Buruli ulcer (BU) is an emerging, neglected, infectious disease most often associated with poor, rural communities within developing nations. To date, the disease has been reported from at least 32 countries, with the highest frequency of new cases being reported from the West African nations of Cote D' Ivoire, Benin and Ghana. It is known that Mycobacterium ulcerans is the pathogen responsible for causing BU disease; however, researchers have yet to conclusively identify the extent of the pathogen's distribution in the environment, the reservoir(s) of the pathogen in nature, or the mode(s) of transmission to humans. It is widely accepted that BU disease is in some way related to exposure to freshwater environments, and furthermore, it has been suggested that human activities leading to environmental disturbance increase risk of BU infection. Aquatic macroinvertebrates have been implicated as both potential reservoirs and vectors M. ulcerans infection to humans; however, field-based ecological studies to investigate the role of macroinvertebrates in BU disease have not been conducted. The purpose of this study was to: 1) characterize and compare overall macroinvertebrate communities from aquatic environments in Ghana, West Africa: 2) identify macroinvertebrate community associations with the presence and absence of M. ulcerans in aquatic environments: and 3) identify potential relationships between specific macroinvertebrates and M. ulcerans. Results from this large survey of aquatic environments in Ghana suggest that macroinvertebrate communities and individual taxa may be useful sentinels for initial identification of pathogen presence or habitat conditions associated with disease agent transmission; however, further studies are needed to elucidate the exact role of macroinvertebrates as reservoirs of M. ulcerans and potential vectors of BU.
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