Abstract
Buruli ulcer is a neglected emerging infectious disease that results in a slowly progressive, destructive infection of soft tissue. It is a result of infection with Mycobacterium ulcerans. Cases have been reported in more than 30 countries with the main burden of disease occurring in West and sub-Saharan Africa. Left untreated, infections can lead to significant scarring and disability.M. ulcerans infection is probably acquired via inoculation of the skin through direct or indirect contact with the environment, although the environmental reservoir and exact route of transmission are not completely understood. There is circumstantial evidence that biting insects including mosquitoes may play a role in transmission.Diagnosis is made on the basis of a typical clinical presentation, with a slowly progressive, destructive, and painless ulcer or plaque with a notable lack of an inflammatory response, both clinically and on histology. Mycobacterial culture and polymerase chain reaction (PCR) can both help confirm the diagnosis. PCR on swabs, fine needle aspirate, or tissue biopsy material is the recommended definitive test as it is both sensitive and specific.In recent years, the approach to therapy has shifted from aggressive surgical resection alone to a greater focus on antibiotic therapy, with more conservative surgery, which sometimes needs to be repeated to obtain the best outcomes for patients.