We describe the fourth reported case involving "Mycobacterium ulcerans subsp. shinshuense." Compared to previous cases, the infection was more invasive with extensive ulceration from the elbow to the forearm. Definitive identification involved IS2404 detection, 16S rRNA gene sequencing, and analysis of the 16S rRNA gene 3'-terminal region and the virulence plasmid pMUM001.
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Nakanaga et al. (2007) studied this question.
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