Buruli ulcer (BU), caused by Mycobacterium ulcerans, is an indolent necrotizing disease of the skin, subcutaneous tissue and bone. BU is the third most common mycobacterial disease of humans, after tuberculosis and leprosy, and the least understood of the three diseases. BU is endemic in Africa, particularly in West African countries. The disease is also endemic outside Africa, but remains uncommon in non-African countries. Several imported and exported cases have also been described. The

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... iology of BU is strongly associated with wetlands, especially those with slow-flowing or stagnant water (ponds, backwaters and swamps). Recently, aquatic insects have been considered as potential passive reservoirs or 'vectors' of M. ulcerans. For the first time, a fully characterized M. ulcerans strain has been cultivated from an aquatic Hemiptera (Gerris) supporting the concept that the agent of BU is a human pathogen with an environmental niche. The use of protected sources of water for domestic purposes reduces exposure to M. ulcerans contaminated sources and consequently may reduce prevalence rates of BU.