title: Histopathologic features of Mycobacterium ulcerans infection.
abstract: Because of the emergence of Buruli ulcer disease, the World Health Organization launched a Global Buruli Ulcer Initiative in 1998. This indolent skin infection is caused by Mycobacterium ulcerans. During a study of risk factors for the disease in Ghana, adequate excisional skin-biopsy specimens were obtained from 124 clinically suspicious lesions. Buruli ulcer disease was diagnosed in 78 lesions since acid-fast bacilli (AFB) were found by histopathologic examination. Lesions with other diagnoses included filariasis (3 cases), zygomycosis (2 cases), ulcerative squamous cell carcinomas (2 cases), keratin cyst (1 case), and lymph node (1 case). Thirty-seven specimens that did not show AFB were considered suspected Buruli ulcer disease cases. Necrosis of subcutaneous tissues and dermal collagen were found more frequently in AFB-positive specimens compared with specimens from suspected case-patients (p<0.001). Defining histologic criteria for a diagnosis of Buruli ulcer disease is of clinical and public health importance since it would allow earlier treatment, leading to less deforming sequelae.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jguarner@cdc.gov
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: Jeanine
authors.initials: J
authors.lastname: Bartlett
authors.forename: Ellen A Spotts
authors.initials: EA
authors.lastname: Whitney
authors.forename: Pratima L
authors.initials: PL
authors.lastname: Raghunathan
authors.forename: Ymkje
authors.initials: Y
authors.lastname: Stienstra
authors.forename: Kwame
authors.initials: K
authors.lastname: Asamoa
authors.forename: Samuel
authors.initials: S
authors.lastname: Etuaful
authors.forename: Erasmus
authors.initials: E
authors.lastname: Klutse
authors.forename: Eric
authors.initials: E
authors.lastname: Quarshie
authors.forename: Tjip S
authors.initials: TS
authors.lastname: van der Werf
authors.forename: Winette T A
authors.initials: WT
authors.lastname: van der Graaf
authors.forename: C Harold
authors.initials: CH
authors.lastname: King
authors.forename: David A
authors.initials: DA
authors.lastname: Ashford
mesh_terms: D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D006801:Humans; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D019911:Mycobacterium ulcerans / Q000302:isolation & purification*; D009336:Necrosis; D016133:Polymerase Chain Reaction / Q000379:methods; D012867:Skin / Q000473:pathology; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D012883:Skin Ulcer / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology*; D013194:Staining and Labeling
chemical_list: D004269:DNA, Bacterial