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Molecular Typing using PCR-RFLP Reveals Diversity of Environmental Mycobacteria Agent of Buruli Ulcer in Ivory Coast, Cote d’Ivoire (West Africa)

Quinet Gregoire1, 2, Kakou Ngazoa E Solange1, 3*, Aka Nguetta3, Vakou Sabine1, 3, Coulibaly Ngolo David13, Kouakou Helene13, Sylla Aboubacar1, Faye-Kette Hortense3, Aoussi Serge1 and Dosso Mireille1, 3

1Department of Technics and Technology, Platform of Molecular Biology, Pasteur Institute Abidjan, BP 490 Abidjan 01, Cote d’Ivoire

2Department of Biochemical Engineering, National Institute of the Applied Sciences, Toulouse, France

3Department of Bacteriology and Virology, Unit of Environmental Mycobacteria, Pasteur Institute Abidjan, BP 490 Abidjan 01, Côte d’Ivoire

*Corresponding Author:
ES Kakou Ngazoa
Institut Pasteur Abidjan, BP 490 Abidjan
Cote d’Ivoire
Tel: 225 08240453
E-mail: [email protected]

Received date: July 29, 2016; Accepted date: June 12, 2017; Published date: June 16, 2017

Citation: Gregoire Q, Solange KN, Nguetta A, Sabine V, David CN, Helene K, Aboubacar S, Hortense F, Serge A, Mireille D (2017) Molecular Typing using PCR-RFLP Reveals Diversity of Environmental Mycobacteria Agent of Buruli Ulcer in Lvory Coast, Cote d’Ivoire (West Africa). Intern Med 7:241. doi: 10.4172/2165-8048.1000241

Copyright: © 2017 Gregoire Q, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Buruli ulcer is a neglected skin disease caused by Mycobacterium ulcerans (MU), and affects 1000 people each year worldwide and particularly in African countries. Eradication of Buruli ulcer is difficult because of the lack of early diagnostic in rural endemic regions, and the unknown of the disease in national health care system. In the rural wetlands and marshes in Central and West Africa, children are most affected. MU belongs to environmental Mycolactone Producing Mycobacteria (MPMs) and presents high genetic diversity of the circulating strains. Diagnoses were applied by culture and genome detection by Polymerase Chain Reaction (PCR). The PCR became a gold method to confirm clinical and environmental samples for MU. The MIRU-VNTR method and the Restriction Fragment Length Polymorphism (RFLP) combined with MIRU-VNTR markers were used to discriminate Mycobacteria from different sources. The aim of this study was to investigate the molecular diversity of different mycobacteria sources, from environment, culture strains, and clinical samples by using combined MIRU-VNTRTyping and RFLP. A total of 26 samples (water, sediment, mycobacteria strains, and swab) from endemic sites were first confirmed by IS2404 or Ziehl-Neelsen staining. The samples were analyzed by PCR typing for 4 specific markers (MIRU-1, VNTR6, VNTR19, ST-1) and the amplicons were digested with MspI restriction endonuclease and separated by 3% agarose gel electrophoresis for PCR-RFLP analysis. Our results showed different amplification by VNTR-MIRU-typing. For environmental samples a low amplification was detected by 25% for PCR-MIRU-1. Culture strains and clinical samples had amplification rate of 35.7% and 62.5% respectively. ST-1 had the best amplified marker for culture strains by 71.4%, while clinical samples have good amplification rate by 62.5 % for all markers. PCR-RFLP-profiles of clinical samples were identical, while environmental and mycobacteria strains showed different PCR-RFLP-profiles. We have developed a PCR-RFLP sensitive, easier and inexpensive approach to confirm genotyping of nontuberculosis mycobacteria in endemic countries for environmental screening. We suggest mutation in repeat loci of VNTR-MIRU sequence and the adaptation of mycobacteria from environment to human. This study confirms the circulation of several genotypes of mycobacteria in Ivory Coast.


Genotyping; PCR-RFLP; Mycobacterium ulcerans; Buruli ulcer; Cote d’Ivoire


Environmental mycobacteria are responsible for many infections in humans. One of them, Mycobacterium ulcerans (MU), is the agent of a skin disease called Buruli ulcer (BU). BU infection is the third most important mycobacteria infection worldwide after Leprosis and Tuberculosis [1]. BU occurs in rural regions in West and Central Africa, Latin America, Australia and Asia [2,3]. Since 2009, over 1000 cases of BU have been reported in Côte d’Ivoire each year [4]. Several studies have demonstrated the evidence of environmental transmission of MU from environmental samples [5,6]. MU genomes have been detected in endemic sites in aquatic environment, like rivers, wetlands and stagnant water spots [7-14] and in small mammals [15,16]. MU is a slow growing mycobaterium and the first positive results appear between 6 to 12 weeks, after several culture transition in various media [17]. For a faster diagnosis of MU, molecular detection is gold standard [18-20]. The virulence gene of MU is coded for Mylolactone, a toxin responsible for the destruction of skin tissues [21]. Further genetic analyses have confirmed high genomic diversity of MU and other MPMs, by using Variable Number Tandem Repeat (VNTR) and Mycobacterial Interspersed Repetitive Units (MIRU) [22-25] has demonstrated the high specificity and sensitivity of several VNTRMIRU markers in clinical and environmental matrices.

Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis is a widely applied method to detect gene mutations, which allows distinguishing mutant-type and wild-type sequences via destructing or generating enzyme restriction sites through PCR and subsequent electrophoresis separation of differential fragments [26]. Compared to other methods, PCR-RFLP offers a simple operation, higher sensitivity and reproducibility, and no complex equipment requirements [27].

The objective of this study is to elucidate the genomic diversity of environmental Mycobacteria in several matrices, by using combined PCR-RFLP-method applied on four MIRU-VNTR markers.

Ethics Statement:

This work was carried out with the approval of the National Buruli Ulcer Control Program in Ivory Coast (PNLUB) and the CNR Buruli at Pasteur Institute no further permissions were required for the environmental sampling and clinical samples.

Materials and Methods


Clinical strains from suspected patients in different endemic sites (Daloa, Divo, Kong, Toumodi, Zouehele, Abidjan) were fresh collected from the National Buruli Control program (PNLUB) and transferred to the National Reference Center (CNR Buruli) in Pasteur Institute between September and November 2015. Two swabs were collected for each patient from ulcers. 500 mL environmental samples (water and sediment) were collected in 6 endemic villages in two points for each site between March and October 2015. The sites were located as follows: Adiopodoume 1 (latitude 5.339201; longitude -4.124042), Adiopodoume 2 (latitude 5.339079; longitude -4.12426), Adzope (latitude 6.107145; longitude -3.855350), Aghien (latitude 5.3887570; longitude -3.9954967), Bodo (latitude 5.916666; longitude -4.683332), Tiassale (latitude5. 904262; longitude -4.826142) (Table 1).

No Source Strains ID Geographic origin Date collection
1 Environmental Adios1 Adiopodoume 1 Sep-15
2 Environmental Adios1 Adiopodoume 1 Sep-15
3 Environmental Adios2 Adiopodoume 2 Sep-15
4 Environmental Adios2 Adiopodoume 2 Sep-15
5 culture Tias1  Tiassale Apr-15
6 culture Ad2 Adiopodoume 2 Apr-15
7 culture Ad3 Adzope May-15
8 culture Ag4 Agboville Jun-15
9 culture Adz5 Adzope Jul-15
10 culture Adz6 Adzope Aug-15
11 culture Adz7 Adzope Jun-14
12 culture Agh8 Aghien Jun-15
13 culture Agh9 Aghien Mar-15
14 culture B10 Bodo Jun-15
15 culture E1-N Adiopodoume 1 Oct-15
16 culture E1-L Adiopodoume 1 Oct-15
17 culture E1-G Adiopodoume 2 Oct-15
18 culture S2-L Adiopodoume 2 Oct-15
19 clinical 181UB15 Daloa Sep-15
20 clinical 226UB15 Divo Oct-15
21 clinical 235UB15 Abidjan Oct-15
22 clinical 236UB15 Tiassale Oct-15
23 clinical 249UB15 Zohouele Oct-15
24 clinical 277UB15 Kong Oct-15
25 clinical 287UB15 Daloa Oct-15
26 clinical 297UB15 Toumodi Oct-15

Table 1: Samples used in this study.

DNA extraction from environmental and clinical samples

The Mobio Powersoil Kit (MOBIO, USA) was used with minor modifications to extract DNA from water and sediment samples. Briefly, 400 μL of samples were added to 60 μL of lysis C1 solution, following by horizontally shaking with the Mobio Vortex and then centrifuged for 30 seconds, 10000 rpm at room temperature. After several incubation by washing and centrifugation, DNA was resuspended in 100 μL of elution buffer. DNA extraction from clinical samples were performed by alkaline heat shock following by ethanol precipitation [28]. The samples were suspended in 2 ml sterile water and centrifuged for 10 min, 15000 rpm at 4°C. 200 μL of pellet were performed in DNA extraction. Each sample was performed twice in DNA extraction. All DNA templates were eluted with 50 μL DNA/ Rnase fee H2O and stored at −20°C until use. Negative and positive extraction samples were applied to verify the presence of inhibitors in the samples.

Culture of mycobacteria from environmental samples

Cultures were performed at 22°C on 3 Lowenstein-Jensen (LJ) solid media: a simple LJ medium, a LJ medium supplemented with NaCl and LJ supplemented with Glycerol. All media were inoculated with 150 μL of inactivated samples. The samples were placed in the dark and in the light for 21 days. Each sample was performed twice in dark and in light incubation. Positive cultures were analyzes using Ziehl-Neelsen (ZN) staining test with microscopy for acid fast bacilli specific for mycobacteria [17].

MIRU-VNTR typing

5 μL of extracted DNA were added to 45 μL PCR-mix containing μM each specific primer for MIRU-1, ST-1, VNTR6, VNTR19, 0.2 mM dNTPs (Sigma, USA), 1X Flexi Taq-polymerase buffer, 1.5 mM MgCl2 and 1Unit Go-Flexi Taq-Polymerase (Promega, Germany). The PCR reaction was described in previous studies [11,28]. PCR were tested by the 1/10 dilution of DNA, to test the presence of PCR inhibitors in the samples. Negative control (sterile DNase/RNase-free water) and positive control (181UB15 genomic DNA) were included in all PCR runs for the test quality and the detection of decontamination. The PCR was running in a thermocycler (GenAmp 9700, Applied Biosystems, USA).


The analysis of MIRU-VNTR sequences of 4 markers was performed in the NCBI bank data, and analyzed with Geneious and RestrictionMapper 3.0 software (Geneious 8.1.7; http:// Restriction maps performed with various restriction enzymes were compared to find the best fitting enzyme in order to have the clearest specific profile after digestion. MspI was found to make better DNA profiles. The RFLP was applied with MspI amplified DNA from PCR reactions of MIRU-1, VNTR6, VNTR19 and ST-1.

The amplified DNAs from PCR were purified by using Qiaquick kit (Qiagen, Germany) with manufactor’s instructions. 5 μL purified PCR product sequence were added to 15 μL restriction digestion-Mix containing 1X enzyme buffer, 10μg/mL BSA and 0.1U/μL MspI (Promega, Germany). The reaction was incubated for 24 h at 37°C.

Electrophoresis of DNA amplified products

5 μL PCR-product were analyzed by electrophoresis in 1.5% Agarose gel, and migrated at 100 Volts. The size was estimated by comparison with a 100 bp ladder (Promega, Germany). For RFLP-product, 20 μL of digested with MspI PCR-product were analyzed by electrophoresis in 3% Agarose gel at 85 Volts.


Culture of mycobacteria

From 24 samples in culture, 62.5% (15/24) were positive and confirm by ZN staining specific for mycobacteria (Table 2). Water samples have the most positive cultures. All positive cultures were observed after 6 days, rapid growing mycobacteria, no slow-growing culture were positive from environmental samples. All positive mycobacteria were from endemic sites.

Genotyping by MIRU-VNTR

ST-1 was the most amplified locus by 57.4% (15/26) of the samples, while 42.3% (11/26), 30.8% (8/26) and 23.1% (6/26) for MIRU-1, VNTR6, and VNTR9 respectively (Table 2).

Variables PCR Analysis (bp size)
Samples ID Source Geographical origin MIRU-1 ST-1 VNTR 6 VNTR 19
Adios1 sediment Adiopodoume 1 - - - -
Adiow1 water Adiopodoume 1 - - - -
Adios2 sediment Adiopodoume 2 - - - -
Adiow2a water Adiopodoume 2 530 - - -
Total 1 (%)       1/4(25%) 0/4(0%) 0/4(0%) 0/4(0%)
Tias1     water Tiassale - - - -
Ad2b   water Adiopodoume 2 - 420 - -
Ad3    water Adzope 3 380 420 - -
Ag4     water Agboville - - - -
Adz5  water Adzope 3 - 420 - -
Adz6c  water Adzope 3 - 420 - 350
Adz7  water Adzope - - - -
Agh8      water Aghien - 420 - -
Agh9d      water Aghien - - 500 -
B10    water Bodo - 420 500 -
E1-N water Adiopodoume 1 380 420 - -
E1-L1e water Adiopodoume 1 380 420 - -
E1-G2e sediment Adiopodoume 1 530/380 420 - -
S2-L sediment Adiopodoume 2 530 420 - -
Total 2 (%)     5/14 (35.7%) 10/14 (71.4%) 2/14 (14.3%) 1/14 (7.1%)
181UB15 swab Daloa 530 420 500 350
226UB15 swab Divo - - 500 350
235UB15 swab Abidjan - 420 500 -
236UB15f swab Tiassale 530 420 500 350
249UB15 swab Zohouele - - - -
277UB15 swab Kong 530 420 500 350
287UB15 swab Daloa 530 420 500 350
297UB15 swab Toumodi 480/380 - - -
Total 3 (%)   5/8 (62.5%) 5/8    (62.5%) 6/8     (75%) 5/8    (62.5%)
Global (%) 11/26   (42.3%) 15/26     (57.7%) 8/26    (30.8%) 6/26   (23.1%)

Table 2: MIRU-VNTR typing of Mycobacteria from different matrices.

Adiow2a, Ad2b, Adz6c, Agh9d, E1-L1e, E1-G2e, 236UB15f were selected for RFLP-analysis.

By clinical samples from BU patients all genotyping markers were amplified MIRU-1, VNTR19, ST-1, by 62.5% (5/8), and by 75% (6/8) for VNTR6 (Table 2). MIRU-1 was detected in clinical samples with 3 profiles corresponding to one copy (380 bp), 3 copies (486 bp) and 5 copies (530 bp).

By environmental samples, only MIRU-1 was detected in water samples. In positive cultures of mycobacteria, ST-1 was most amplified by 71.4% (10/14) and by 35.7 % (5/14), 14.3 % (2/14), 7.1% (1/14), for MIRU-1, VNTR6 and VNTR19 respectively (Table 2).


From all including samples, only positive PCR-typing was analyzed in RFLP-Analyzing. We compared the digestion profile of the 500 bp or 380 bp of MIRU-1 from 3 matrices.

RFLP from MIRU-1 by clinical samples showed an identical profile with DNA bands of 205, 195, 160, 120, 90 and 30 bp (Figure 1). For environmental samples and culture 3 major bands by 185, 100, 50 bp or 205,185, 150, 45 bp were observed respectively (Figure 1). RFLP from ST-1 by clinical sample (236UB15), had an identical profile with DNA fragments 190, 90, 60, and 30 bp (Figure 2). For culture strain (Ad2), the RFLP showed 2 corresponding bands of 190 and 90 bp. No environmental sample has been analyzed in RFLP-method for ST-1.


Figure 1: PCR-RFLP analysis with MIRU-1 for clinical, culture and environmental samples. M: 100 bp DNA ladder. (A) PCRproduct of MIRU-1; 1: clinical sample (236UB15), 2-3: cultures samples (E1-G, E1-L); 4: environmental sample (Adiow2); (B) Digested with endonuclease MspI; 1a: clinical sample (236UB15); 2a-3a: culture samples (E1-G, E1-L); 4a: environmental sample (Adiow 2).


Figure 2: PCR-RFLP analysis with ST-1 for clinical and culture samples. M: 100 bp DNA ladder. (A) PCR-ST-1 product; 1: clinical sample (236UB15); 2: culture sample (Ad2); (B) Digested with endonuclease MspI; 1a: clinical sample (236UB15); 2a: culture sample (Ad2).

RFLP for VNTR6 showed an identical profile for clinical samples with different DNA bands with 190, 180 and 170 bp (Figure 3). For culture sample (Agh9), 3 DNA bands with 190, 90 and 50 bp were detected (Figure 3). No environmental sample was analyzed in RFLPmethod for VNTR6. The RFLP-VNTR19 detected 4 DNA bands (200, 190, 150, 50 bp) for clinical sample (236UB15), while in culture sample (Adz6), 5 bands were detected with different approximated size of 300, 250, 200, 110, 90, and 50 bp (Figure 4). No environmental sample was analyzed in RFLP-method for VNTR19.


Figure 3: PCR-RFLP-analysis with VNTR6 for clinical and culture samples. M: 100 bp DNA ladder. (A) PCR-VNTR6 product; 1: clinical sample (236UB15); 2: culture sample (Agh9); (B) Digested with endonuclease MspI; 1a: clinical sample (236UB15); 2a: culture sample (Agh9).


Figure 4: PCR-RFLP analysis with VNTR19 for clinical and culture samples. M: 100 bp DNA ladder. (A) PCR-VNTR19-product; 1: clinical sample (236UB15); 2: culture sample (Adz6); (B) Digested with endonuclease MspI; 1a: clinical sample (236UB15); 2a: culture sample (Adz6).


M. ulcerans , the agent of BU is endemic in Ivory Coast, and its epidemiology unknown. The evidence of environmental transmission of MU and MPMs from molecular studies were essential to discriminating clinical and environmental or their interaction. In this study, we have demonstrated that specific markers from mycobacteria were not detected in different samples in the environment and in clinical samples. The high amplification rate by PCR was detected for ST-1 by 57% for all samples. Our results were similar with the findings of Kakou et al. [28] for the polymorphism of MU for clinical samples in Ivory Coast. The authors have found the circulation of 2 clones in the same endemic sites and the high amplification rate of ST-1 by 85%. Previous studies have detected different genotypes and profiles of MU in West Africa [13]. In this study, the using of endonuclease enzyme MspI to confirm the DNA profiles of amplified PCR-VNTR has demonstrated that clinical and environmental samples have difference in genotyping’s markers.

We have detect only rapidly growing mycobacteria, in contrast of findings of Aboagye et al. [29], the have detected 60% of slow growing mycobacteria in Ghana. This could be explains by the use of another decontamination method in this study and the difficulties of the growth mycobacteria from environmental samples [29]. In Ivory Coast, molecular tests have confirm the BU incidence in the country [19] and reveals the diversity of circulating strains in humans in endemic sites, but the goal is to elucidate the correlation between all nontuberculosis mycobacteria in the environment involved in the incidence of BU in the country.

Recently, Ablordey et al. [30] have demonstrated using whole genome sequencing that two exotic genotypes were found in an endemic site in Ghana with highly restricted intra-strain genetic variation. Our finding shown the profiles difference between genotyping markers. MIRU-VNTR are variable repeat sequences with some new deletion or insertion in the repeat loci, we suggest the evidence of mutation in the MIRU-VNTR loci from the environment in human. This can been explain the difference in RFLP-method from clinical, culture or environmental matrices. VNTR-MIRU could be an adaptation genotyping marker of mycobacteria during infection from environment to human. The using of RFLP-method is consistent to detect low rate of gene mutations in cancer cells [31].

The high specificity and sensitivity of genotyping markers for MU and MPMs cannot be the evidence for detection in all matrices and in particular in endemic sites of MPMs. This study confirmed those VNTR profile variability between MU clinical strains in one hand, but also between environmental mycobacteria strains. The use of RFLP with MspI to confirm each amplified marker, gives better resolution of MIRU-VNTR-typing method. The RFLP-profiles confirm the difference in MIRU-VNTR markers. Chemlial et al. [32] has demonstrated the high diversity of MU strains by using RFLP with IS2404. IS2404 is located both in chromosome and in plasmid in MU and was abundant copies in mycobacteria. Our study is only focused on chromosome genome for all genotyping markers to elucidate the polymorphism of mycobacteria.


Buruli ulcer is endemic in Ivory Coast, and the need to control and understand the transmission from the environment to human is very important. We used molecular tools to elucidate the diversity of circulating strains in different matrices. Our results confirm the existence of polyclonal infection of BU in the high endemic country and the spread of several mycobacteria strains in the environment. We have developed first a PCR-RFLP sensitive, easier and inexpensive approach to confirm genotyping of nontuberculosis mycobacteria in endemic countries for environmental screening. In perspective, we will explore the whole genome sequencing for circulating strains in Ivory Coast.


We thank Rousseau Djaouka for critical review of the analysis methods and Miriam Eddyani for the providing of positive strains. Financial funding of RIIP (Institute Pasteur Network) for Gregoire Quinet.

Author Contributions

Conceived and designed the experiments: KNS, DM. Performed the experiments: GQ, VS, SA, HK, KS. Analyzed the data: GQ, KNS, VS. Contributed reagents/materials/analysis tools: AK, AS, CDD. Wrote the paper: KNS, GQ.


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