Mycobacterium ulcerans is the causative agent of Buruli ulcer, a severe necrotizing skin disease that causes significant morbidity in Africa and Australia. Person-to-person transmission of Buruli ulcer is rare. Throughout Africa and Australia infection is associated with residence near slow-moving or stagnant water bodies. Although M. ulcerans DNA has been detected in over 30 taxa of invertebrates, fish, water filtrate, and plant materials and one environmental isolate cultured from a water strider (Gerridae), the invertebrate taxa identified are not adapted to feed on humans, and the mode of transmission for Buruli ulcer remains an enigma. Recent epidemiological reports from Australia describing the presence of M. ulcerans DNA in adult mosquitoes have led to the hypothesis that mosquitoes play an important role in the transmission of M. ulcerans. In this study we have investigated the potential of mosquitoes to serve as biological or mechanical vectors or as environmental reservoirs for M. ulcerans. Here we show that Aedes aegypti, A. albopictus, Ochlerotatus triseriatus, and Culex restuans larvae readily ingest wild-type M. ulcerans, isogenic toxin-negative mutants, and Mycobacterium marinum isolates and remain infected throughout larval development. However, the infections are not carried over into the pupae or adult mosquitoes, suggesting an unlikely role for mosquitoes as biological vectors. By following M. ulcerans through a food chain consisting of primary (mosquito larvae), secondary (predatory mosquito larva from Toxorhynchites rutilus septentrionalis), and tertiary (Belostoma species) consumers, we have shown that M. ulcerans can be productively maintained in an aquatic food web.

Highlights The COVID-19 pandemic has greatly impacted medical education, including cancellation of clinical rotations and novel use of virtual platforms for didactic teaching. We provide an outline of virtual teaching techniques to be employed to introduce medical students to the specialty of urology and increase clinical knowledge surrounding common urologic conditions.

Highlights Muscle invasive bladder cancer with variant histology has worse outcomes. Chemoradiation is associated with similar OS to surgery for variant histology. Adenocarcinoma and SCC have worse OS associated with chemoRT compared to surgery.

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distinguish surgeon experience while maintaining rater reliability. The future of EASE may include automated technical skills assessment where the most explicit formative feedback will benefit training surgeons.