Mycobacterium ulcerans disease, Peru

Abstract

Eight adult patients (ages 18-58, 5 women) with Buruli ulcer (BU) confirmed by at least 2 diagnostic methods were seen in a 10-year period. Attempts to culture Mycobacterium ulcerans failed. Five patients came from jungle areas, and 3 from the swampy northern coast of Peru. The patients had 1-5 lesions, most of which were on the lower extremities. One patient had 5 clustered gluteal lesions; another patient had 2 lesions on a finger. Three patients were lost to follow-up. All 5 remaining patients had moderate disease. Diverse treatments (antituberculous drugs, World Health Organization [WHO] recommended antimicrobial drug treatment for BU, and for 3 patients, excision surgery) were successful. Only 1 patient (patient 7) received the specific drug treatment recommended by WHO. BU is endemic in Peru, although apparently infrequent. Education of populations and training of health workers are first needed to evaluate and understand the full extent of BU in Peru.

Figure 1

Map of Peru showing the locations where 8 Buruli ulcer patients were probably infected. Red, Peruvian River basin; gold, coastal area.

Figure 2

Patient 8. A) Nonulcerative edematous lesion on the right middle finger as first seen; B) ulcerated lesions on the right middle finger ≈4 weeks later; C) extensive debridement, 5.5 weeks after first seen; D) cured lesion 5 months after first seen, 1 month after autologous skin graft.