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Treatment and prevention of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: guideline update

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Buruli ulcer (BU) is a neglected tropical disease that is increasingly common in Australia and has become an important public health issue in rural sub-Saharan Africa in the past 30 years.1 BU is a slowly progressive destructive infection of skin and of adipose and soft tissue caused by Mycobacterium ulcerans, an environmental pathogen that produces a potent toxin.2 It is because of progressive destruction of subcutaneous tissue that the characteristic ulcer becomes widely undermined. BU only occurs in specific endemic areas, particularly coastal Victoria, where the disease is known locally as Bairnsdale ulcer.3 The second major Australian focus is a small region between Mossman and just beyond the Daintree River, north of Cairns, Queensland (Daintree ulcer).4,5 Occasional cases also occur on the Capricorn coast of southern Queensland6 and in the Northern Territory.7 Typically, 0–5 cases per year occur in the Daintree region but, in 2011–2012, there was a major outbreak, with at least 75 cases identified. In Victoria, 157 cases occurred…