ulcerans Disease

Buruli ulcer, an ulcerating skin disease caused byMycobacterium ulcerans infection, is common in tropical areas of western Af-rica. We determined the clinical andmicrobiological responses to administration of rifampin and streptomycin for 2 weeks fol-lowed by administration of rifampin and clarithromycin for 6 weeks in 43 patients with small laboratory-confirmed Buruli le-sions andmonitored for recurrence-free healing. Bacterial load in tissue samples before and after treatment for 6 and 12 weeks was monitored by semiquantitative culture. The success rate was 93%, and there was no recurrence after a 12-month follow-up. Eight percent had a positive culture 4 weeks after antibiotic treatment, but their lesions went on to heal. The findings indicate that rifampin and clarithromycin can replace rifampin and streptomycin for the continuation phase after rifampin and strepto-mycin administration for 2 weeks without any apparent loss of efficacy. Buruli ulcer (BU) is an ulcerating skin disease caused by Myco-bacterium ulcerans infection that is common in tropical areas of western Africa, predominantly affecting children in the 5-to-15-year age group. The disease starts as a painless subcutaneous nodule or plaque and sometimes as a more aggressive edematous lesion. All these lesions ulcerate and enlarge progressively over the ensuing months. Until recently, the mainstay of treatment for Buruli ulcer was excision of lesions with a wide margin to ensur