Bulletin of the World Health Organization

Mycobacterium ulcerans disease

Tjip S. van der Werf, Ymkje Stienstra, R. Christian Johnson, Richard Phillips, Ohene Adjei, Bernhard Fleischer, Mark H. Wansbrough-Jones, Paul D.R. Johnson, Françoise Portaels, Winette T.A. van der Graaf, & Kingsley Asiedu


Mycobacterium ulcerans disease (Buruli ulcer) is an important health problem in several west African countries. It is prevalent in scattered foci around the world, predominantly in riverine areas with a humid, hot climate. We review the epidemiology, bacteriology, transmission, immunology, pathology, diagnosis and treatment of infections. M. ulcerans is an ubiquitous micro-organism and is harboured by fish, snails, and water insects. The mode of transmission is unknown. Lesions are most common on exposed parts of the body, particularly on the limbs. Spontaneous healing may occur. Many patients in endemic areas present late with advanced, severe lesions. BCG vaccination yields a limited, relatively short-lived, immune protection. recommended treatment consists of surgical debridement, followed by skin grafting if necessary. Many patients have functional limitations after healing. Better understanding of disease transmission and pathogenesis is needed for improved control and prevention of Buruli ulcer.