Open AccessNineteen Cases of Buruli Ulcer Diagnosed in Japan from 1980 to 2010
Author(s) -
Kazue Nakanaga,
Yoshihiko Hoshino,
Rie Roselyne Yotsu,
Masahiko Makino,
Norihisa Ishii
Publication year - 2011
Publication title -
journal of clinical microbiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.349
H-Index - 255
eISSN - 1070-633X
pISSN - 0095-1137
DOI - 10.1128/jcm.00783-11
Subject(s) - mycobacterium ulcerans , buruli ulcer , rpob , mycobacterium marinum , etiology , dermatology , biology , rifampicin , 16s ribosomal rna , scabies , skin ulcer , antibiotics , medicine , mycobacterium , microbiology and biotechnology , bacteria , disease , genetics
The etiology, clinical manifestations, and treatment of 19 sporadic cases of Buruli ulcer (BU) in Japan are described. The cases originated in different regions of Honshu Island, with no evidence of patient contact with an aquatic environment. The majority (73.7%) of cases occurred in females, with an average age of 39.1 years for females and 56.8 years for males. All patients developed ulcers on exposed areas of the skin (e.g., face, extremities). Most ulcers were <5 cm in diameter (category I), except in one severe progressive case (category II). Pain was absent in 10 of the 19 cases. Fourteen ulcers were surgically excised, and nine patients needed skin grafting. All cases were treated with various antibiotic regimens, with no reported recurrences as of March 2011.Mycobacterium ulcerans -specific IS2404 was detected in all cases. Ten isolates had identical 16S rRNA gene sequences, which were similar to those ofM. ulcerans . However, therpoB gene showed a closer resemblance toMycobacterium marinum orMycobacterium pseudoshottsii . PCR identified pMUM001 in all isolates but failed to detect one marker. DNA-DNA hybridization misidentified all isolates asM. marinum . The drug susceptibility profile of the isolates also differed from that ofM. ulcerans . Sequence analysis revealed “Mycobacterium ulcerans subsp.shinshuense ” as the etiologic agent of BU in Japan. Clinical manifestations were comparable to those ofM. ulcerans but differed as follows: (i) cases were not concentrated in a particular area; (ii) there was no suspected connection to an aquatic environment; (iii) drug susceptibility was different; and (iv) bacteriological features were different.