title: Mycobacterium ulcerans disease.
abstract: Mycobacterium ulcerans disease (Buruli ulcer) is an important health problem in several west African countries. It is prevalent in scattered foci around the world, predominantly in riverine areas with a humid, hot climate. We review the epidemiology, bacteriology, transmission, immunology, pathology, diagnosis and treatment of infections. M. ulcerans is an ubiquitous micro-organism and is harboured by fish, snails, and water insects. The mode of transmission is unknown. Lesions are most common on exposed parts of the body, particularly on the limbs. Spontaneous healing may occur. Many patients in endemic areas present late with advanced, severe lesions. BCG vaccination yields a limited, relatively short-lived, immune protection. Recommended treatment consists of surgical debridement, followed by skin grafting if necessary. Many patients have functional limitations after healing. Better understanding of disease transmission and pathogenesis is needed for improved control and prevention of Buruli ulcer.
authors.affiliation: Department of Medicine, University Medical Centre Groningen, University of Groningen, the Netherlands. t.s.van.der.werf@int.umcg.nl
authors.forename: Tjip S
authors.initials: TS
authors.lastname: van der Werf
authors.forename: Ymkje
authors.initials: Y
authors.lastname: Stienstra
authors.forename: R Christian
authors.initials: RC
authors.lastname: Johnson
authors.forename: Richard
authors.initials: R
authors.lastname: Phillips
authors.forename: Ohene
authors.initials: O
authors.lastname: Adjei
authors.forename: Bernhard
authors.initials: B
authors.lastname: Fleischer
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wansbrough-Jones
authors.forename: Paul D R
authors.initials: PD
authors.lastname: Johnson
authors.forename: Françoise
authors.initials: F
authors.lastname: Portaels
authors.forename: Winette T A
authors.initials: WT
authors.lastname: van der Graaf
authors.forename: Kingsley
authors.initials: K
authors.lastname: Asiedu
mesh_terms: D000354:Africa, Western; D006801:Humans; D015201:Meta-Analysis as Topic; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000628:therapy / Q000635:transmission; D019911:Mycobacterium ulcerans / Q000472:pathogenicity*