Chronic cutaneous mycobacterial ulcers due to Mycobacterium ulcerans (Buruli ulcer): the first indigenous case report from Jordan and a literature review.
BACKGROUND
Buruli ulcer is the third most common mycobacterial infection worldwide. It is endemic in tropical, subtropical, and temperate climates. It causes devastating disease with morbidity and mortality. The treatment duration is long and the regimens considered are limited. Chronic cutaneous ulcers of mycobacterial etiology have been reported previously in Amman, but these were not associated with Mycobacterium ulcerans infection.


METHODS
The case patient's initial diagnosis was based on chronological and morphological features, combined with appropriate diagnostic tests. The skin features were assessed histopathologically. Skin testing was positive for acid-fast bacilli (AFB), and M. ulcerans was identified by DNA strip test (GenoType Mycobacterium CM/AS, Hain Lifescience), which is based on a PCR technique targeting a 23S rRNA gene region, followed by reverse hybridization and a line probe technology.


RESULTS
The skin mycobacterial infection was evaluated and verified as having a Mycobacterium marinum-M. ulcerans pattern in the GenoType CM assay. It was then counted as a pattern representing individual species and was resolved with the GenoType AS assay as having an M. ulcerans pattern. M. ulcerans DNA was isolated and amplified by PCR, and then detected against reverse hybridization probes in the strip assay.


CONCLUSIONS
An indigenous case of M. ulcerans (Buruli ulcer) is reported for the first time from Jordan and the surrounding region.
University of Jordan, School of Medicine and Al Khalidi Medical Center, 29 Adeeb Wahbeh St., Amman 11118, Jordan. Electronic address: jamalwadimd@gmail.com.
Jamal Wadi
JW
Al Ramahi
Laboratory Department, Jordan Hospital and Medical Center, Amman, Jordan.
Hassan
H
Annab
Surgical Department, Jordan Hospital and Medical Center, Amman, Jordan.
Mutaz
M
Al Karmi
Surgical Department, Jordan Hospital and Medical Center, Amman, Jordan.
Basel
B
Kirresh
Surgical Department, Jordan Hospital and Medical Center, Amman, Jordan.
Mahmoud
M
Wreikat
Internal Medicine Department, Jordan Hospital and Medical Center, Amman, Jordan.
Rami
R
Batarseh
Molecular and PCR Laboratory, Al Takhassusi Hospital, Amman, Jordan.
Muhannad
M
Yacoub
Internal Medicine Department, Jordan Hospital and Medical Center, Amman, Jordan.
Mais
M
Kaderi
D000368:Aged; D054312:Buruli Ulcer / Q000382:microbiology*; D005260:Female; D006801:Humans; D007597:Jordan; D019911:Mycobacterium ulcerans; D016133:Polymerase Chain Reaction; D017192:Skin Diseases, Bacterial / Q000382:microbiology*
Buruli ulcer; Cutaneous non-tuberculous ulcer; Mycobacterium ulcerans; Mycolactone-producing mycobacteria; Skin trauma