||ycobacterium ulcerans disease (‘Buruli ulcer’, BU) is
the most common mycobacterial disease in humans
after tuberculosis (see Chapter 40) and leprosy (see
• M. ulcerans disease mainly affects children, and is stigmatizing,
disfiguring and disabling if not treated early.
• Sub-Saharan Africa carries the main burden of disease,
but it also occurs in Asia, the South Pacific and Latin
• Active early case detection and treatment are key to
• M. ulcerans disease can be treated effectively with antibiotics,
particularly when treated early.
• The potential development of drug resistance needs to
be carefully observed.
• In addition to specific treatment, patients require wound
care and, in advanced disease, skin grafting.
• Patients with advanced disease in particular require
nutritional and psychological support, physiotherapy
and reconstructive surgery.
• Sooner or later after the initiation of antimycobacterial
treatment, healing frequently stops or deteriorates for
some time (so-called ‘paradoxical reaction’). A major
challenge is to distinguish this from secondary bacterial
infections and specific treatment failure (which is rare).
• Prevention is limited since the modes of transmission
which could be targeted are still unclear.