River Offin in the Amansie West District of Ghana showing a typical environmental setting for a region of Buruli ulcer endemicity, and <i>M. ulcerans</i> infection of the elbow of a female patient from the same district.

<p>River Offin in the Amansie West District of Ghana showing a typical environmental setting for a region of Buruli ulcer endemicity, and <i>M. ulcerans</i> infection of the elbow of a female patient from the same district.</p

The IP for BU infection in the study population.

<p>The IP range (X-axis) for each patient (Y-axis) is demonstrated, arranged from shortest to longest IP. IP range midpoint values are marked as the middle line of each bar.</p

Geographic representation of East Gippsland, considered endemic for BU as of 2012.

<p>East Gippsland: East of Sale and south of the great divide.</p

The IP according to variables investigated.

<p><b>Abbreviations:</b> Bellarine, Bellarine Peninsula; Mornington, Mornington Peninsula; NT, Northern Territory; NQLD, Northern Queensland; X, median; M, mean; d, days; m, months.</p>a<p><b>Mean</b>: The mean IP for each variable.</p>b<p><b>Range</b>: Shortest and longest incubation period recorded for specific variable,</p

Characteristics of the 23 cases of BU included in the study cohort.

a<p>Three cases had 2 single visit exposures to endemic areas. The causative single visit endemic area exposure was determined via VNTR sequencing.</p>b<p>Clinical presentation was described by patient as the most prominent clinical presentation. Oedematous form was noted in two of the patients with cellulitis.</p

Geographic representation of Bellarine Peninsula, considered endemic for BU as of 2012.

<p>Bellarine Peninsula – east of line from Geelong to Torquay. Mornington and Westernport – southwest of line from Hampton to Tooradin (including Phillip Island).</p

Regions within Eastern Australia defined as endemic for <i>M.ulcerans</i>.

<p>Regions within Eastern Australia defined as endemic for <i>M.ulcerans</i>.</p

Clinical details for BU patients enrolled in the study.

<p>*STR = WHO recommended treatment of 8 weeks streptomycin and rifampicin;</p>#<p>‘Category’ refers to WHO clinical severity scoring system for BU E = edematous, N = nodule, Q = Plaque, U = ulcerative.</p

Sketch map of places and towns referred to in the text.

<p>Sketch map of places and towns referred to in the text.</p

Time-kill assay showing the effect of ivermectin against <i>M</i>. <i>ulcerans</i> over 8-weeks.

<p><i>M</i>. <i>ulcerans</i> was grown in 25cm² culture flasks in the presence of 0, 8 and 20μg/ml ivermectin. Ethanol (solvent for ivermectin) at the concentration in the IVM-20 dose was used in the no-drug control. Weekly, ten-fold dilutions of each culture were plated onto 7H10 agar, using a 3-μl spot-dilution method, with five replicates per dilution. The plates were examined for growth after incubation for 8-weeks at 30°C, and colony forming units per ml calculated. The mean and range for duplicate biological experiments are shown.</p