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Mycobacterium ulcerans infection, the "Buruli ulcer or "Bairnsdale ulcer" is an infectious disease which was first described in 1948 from the Bairnsdale district in south-east Australia. The disease was well known in Africa before this time but the mycobacterium had never been identified. [(James Augustus Grant)] in his book "A Walk across Africa" describes how his leg became grossly swollen and stiff with later a copious discharge. This was almost certainly the severe oedematous form of the disease, and his is the first known description of the infection. The infection occurs in well defined areas throughout the world, mostly tropical areas - in several areas in Australia, in Uganda, in several countries in West Africa, in Central and South America, in south-east Asia and New Guinea. The name "Buruli Ulcer" comes from an area in Uganda where the disease was once most prevalent. In East Africa thousands of cases occur annually and in these areas the disease has displaced leprosy to become the second most important mycobacterial disease of man (after tuberculosis). The mycobacterium has been identified in stagnant or slowly moving water sources in endemic areas and in aquatic insects (Naucoridiae). Transmission to man may be by means of insects or by a contaminated aerosol generated from decaying vegetation in the water source. Infection in Australia has occurred in an alpaca, in koalas, possums and other marsupials. The infection in most instances presents as a subcutaneous nodule, which is characteristically painless. In southern Australia the presentation is more often as a papule (or pimple), which is in the skin (dermis) rather than subcutaneous (beneath the skin). The infection is mostly on the limbs, most often on exposed areas but not on the hands or feet. In children all areas may be involved, including the face or abdomen. A more severe form of infection produces diffuse swelling of a limb, which, unlike the papule or nodule, can be painful and accompanied by fever. Infection may frequently follow trauma, often minor trauma such as a small scratch. The disease is primarily an infection of subcutaneous fat, resulting in a focus of necrotic (dead) fat containing myriads of the mycobacteria in characteristic spherules formed within the dead fat cells. Skin ulceration is a secondary event. The mycobacterium produces a toxin, named mycolactone, which causes this fat necrosis and inhibits an immune response. Healing may occur spontaneously but more often the disease is slowly progressive with further ulceration, granulation, scarring, and contractures. Secondary infection may occur with other nodules developing and infection may occur into bone. Although seldom fatal the disease may result in considerable morbidity and hideous deformities. Treatment is primarily by surgical excision of the lesion, which may be only a minor operation and very successful if undertaken early. Advanced disease may require prolonged treatment with extensive skin grafting. Presently available antibiotics are not effective in the primary treatment of the disease but may help to prevent recurrence after surgery. The disease is more likely to occur where there have been environmental changes such as the development of water storages, sand mining and irrigation. It is a major health problem in many countries in West Africa.
It's clear that two articles refer to the same thing. I'd have gone ahead and just did merge except the Mycobacterium ulcerans article contains a lot of medical terminology that I am not familiar with so I don't feel very qualified to make the merge. -- Whpq 18:20, 8 March 2007 (UTC)
- I don't agree that the articles should be merged. There seems to be an article for every known actinobacterium, although most are just stubs. Now I'm not an expert, but I guess that not every actinobacterium causes a disease in humans, so it would be wrong to have an article for the bacteria that don't cause a notable disease, but only a redirect for those that do. There's precedent for keeping both: see Mycobacterium leprae and leprosy or Mycobacterium tuberculosis and tuberculosis. Having said that, much of the content of the M. ulcerans article does need moving into this one, as it spreads considerably into the realm of the disease it causes. What do you think? --Smalljim 10:00, 24 March 2007 (UTC)
Some changes should be made in the description of the symptoms.
I believe the ulcerated form is more found than the nodule. Although a nodule might occur more often and frequently before developing into an ulcer, patients in African countries tend to wait to seek health care until the disease has developed into the ulcerated stage, thus (over)representing more ulcers.
Also, the infection can occur on hands or feet, so 'rarely' should be inserted in that sentence.
More importantly, about the physical trauma that seems to occur before infection. There is no proof at all for this! It is suspected that minor trauma or insect bites could introduce the mycobacterium into the skin, but there is no solid proof yet. This should be adjusted in the text.
"In East Africa, thousands of cases occur annually and in these areas the disease has displaced leprosy to become the second most important mycobacterial disease of man (after tuberculosis)." OK, first of all, there is no cited reference for this statement. Secondly, the article and its accompanying map both focus on West Africa, and I believe the author intended to say West, but typed East. Similarly, the article only mentions the temperate South of Australia, whereas the North is tropical. I have deleted the quoted sentence above.--184.108.40.206 (talk) 17:17, 29 September 2016 (UTC)