[Mycobacterium ulcerans infection: epidemiological, clinical and therapeutical aspects]

Mycobacterium ulcerans causing Buruli ulcer is an environmental mycobacteria responsible for an infectious necrotizing panniculitis. The epidemiology of this disabling disease is strongly linked to the aquatic ecosystem. Occuring mainly in children, it is an emergent public health threat in many humid rural tropical areas. Human contamination probably follows a direct percutaneous route from humid environment, but some insects may play a role in transmission. The clinical features develop in three phases: pre-ulcer, ulcer with unstick margins, healing leading to functional sequelae. Treatment relies on antibiotics in order to sterilize the infectious focus, together with the surgical repair of lost skin and joint deformities, as well as early physiotherapy. Despite uncertainties of in vivo efficacy of antibiotics, it seems logical to administer chemotherapy with both Rifampicin and Aminoglycosid or Fluroquinolon and Aminoglycosid. Surgical treatment depends on the size of the ulcer, as well as available techniques and skills on the field. Wide excision and graft are often recommended, however limited excision followed by small islet grafts may be successful.