Buruli ulcer in West Africa: Strategies for early detection and treatment in the antibiotic era

Buruli ulcer (BU), caused by Mycobacterium ulcerans infection, has become one of the most rapidly emerging diseases in West Africa in recent decades. Until recently, the definitive treatment involved wide surgical excision. Recent data suggest that antibiotic therapy with rifampin and streptomycin may reduce the extent or prevent excision when initiated during the early phases of the disease. New strategies for BU control are needed, emphasizing early detection and increasing public awareness about the disease and treatment. Here we review current knowledge about BU and examine clinical, public health and anthropological research in the context of this new treatment paradigm to identify potential strategies for more effective control of this disease.