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Risk factors for recurrent Mycobacterium ulcerans disease after exclusive surgical treatment in an Australian cohort

Mycobacterium ulcerans causes necrotising lesions of skin and soft tissue. The major disease burden is found in tropical climates, mainly in Africa, but cases have been reported from 33 countries worldwide.1 It is endemic in both the temperate south-eastern region and tropical areas of north-eastern Australia, where cases have recently been increasing.2

Traditionally, wide surgical excision of lesions was the recommended treatment for M. ulcerans disease, as antibiotics were felt to be ineffective.3,4 However, recurrences are common with surgical treatment alone, occurring in 16%–30% of cases,58 and patients often require multiple operations, resulting in significant morbidity, time in hospital6,9 and cost to achieve cure.10 Recently, antibiotics have been shown to be highly effective in sterilising lesions…