Mycobacterium ulcerans infection in Australian children: report of eight cases and review.

In the past 25 years, eight patients with presumed or proven Mycobacterium ulcerans infection have been treated at the Royal Children's Hospital, Melbourne, Australia. At least four of these patients had recently been in southeastern Victoria, Australia, a temperate region where the disease was first described and where sporadic infection occurs. Nonspecific clinical manifestations and an indolent course often lead to delayed diagnosis. Surgical excision is the mainstay of treatment and was used for all of the patients; however, for one of the patients, adjunctive heat treatment was limb saving because both antimycobacterial drugs and surgery failed to stop the progression of necrotizing ulceration. We describe this case as well as that of a patient who presented with a rare manifestation of the infection--panniculitis. In addition, we review the microbiology, epidemiology, clinical presentation, pathology, and management of M. ulcerans infection.