Buruli ulcer: <i>Mycobacterium ulcerans</i> infection

Wayne M. Meyers and Françoise Portaels

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

ISBN: 9780199204854
Published online May 2012 | e-ISBN: 9780199570973 | DOI:

Series: Oxford Textbooks

Buruli ulcer: Mycobacterium ulcerans infection

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  • Medical Microbiology and Virology
  • Infectious Diseases


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Buruli ulcer is caused by Mycobacterium ulcerans, which secretes a cytotoxic and immunosuppressive toxin, mycolactone. The disease is characterized by necrosis of skin, subcutaneous tissue, and bone, and is re-emerging as a potentially disabling affliction of inhabitants of tropical wetlands. Major foci are in West and Central Africa, but there are minor endemic foci in Australia, Mexico, South America, and South-East Asia. It is not contagious; environmental sources include water, vegetation, and insects, with humans probably becoming infected by traumatic introduction of the bacillus into the skin from the overlying M. ulcerans-contaminated surface in most instances. Clinical presentation may be as a cutaneous nodule, undermined ulcer, plaque or widely disseminated oedematous lesion. Clinical diagnosis is often accurate, but smears for acid fast bacilli, culture, polymerase chain reaction (PCR) assays, and histopathology are confirmatory. Treatment was formerly by wide surgical excision and skin grafting, but antibiotics (rifampicin with streptomycin) have now been found effective; the best treatment approach remains to be clarified.

Chapter.  1823 words.  Illustrated.

Subjects: Medical Microbiology and Virology ; Infectious Diseases

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