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A cutaneous infection caused by Mycobacterium ulcerans received its common name, Buruli ulcer, after the county in Uganda where the first large epidemic occurred in 1961. The organism grows best at 32ºC (89.6ºF), which explains its predilection for skin. It elaborates toxic macrolides that cause tissue necrosis. Present in tropical wetlands with slow-flowing or stagnant water, especially in West Africa, the mycobacterium infects humans through traumatic inoculation into the skin, sometimes perhaps via aquatic insect bites. The incubation period is probably 2 to 3 months, and the first sign may be a papule, nodule, or edema that gradually ulcerates and enlarges, although spontaneous healing sometimes may occur.
Extensive surgical excision is …