After that, the disease was forgotten for half a century. It was in 1948 that the first case study was published in Australia. The World Health Organization began to address Buruli ulcer as a public health problem in 1998. A disease of the poor, Buruli ulcer managed to stay out of the spotlight of the research community to such an extent that even today no one knows the exact mode of transmission and there is no progress in developing simple diagnostic tools for detecting the presence of infection. There is still no effective drug treatment and no vaccine for the disease.
Incubation period is anywhere between two months and several years.
Skin contamination is universally believed to be the route of infection. Any minor penetrating injury serves as a gateway. There is no evidence to date to suggest person to person transmission. What starts as a painless swelling in the skin often develops into grossly deforming ulcers. Unlike other mycobacteria, Mycobacterium ulcerans produces a toxin that destroys tissue and bone and suppresses the immune system.