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Rudolph's PediatricsRudolph's Pediatrics

Section 17. Infectious Diseases > 

Part 5. Bacterial Infections > 

Chapter 272. Buruli Ulcer (Mycobacterium Ulcerans Infection)

Mycobacteriology and Pathophysiology

Wayne 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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