Shift in the skin microbiome among individuals presenting with filarial lymphedema compared to non-filarial healthy individuals in Ghana

Background: Lymphatic filariasis (LF) is a debilitating neglected tropical disease that remains a major public challenge in endemic countries. In addition to providing mass drugs administration (ivermectin, albendazole and diethylcarbamazine) to reduce parasite burden in endemic communities, there is also a need to mitigate the challenges associated with lymphedema progression. Filarial lymphedema is known to be complicated by secondary bacterial infections; however, this is yet to receive considerable attention in LF-endemic communities in rural Ghana. Thus, the focus of this study was to understand the skin microbiome of individuals presenting with filarial lymphedema over a period. Methods: This longitudinal study employed culture and Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) to characterize the microbiota of filarial lymphedema lesions over 24 months follow-ups and considered how different it is from the skin bacterial composition of non-filarial individuals described previously in literature. Results: The result reveals that filarial lymphedema lesions had four main phyla: Firmicutes (69.7%), Proteobacteria (16.6%), Actinobacteria (13.3%), and Bacteroidetes (0.3%). Firmicutes presented the highest abundance. There were observable differences in the distribution of Firmicutes, Proteobacteria, Bacteroidetes, and Actinobacteria, with the Firmicutes and Proteobacteria phyla enriched while the Bacteroidetes and Actinobacteria were markedly diminished in the filarial lymphedema lesions, relative to healthy skin. Propionibacterium and Corynebacterium, which are usually resident and abundant in healthy skin, were underrepresented in the skin from lymphedema lesions. Most of the taxa found in the skin from lymphedema lesions are not the typical organisms in human skin instead they were potentially pathogenic, with the Streptococcus, Acinetobacter, Klebsiella, Pseudomonas, Bacillus, Corynebacterium, Micrococcus, Enterococcus, Proteus and Staphylococcus genera being topmost isolates. Conclusion: Our data revealed a significant shift of the bacterial population with the introduction of potentially pathogenic bacteria to compete with the healthy skin resident microbiota during LF infection.