant ainsi une écologie et une épidémiologie (micro-)contexte-dépendant ayant des incidences pathologiques et cliniques très particulières.Dans leur ensemble, nos résultats participent à une recherche permettant de mieux comprendre les paramètres clés de la niche écologique de M. ulcerans et au-delà contribue à l’identification des écosystèmes aquatiques favorables, ou non, au maintien et au développement de cette mycobactérie responsable de l’ulcère de Buruli. / Mycobacterium ulcerans (MU), the causative agent of Buruli ulcer (BU), an emerging human infectious disease, is associated with tropical aquatic environments, particularly those modified by human activities. The ecology of this mycobacterium is still poorly understood, and questions remain about its transmission cycle within ecosystems and from nature to humans. Nowadays the research orientation is to show the existence of a multitude of host taxa carrying the bacillus in both aquatic and riparian ecosystems. Thus, it is likely to think that one or a few common factors might contribute and explain the presence and development of this bacillus across distinct localities and regions.In this context, we have developed experimental approaches in the laboratory to analyze the effects of several environmental parameters, selected as being important in the definition of the MU ecological niche and in its growth and persistence in natural ecosystems. Considering ranges of values encountered in endemic and non-endemic regions where BU occurs, we first tested the effect on MU growth of two polysaccharides widely present in nature (chitin and starch) and five chemical components (iron, calcium, zinc, phosphate and sulfate) representing essential nutrients for bacteria. Our work shows that chitin increases significantly the growth of MU. Conversely, the presence of starch does not favor its development with time. Calcium is the only chemical element contributing to increase MU cell number over time, but this effect remains very marginal. The lack of effect exerted by iron, zinc, sulfate and phosphate on the in vitro growth of MU suggests that values used in our experiments correspond to the limit values to explain the geographical distribution of MU in tropical aquatic ecosystems.Secondly, given the few existing information about the role of pH on the presence and development of MU in natural settings, we have reproduced in the lab some environments to study the growth of MU depending on different pH values encountered in regions of Cameroon and French Guiana where the mycobacterium can be present or absent. Our results show that pH has a significant effect on MU growth with a greater effect at pH values close to 6.0. In addition, there is a strong interaction between pH and chitin as to the same pH bacterial growth is 10 times greater in the presence of medium with chitin. These results also suggest that pH too acidic, lower than 5.0 are unfavorable for MU growth.Finally, we looked at gene expression of different MU cultures from different experimental frameworks. Here, and by making use of a new RNA sequencing approach, we studied the genetic expression of MU in differents environments. We are especially interested in the expression of genes implicated in the metabolic pathways of mycolactone production, the peptide toxin responsible of ulcerations in human. Specific environmental contexts could lead to an over-expression of these genes by MU populations, thus pinpointing the fact that MU ecology and epidemiology could be (micro-) context-dependent having some pathological and clinical implications. Taken together, our results participate in a research allowing to better understand the key parameters of the ecological niche of MU, and beyond helping to identify the aquatic ecosystems favorable or not to the maintenance and development of this mycobacterium responsible for Buruli ulcer.

L’ulcère de Buruli est la troisième mycobactériose la plus prévalente dans le monde après la tuberculose et la lèpre. L’ulcère de Buruli sévit dans au moins 33 pays dont l’Afrique de l’Ouest qui présente la prévalence la plus élevée. Parmi ces pays dans lesquels l’ulcère de Buruli est rapporté, la Côte d’Ivoire dont nous sommes originaires présente la plus forte incidence de 36% déclarée à l’Organisation Mondiale de la Santé. L’ulcère de Buruli est causé par Mycobacterium ulcerans, une mycobactérie environnementale dont le réservoir et les sources de transmission à l’homme, ne sont pas élucidés. Notre revue de la littérature a porté sur les sources environnementales de cette mycobactérie en Afrique de l’Ouest. Sur cette base, nous avons réalisé une vaste campagne de prélèvements d’échantillons environnementaux en Côte d’Ivoire et détecté par PCR en temps réel M. ulcerans dans l’eau stagnante, le sol et les selles d’un mammifère herbivore Thryonomys swinderianus. Ensuite, nous avons prouvé expérimentalement que M. ulcerans pouvait survivre dans le sol pendant au moins quatre mois et que le sol était source d’infection expérimentale par M. ulcerans dans un modèle animal. Ces résultats suggèrent que, en Côte d’Ivoire, l’eau stagnante, le sol et cet animal pourraient jouer un rôle dans le cycle de vie de la bactérie. Dans le second travail, nous avons valorisé des plantes tropicales aquatiques par l’utilisation de leurs extraits dans le milieu de culture de M. ulcerans, mycobactérie à croissance lente pour accélérer sa croissance. Dans le troisième travail, nous avons montré l’efficacité in vitro et dans un modèle animal, du bleu de méthylène contre M. ulcerans. / Buruli ulcer is the third mycobacteriosis in the world after tuberculosis, leprosy. Buruli ulcer is widespread in at least 33 countries including West Africa which has the highest prevalence. Among the countries in which Buruli ulcer is reported, Ivory Coast which we come from has the highest incidence of 36% reported in the World Health Organization. Buruli ulcer is caused by Mycobacterium ulcerans, an environmental mycobacterium whose reservoir and source of transmission to humans, are not understood. Our review of the literature focused on environmental sources of this mycobacterium in West Africa, which converge stagnant aquatic environment. On this basis, we conducted an extensive campaign of environmental sampling in Ivory Coast and detected by real-time PCR M. ulcerans in stagnant water, soil and feces of an herbivorous mammal Thryonomys swinderianus. Then we experimentally proved that M. ulcerans could survive in the soil for at least four months. These results suggest that, in Ivory Coast, stagnant water, soil and animal could play a role in the life cycle of the bacterium. In the second work, we have upgraded aquatic tropical plants by the use of extracts in the culture medium of M. ulcerans, slow growing mycobacteria to accelerate its growth. In the third work, we proposed the methylene blue, less expensive, easy to access as an alternative treatment for Buruli ulcer. It is appropriate to resume the experiment on methylene blue by other teams of researchers and after reproducing our experimental data, suggest the topical use of purified, non-toxic methylene blue in human clinical.

Mycobacterium ulcerans is sweeping across sub-Saharan Africa, but little is known about the mode of transmission and its natural reservoirs. Since the only effective treatment is excision of the infection and surrounding tissue, early diagnosis and treatment is the only way to reduce the havoc associated with Buruli ulcer. Using data from a national case search survey conducted in Ghana during 2000 and suspected risk factors this study tests the hypothesized factors and probes the challenges of developing a spatial epidemiological regression model to explain Buruli ulcer prevalence in the southwestern region of Ghana representing 42 districts. Results suggest that prevalence is directly related to the degree of land cover classified as soil, elevation differential, and percent rural population of the area.

In the fields of development and public health, the decisions of the rural poor are often treated as simple, unanimous, and driven by cultural preconceptions and beliefs. This is particularly the case for sub-Saharan Africa, where a dehistoricizing tendency presupposes an ontological link between an African culture and its tendency to interpret the world through the lens of belief. Generally, household activities are not seen as the kinds of modes of objectifying social practice that are the outcome of complex historical struggles over representation, and pre-disposing cultural factors are presumed to be the key determinants of household behavior. The three papers that constitute this alternative-format, article-based dissertation interrogate these assumptions. Although they address diverse subjects (the rise of West African Pentecostalism; the logic of treatment-seeking behavior in Benin; credit and savings strategies in rural Mali), they share a methodological concern with close analysis of the complexity of household decision-making in the moment, study over time, and attention to local concerns in the context of larger social transformations. In both medical and economic contexts, this approach demonstrates not only that behavior is primarily determined by enabling factors, but that the cultural factors that do condition behavior can be understood as creative, rational, and instructive of larger concerns, rather than merely as an impediment to development goals.

Buruli ulcer (BU) is an environmental bacterium caused by Mycobacterium ulcerans. Modes of transmission and hosts of the disease remain unknown. The purposes of this study are to explore the environmental factors that are possibly explain the spatial distribution of BU, to predict BU cases by using the environmental factors, and to investigate the impact of land use and land cover change on the BU distribution. The study area covers the southwest portion of Ghana, 74 districts in 6 regions. The results show that the highest endemic areas occur in the center and expand to the southern portion of the study area. Statistically, the incidence rates of BU are positively correlated to the percentage of forest cover and inversely correlated to the percentages of grassland, soil, and urban areas in the study area. That is, forest is the most important environmental risk factor in this study. Model from zero-inflated Poisson regression is used in this paper to explain the impact of each land use and land cover type on the spatial distribution of BU. The results confirm that the changes of land use and land cover affect the spatial distribution of BU in the study area.

Buruli ulcer (BU), an infectious disease caused by Mycobacterium ulcerans, is the third most common mycobacterial disease after leprosy and tuberculosis and a WHO-defined neglected tropical disease. Despite years of research, the mode of transmission of BU remains unknown. This master’s thesis provides an integrated spatial analysis of disease dynamics in Ghana, West Africa, an area of comparatively high BU incidence. Within a case/matched control study design, environmental factors associated with BU infection and spatial behaviors are investigated to uncover possible links between individual daily activity spaces and terrains of risk across disturbed landscapes. This research relies upon archival and field-collected data and analyses conducted with geographical information systems (GIS).

Yes / Buruli ulcer is a neglected tropical disease of skin and subcutaneous tissue caused by infection with the pathogen Mycobacterium ulcerans. Many critical issues for disease control, such as understanding the mode of transmission and identifying source reservoirs of M. ulcerans, are still largely unknown. Here, we used genomics to reconstruct in detail the evolutionary trajectory and dynamics of M. ulcerans populations at a central African scale and at smaller geographical village scales. Whole-genome sequencing (WGS) data were analyzed from 179 M. ulcerans strains isolated from all Buruli ulcer foci in the Democratic Republic of the Congo, The Republic of Congo, and Angola that have ever yielded positive M. ulcerans cultures. We used both temporal associations and the study of the mycobacterial demographic history to estimate the contribution of humans as a reservoir in Buruli ulcer transmission. Our phylogeographic analysis revealed one almost exclusively predominant sublineage of M. ulcerans that arose in Central Africa and proliferated in its different regions of endemicity during the Age of Discovery. We observed how the best sampled endemic hot spot, the Songololo territory, became an area of endemicity while the region was being colonized by Belgium (1880s). We furthermore identified temporal parallels between the observed past population fluxes of M. ulcerans from the Songololo territory and the timing of health policy changes toward control of the Buruli ulcer epidemic in that region. These findings suggest that an intervention based on detecting and treating human cases in an area of endemicity might be sufficient to break disease transmission chains, irrespective of other reservoirs of the bacterium.

No / Since 2000, cases of the neglected tropical disease Buruli ulcer, caused by infection with Mycobacterium ulcerans, have increased 100-fold around Melbourne (population 4.4 million), the capital of Victoria, in temperate southeastern Australia. The reasons for this increase are unclear. Here, we used whole-genome sequence comparisons of 178 M. ulcerans isolates obtained primarily from human clinical specimens, spanning 70 years, to model the population dynamics of this pathogen from this region. Using phylogeographic and advanced Bayesian phylogenetic approaches, we found that there has been a migration of the pathogen from the east end of the state, beginning in the 1980s, 300 km west to the major human population center around Melbourne. This move was then followed by a significant increase in M. ulcerans population size. These analyses inform our thinking around Buruli ulcer transmission and control, indicating that M. ulcerans is introduced to a new environment and then expands, rather than it being from the awakening of a quiescent pathogen reservoir. / National Health and Medical Research Council of Australia (NHMRC), an NHMRC Senior Research Fellowship to T.P.S. (grant GNT1105525); and an NHMRC Practitioner Fellowship to B.P.H. (GNT1105905). A.H.B. was supported by an Australian Postgraduate Award Ph.D. scholarship.