02289nas a2200253   4500000000100000008004100001260001300042653001700055653002000072653001100092653003900103653001100142100001700153700001200170700001500182700001400197700001400211700001500225700001300240700001300253245015900266856006400425520154600489       2017                            d  bElsevier10aBuruli ulcer10aChronic Disease10aJordan10aNeglected tropical diseases (NTDs)10aUlcers1 aAl Ramahi JW1 aAnnab H1 aAl Karmi M1 aKirresh B1 aWreikat M1 aBatarseh R1 aYacoub M1 aKaderi M00aChronic cutaneous mycobacterial ulcers due to Mycobacterium ulcerans (Buruli ulcer): the first indigenous case report from Jordan and a literature review.  uhttp://www.ijidonline.com/article/S1201-9712(17)30061-9/pdf3 a<p>Background<br />
Buruli ulcer is the third most common mycobacterial infection worldwide. It is endemic in tropical, subtropical, and temperate climates. It causes devastating disease with morbidity and mortality. The treatment duration is long and the regimens considered are limited. Chronic cutaneous ulcers of mycobacterial etiology have been reported previously in Amman, but these were not associated with Mycobacterium ulcerans infection.</p>

<p>Methods<br />
The case patient’s initial diagnosis was based on chronological and morphological features, combined with appropriate diagnostic tests. The skin features were assessed histopathologically. Skin testing was positive for acid-fast bacilli (AFB), and M. ulcerans was identified by DNA strip test (GenoType Mycobacterium CM/AS, Hain Lifescience), which is based on a PCR technique targeting a 23S rRNA gene region, followed by reverse hybridization and a line probe technology.</p>

<p>Results<br />
The skin mycobacterial infection was evaluated and verified as having a Mycobacterium marinum–M. ulcerans pattern in the GenoType CM assay. It was then counted as a pattern representing individual species and was resolved with the GenoType AS assay as having an M. ulcerans pattern. M. ulcerans DNA was isolated and amplified by PCR, and then detected against reverse hybridization probes in the strip assay.</p>

<p>Conclusions<br />
An indigenous case of M. ulcerans (Buruli ulcer) is reported for the first time from Jordan and the surrounding region.</p>