A Genotypic Approach for Detection, Identification, and Characterization of Drug Resistance in Mycobacterium ulcerans in Clinical Samples and Isolates from Ghana

Standardized antimycobacterial therapy is considered the treatment of choice for Buruli ulcer disease To assess the prevalence of drug resistance among clinical Mycobacterium ulcer-ems isolates in Ghana we conducted a sequence based approach to detect mutations associated with drug resistance We subjected clinical samples to direct DNA sequencing of rpoB and rpsL genes and compared culture and whole genome extracts regarding the efficiency of sequence analysis, 99 1% (rpoB) and 100% (rpsL) of the patients harbored M ulcerans wild type In one isolate (0 9%) a point mutation of the rpoB gene at codon Ser522 leading to an amino acid change was detected Culture, extracts yielded a significantly higher sequencing efficiency than whole genome extracts Our data suggest a low level of drug resistance in Ghana However mutations associated with drug resistance do occur and require monitoring Improved techniques are necessary to enhance the efficiency of sequence analysis of whole genome extracts