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Buruli ulcers, named after a Ugandan district where an outbreak occurred years ago, are skin infections caused by Mycobacterium ulcerans. The organism produces the toxin mycolactone, the cytotoxic and immunosuppressive properties of which induce ulceration and necrosis. Buruli ulcers have been identified in about 30 tropical countries, including areas of Australia, but most cases arise in West Africa. Infections occur in areas with stagnant or slow-flowing water (considered the environmental source of the mycobacteria) and probably follow inoculation of organisms into the skin via direct trauma. Insects are a potential vector.
The lesions begin as painless nodules, papules, plaques, or areas of edema, most commonly on the limbs, that develop…