{
  "abstract": "Background Understanding the spatial distribution of skin neglected tropical diseases (NTDs) is paramount for surveillance and control strategies, although little is known regarding their natural origin, ecology, and distribution. This study aims to determine how natural and anthropogenic factors affect local to global spatial distribution patterns of a major skin NTD, Buruli ulcer (BU), and its pathogen, Mycobacterium ulcerans (MU). Methods Generalized linear modelling of 110 variables grouped into five categories (i.e., physical, edaphic/climatic, animal diversity, plant diversity, and socio-demographic/ geographic) were used to estimate continental-scale patterns of both MU and BU cases in Africa. Spatial models allowed the production of BU and MU maps for tropical and subtropical zones worldwide.\n\nResults Natural factors and their interactions consistently influence MU and BU distributions in Africa, with these distributions also responding to anthropogenic factors such as invasive plant species, agriculture and other activities. BU case distribution was driven by sunlight radiation, especially UV-B seasonality. Our extrapolation maps provide a quantitative understanding of the potential distribution of this pathogen and associated BU disease burden. Discussion Our findings highlight the utility of a disease ecology perspective using largescale spatial data for understanding drivers of skin NTDs. Complex interactions between natural and anthropogenic factors indicate that developing preventive and control measures is challenging. Particular attention is needed on the role of invasive plant species in the spread of these pathogens, and the complex influence of sun exposure on skin NTDs.\n\nSkin-related neglected tropical diseases (skin NTDs), including leprosy, cutaneous leishmaniasis, yaws (or pian, pinta, bejel), and Buruli ulcer, impact humans through stigma and social exclusion 1 . Globally, skin NTDs are the fourth leading cause of human disease and 18th for disabilityadjusted life years (DALY) 2 . Common features among multiple skin NTDs highlight the utility of shared care strategies 3,4 . Such an approach is relatively new, and draws on older paradigms, which is different from current diseasespecific approaches, of pathocoenosis (stipulating that diseases do not occur in isolation but through dynamic interactions with environmental, social, and cultural factors) and can benefit from an ecosystem-based framework 5 . The 78th World Health Assembly recently adopted the resolution \"Skin Diseases as a Global Public Health Priority\" 6 , highlighting the growing recognition of the importance of integrating skin NTDs into global health agendas.\n\nConsiderable research has addressed drivers responsible for emerging infectious diseases (EIDs) through the adoption of a disease ecology and",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "name": "Alisa Aliaga-Samanez"
    },
    {
      "name": "Marina Cobos-Mayo"
    },
    {
      "name": "Christine Chevillon"
    },
    {
      "name": "Magdalene Dogbe"
    },
    {
      "name": "Kayla M Fast"
    },
    {
      "name": "Matthew E Scott"
    },
    {
      "name": "Kelly Waters"
    },
    {
      "name": "Joseph P Receveur"
    },
    {
      "name": "Jennifer L Pechal"
    },
    {
      "name": "Michael W Sandel"
    },
    {
      "name": "Heather R Jordan"
    },
    {
      "name": "M Eric Benbow"
    },
    {
      "name": "Jean-François Guégan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8fphbcjtc2zdv.bib",
  "cited_by": 2,
  "doi": "10.1038/s43856-026-01692-6",
  "fulltext_url": null,
  "id": "8fphbcjtc2zdv",
  "issns": [
    "2730-664X"
  ],
  "landing_url": "https://hal.umontpellier.fr/hal-05850143v1",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "openalex",
      "2713|Mycobacterium research and diagnosis"
    ]
  ],
  "openalex": "W7163584058",
  "pdf_url": "https://hal.umontpellier.fr/hal-05850143/document",
  "pmcid": null,
  "pmid": null,
  "published": "2026-06-04",
  "publisher": "Nature",
  "ris": "https://research.draconitic.com/paper/8fphbcjtc2zdv.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T12:20:52Z",
      "native_id": "hal-05850143",
      "source": "hal",
      "url": "https://hal.umontpellier.fr/hal-05850143v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Mycobacterium research and diagnosis",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Human-induced pressures and environmental factors drive the distribution of neglected tropical disease Buruli ulcer",
  "title_text": "Human-induced pressures and environmental factors drive the distribution of neglected tropical disease Buruli ulcer",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:12Z",
  "url": "https://research.draconitic.com/paper/8fphbcjtc2zdv",
  "venue": "Communications Medicine",
  "versions": []
}