Mycobacterium ulcerans Infection in French Guiana; Current State of Knowledge

M. ulcerans infections (Buruli ulcer; BU) have been reported in French Guiana since the 1960s [1]. It is striking to see that French Guiana concentrates most of the cases of BU in America with only a few cases reported in Suriname, Peru, Mexico and Bolivia in the past [2, 3]. Either BU is underdiagnosed and underreported in most of the continent; or the specific environmental conditions in French Guiana represent a unique niche for the disease to appear; or a sublineage of M. ulcerans has established in French Guiana that has a higher virulence than other members of the ancestral lineage found in the Americas.