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Background  Buruli ulcer, caused by  Mycobacterium ulcerans , is a localized skin lesion that can progress to extensive ulceration and necrosis if left untreated. Unpublished studies of hydrated clays for therapeutic, topical treatment of Buruli ulcer suggest that specific clay mineral products may have beneficial effects on wound healing. In this study, we evaluated the  in vitro  antibacterial activity of a panel of clay mixtures and their derivative leachates against  M. ulcerans  and assessed the  in vivo  efficacy of topically-applied, hydrated clays on Buruli ulcer progression in mice infected with  M. ulcerans.Methods    M. ulcerans  1615 was incubated with 10 % suspensions of CB07, CB08, CB09, CB10, and BY07 clay mixtures, and survival was determined over 28 days. For animal experiments, we examined the effect of topical hydrated clay therapy on Buruli ulcer progression  in vivo  in mouse tails subcutaneously infected with  M. ulcerans  1615 .Results  The CB07, CB08, and CB09 clays exhibited bactericidal activity against  M. ulcerans  after 7, 14, 21, and 28 days of incubation. In contrast, clay leachates exhibited inhibitory, bacteriostatic effects on  M. ulcerans  growth  in vitro . After establishing an ulcerative  M. ulcerans  infection for three months, ulcerated regions of the tails were treated once daily (five consecutive days per week) for 22 days with hydrated CB09 clay poultices. Mice in the clay treatment group exhibited healing as assessed by gross morphological changes and a reduction in  M. ulcerans  present in the wounds.    Conclusions  These data reveal that specific clays exhibit  in vitro  bactericidal activity against  M. ulcerans  and that hydrated clay poultices may offer a complementary and integrative strategy for topically treating Buruli ulcer disease.

In vitro antibacterial activity and in vivo efficacy of hydrated clays on Mycobacterium ulcerans growth