01982nas a2200181   4500000000100000008004100001260002500042653002400067653005700091100001400148700001400162700001400176245010000190856015300290300001100443520133200454022001401786       2021                            d  c08/2021bElsevier BV10aInfectious Diseases10aPublic Health, Environmental and Occupational Health1 aDhungel L1 aBenbow ME1 aJordan HR00aLinking the Mycobacterium ulcerans environment to Buruli ulcer disease: Progress and challenges  uhttps://www.sciencedirect.com/science/article/pii/S2352771421001014/pdfft?md5=13988d9b2af9d8b91c7cb3735f7bdf51&pid=1-s2.0-S2352771421001014-main.pdf  a1003113 aBuruli ulcer (BU), the second most common mycobacterial disease in West Africa, is a necrotizing skin disease that can lead to high morbidity in affected patients. The disease is caused by Mycobacterium ulcerans (MU), whose major virulence factor is mycolactone. Although early infection can be treated with antibiotics, an effective preventative strategy is challenging due to unknown reservoir(s) and unresolved mode(s) of transmission. Further, disease occurrence in remote locations with limited access to health facilities further complicates disease burden and associated costs. We discuss here MU transmission hypotheses and investigations into environmental reservoirs and discuss successes and challenges of studying MU and Buruli ulcer across human, animal, and environmental interfaces. We argue that a One Health approach is needed to advance the understanding of MU transmission and designing management scenarios that prevent and respond to epidemics. Although previous work has provided significant insights into risk factors, epidemiology and clinical perspectives of disease, understanding the bacterial ecology, environmental niches and role of mycolactone in natural environments and during infection of the human host remains equally important to better understanding and preventing this mysterious disease.  a2352-7714