Section 17. Infectious Diseases >
Part 5. Bacterial Infections >
Chapter 272. Buruli Ulcer (Mycobacterium Ulcerans Infection)
Mycobacteriology and PathophysiologyWayne M. Meyers, Françoise Portaels, and Douglas S. Walsh
Topics Discussed: buruli ulcer; infectious diseases; mycobacterium ulcerans.
Sections: Complications, Prognosis, Prevention, References.
Excerpt:"MacCallum and associates in 1948 in Australia were the first
to isolate the etiologic agent in culture.38 M
ulcerans is strongly acid-fast, with an optimal growth
temperature of 30°C to 32°C on routine mycobacteriologic media such
as Löwenstein-Jensen medium. The organism is a slow grower,
often requiring several months' incubation to achieve isolation
in primary culture. Microaerophilic conditions promote the growth
of M ulcerans, and the organism is strikingly sensitive
to temperatures of 37°C or higher.39,40 After a
multitude of attempts to cultivate the organism from the environment
by many investigators over half a century, the first isolation of M
ulcerans from nature was reported in 2008.46 The
development of polymerase chain reaction (PCR) techniques for the
identification of M. ulcerans, facilitated detection
in the environment in Australia and West Africa.41-45In eFigure 272.5 a proposed classification
of most of the clinical forms of M ulcerans is provided.
World Health Organization (WHO) designations of the various forms of lesions
of M ulcerans infection include: (1) papules that are
painless, elevated, measure up to 1 cm in diameter, and ulcerate
early (seen only in Australia); (2) nodules that
are primarily subcutaneous and firm, measure approximately 2 cm in
diameter, and are painless, though often pruritic [the
initial stage in most African patients (eFig...."
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