SYMPOSIUM Complete Healing of a Laboratory-Confirmed Buruli Ulcer Lesion after Receiving Only Herbal Household Remedies

OnMarch 7, 2011, an 11-year-old boy from the town of Bankim in the Adamaoua Region of Cameroon—a known endemic focus of Buruli ulcer (BU) [1]—was accompanied by his father to the district hospital in Bankim. The patient presented with a BU lesion classified as Category II, according to the classifications of the World Health Organization (WHO). The partially ulcerated plaque lesion, which was approximately 14 x 6 cm in size, had undermined edges characteristic of BU (Fig 1A) [2,3]. Following clinical examination and sample collection for diagnosis, the patient’s family refused the standard WHO-recommended treatment for BU, which consists of daily rifampicin (10 mg/kg orally) and streptomycin (15mg/kg intramuscu-larly) for eight weeks [4], and the patient left the hospital. Wound exudates collected from the patient tested positive in theMycobacterium ulcerans-specific IS2404 quantitative polymerase chain reaction (qPCR) assay [5] with threshold cycle (Ct) values ranging from 20.0 to 28.6, indicating a high mycobacterial load. Swab exudates were also used for the initiation of aM. ulcerans primary culture on Löwenstein-Jensen medium, as previously described [6]. After 8.5 weeks of incubation at 30°C, mycobacterial growth was observed, and the cultured mycobacte-ria were reconfirmed asM. ulcerans by IS2404 colony PCR [6]. Whole genome sequencing o