Buruli ulcer (BU), a disease caused by Mycobacterium ulcerans, is a neglected disease of the poor in remote rural areas. BU is the third most common mycobacterial disease after tuberculosis and leprosy. It is most endemic in West Africa with incidences as high as 280 / 100,000, but cases occur around the globe. Currently, BU is treated by surgery - no anti-mycobacterial drug trials have been conducted. Surgery with wide margins resembles radical oncological surgery but this is not a modern therapy for an infectious disease. Moreover, it is neither affordable nor sustainable in endemic regions; and it is poorly accepted among people in endemic areas. Indeed, fear for mutilating surgery has been identified as an important cause of patient delay, resulting in even more extensive lesions at presentation. Though mortality of the disease is low, morbidity and subsequent disability are very high, with up to half of those treated are left with disabilities that have long-term social and economic impact. New ?
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