Mycobacterium ulcerans is the causative agent of Buruli ulcer, a rare but chronic debilitating skin and soft tissue disease found predominantly in West Africa and Southeast Australia. While a moderate body of research has examined the distribution of M. ulcerans, the specific route(s) of transmission of this bacterium remain unknown, hindering control efforts. M. ulcerans is considered an environmental pathogen given it is associated with lentic ecosystems and human-to-human spread is negligible. However, the pathogen is also carried by various mammals and invertebrates, which may serve as key reservoirs and mechanical vectors, respectively. Here, we examine and review recent evidence from these endemic regions on potential transmission pathways, noting differences in findings between Africa and Australia, and summarising the risk and protective factors associated with Buruli ulcer transmission. We also discuss evidence suggesting that environmental disturbance and human population changes precede outbreaks. We note five key research priorities, including adoption of One Health frameworks, to resolve transmission pathways and inform control strategies to reduce the spread of Buruli ulcer.

中文翻译：

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了解溃疡分枝杆菌的传播：迈向控制布鲁里溃疡的一步。

溃疡分枝杆菌是布鲁里溃疡的病原体，布鲁里溃疡是一种罕见但慢性使人衰弱的皮肤和软组织疾病，主要见于西非和澳大利亚东南部。虽然适度的研究已经检查了溃疡分枝杆菌的分布，但这种细菌的具体传播途径仍然未知，阻碍了控制工作。溃疡分枝杆菌被认为是一种环境病原体，因为它与惰性生态系统有关，而且人与人之间的传播可以忽略不计。然而，病原体也被各种哺乳动物和无脊椎动物携带，它们可能分别作为关键的宿主和机械载体。在这里，我们检查并审查了来自这些流行地区的关于潜在传播途径的最新证据，并注意到非洲和澳大利亚之间的研究结果存在差异，并总结与布鲁里溃疡传播相关的风险和保护因素。我们还讨论了表明环境干扰和人口变化先于疫情爆发的证据。我们注意到五个关键的研究重点，包括采用 One Health 框架，以解决传播途径并为控制策略提供信息，以减少布鲁里溃疡的传播。