Classification: ICD-9 031.1; ICD-10 A31.1
Syndromes and synonyms: Bairnsdale ulcer (southern Australia), Daintree ulcer (northern Australia) Kumusi ulcer (Papua New Guinea), Searl ulcer.
Agent: Mycobacterium ulcerans, an acid-fast, slow-growing bacillus. There are at least four geographically distinct strains: African, American, Asian, and Australian. They all produce mycolactone, which destroys tissue and suppresses the immune system. Variations in the structure of mycolactone may correlate with disease severity in different regions.
Reservoir: This is unknown at present. M. ulcerans has been found in biofilms on vegetation in swamps and other permanent wetlands, aquatic insects, snails, and fish. In Australia, some land animals, particularly native possums, have been found to carry M. ulcerans in their gastrointestinal tracts.
Vector: Aquatic insects; in southern Australia mosquitoes; not yet fully understood.
Transmission: Contamination of a break in the skin by bacilli in the environment, or by the bite of an infected aquatic insect or mosquito. Person-to-person transmission is rare.
Cycle: The disease ecology is not completely understood. Humans are likely dead end hosts.
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