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culture media. Microscopic examination of tissues can show mixed suppurative and
granulomatous inflammation. Other patterns include epithelioid granulomas, ulcerative necrosis,
lichenoid dermatitis with granulomas, interface dermatitis, and necrotizing small-vessel
vasculitis. Persons with AIDS may have impaired inflammatory responses so that granulomas
and acid fast bacilli may not be detectable. Infected patients may respond to antibiotic therapy
that may include macrolides and rifamycins.[448]
Mycobacterium ulcerans is an environmental, non-communicable agent that causes an
indolent, necrotizing skin lesion known as Buruli ulcer (BU). M. ulcerans involving skin may
spread to underlying bone producing reactive osteitis or osteomyelitis or spread via lymphatics
or hematogenously to bone. This infection is most common in children living in West Africa.
The risk for BU is increased with HIV infection, which also makes BU more aggressive. [449]
