Buruli ulcer (BU) is not endemic to Japan, but 60 cases have been reported since 1982. The causative bacterium is Mycobacterium ulcerans subsp. shinshuense, which appears to be unique to Japan and potentially China. Genetic characterization of this species has begun, and the efficacy of various therapies has been analyzed. Although treatment with triple antimicrobial therapy comprising rifampicin (RFP; 450 mg/day), levofloxacin (LVFX; 500 mg/day), and clarithromycin (CAM; 800 mg/day) seemed to be effective in Japanese BU cases, establishment of a standard diagnosis and treatment guideline optimized for BU infections in Japan and other Asian countries is needed. Furthermore, a comprehensive comparison of the proteomes of M. ulcerans subsp. shinshuense with classical M. ulcerans may clarify the differences in their adaptive biology and response to antibiotic treatment. Because of the distinctive four seasons in Japan, there is a clear seasonal variation in the occurrence of BU and possibly of the number of bacteria in the environment. Therefore, although there are not many cases of BU in Japan, studying them will shed light on the bacteriological and clinical aspects of BU.
Copyright 2019, The Author(s).