Mycobacterium ulcerans infection (Buruli ulcer): first reported case in a traveler

• Published in: The American journal of tropical medicine and hygiene Vol. 61; no. 5; p. 689
• Main Authors: Semret, M, Koromihis, G, MacLean, J D, Libman, M, Ward, B J
• Format: Journal Article
• Language: English
• Published: United States 01-11-1999
• Subjects: Adult; Africa; Anti-Bacterial Agents - therapeutic use; Antibiotics, Antitubercular - therapeutic use; Antitubercular Agents - therapeutic use; Ciprofloxacin - therapeutic use; Clarithromycin - therapeutic use; Cloxacillin - therapeutic use; Ethambutol - therapeutic use; Humans; Leg Ulcer - diagnosis; Leg Ulcer - drug therapy; Leg Ulcer - microbiology; Male; Metronidazole - therapeutic use; Mycobacterium Infections, Nontuberculous - diagnosis; Mycobacterium Infections, Nontuberculous - drug therapy; Mycobacterium ulcerans - drug effects; Mycobacterium ulcerans - isolation & purification; Mycobacterium ulcerans - pathogenicity; Penicillins - therapeutic use; Rifampin - therapeutic use; Skin Diseases, Bacterial - diagnosis; Skin Diseases, Bacterial - drug therapy; Skin Diseases, Bacterial - microbiology; Skin Transplantation; Travel; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Virulence; Africa
• DOI: 10.4269/ajtmh.1999.61.689
• ISSN: 0002-9637

A chronic, painless sore developed over a 2-month period on the left calf of a Canadian man traveling for 8 months in Africa. A presumptive diagnosis of a Mycobacterium spp. infection was made despite initially negative biopsy and culture results, after failure of several courses of anti-bacterial antibiotics. Mycobacterium ulcerans was eventually isolated and the lesion progressed despite treatment with multiple anti-mycobacterial agents. The lesion finally responded to wide and repeated excision, aggressive treatment with anti-mycobacterial antibiotics, and split-thickness skin grafting. The isolation and treatment of this unusual organism are discussed.