Mycobacterium ulcerans infection results in a debilitating disease that is characterised by extensive and severe destruction of the skin and subcutaneous tissue. Adewale Oke and colleagues report on a study that aimed to identify cases of so-called Buruli ulcer in five states of south-west Nigeria.
Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a necrotising disease of the skin occurring in tropical and subtropical regions of the world. It has been reported in over 33 countries in tropical and sub-tropical regions of the world particularly in Africa, Asia, Australia, South America and the Pacific. It is most prevalent in Central and West Africa, the latter being regarded as the epicentre of the disease, and is one of the world’s neglected tropical diseases.1
Mycolactone, a macrocyclic polyketide toxin (which is cytotoxic and immunosuppressive in nature), produced by the causative pathogen is responsible for the characteristic chronic necrosis of tissue and skin, usually with undermined edges.
Mycobacterium ulcerans is closely related to the mycobacteria that cause tuberculosis and leprosy. Buruli ulcer is the third most common mycobacteriosis in immunocompetent humans after tuberculosis and leprosy, but in some communities in West Africa it has overtaken both tuberculosis and leprosy to become the most common.2 While the mode of transmission of M. ulcerans is poorly understood, awareness of the disease among the population and healthcare professionals is equally poor, thus making diagnosis a challenging exercise.
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