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article imageSpread of flesh-eating ulcer in Australia a 'worsening epidemic'

By Karen Graham     Apr 16, 2018 in Health
Victoria - A severe tissue-destroying ulcer once rare in Australia is rapidly spreading and is now at epidemic proportions in regions of Victoria, prompting infectious diseases experts to call for urgent research into how it is contracted and spread.
Buruli ulcer, also called Bairnsdale ulcer, Mossman ulcer and Daintree ulcer in Australia, is an infectious disease caused by Mycobacterium ulcerans - a mycobacterium related to those that cause TB and leprosy.
Buruli infection, or just Buruli, usually starts out as a painless lump on the skin often dismissed as an insect bite. The infection then burrows into a layer of fat located between the skin and the lining that covers muscles. It is in this fatty layer that the infection takes hold - spreading sideways and destroying tissue and causing a swelling. It eventually erupts through the skin, causing an ulcer.
Most people with the infection don't even know they have it until the ulcer erupts, and then it is very painful. The damage to the skin, muscle, and tissue is caused by a toxin called mycolactone that is released by M. ulcerans. Treatment requires a two-month course of antibiotics, usually, rifampicin plus clarithromycin used together to kill the bacterium.
Buruli ulcer on the hand of a patient from Peru. A) Nonulcerative edematous lesion on the right midd...
Buruli ulcer on the hand of a patient from Peru. A) Nonulcerative edematous lesion on the right middle finger as first seen; B) ulcerated lesions on the right middle finger ≈4 weeks later; C) extensive debridement, 5.5 weeks after first seen; D) cured lesion 5 months after first seen, 1 month after autologous skin graft.
CDC/Emerging Infectious Diseases, Volume 14, Number 3.
Buruli in Australia
In an article published Monday in the Medical Journal of Australia (MJA), authors led by associate professor Daniel O’Brien from Barwon Health said incidents of Buruli ulcer were on the rise, particularly in Victoria.
The cautioned that the outbreak of the ulcers, described as an “epidemic” in the study, requires an “urgent scientific response.” In the report, they write Victoria is facing a worsening epidemic “defined by cases rapidly increasing in number, becoming more severe in nature, and occurring in new geographic areas.”
Between 2013-2016 there were at least 452 confirmed cases of Buruli in Australia, giving an approximate annual national incidence of 0.5 per 100,000 population. But because the infection occurs in small and often isolated areas, the incidence of infections could be higher.
Lake Eildon National Park is in the northern foothills of Victoria s Central Highlands  150 km north...
Lake Eildon National Park is in the northern foothills of Victoria's Central Highlands, 150 km north-east of Melbourne. Situated on the shores of Lake Eildon, the park protects 27,750 ha of rugged hills with open woodlands through to dense forest.
© Parks Victoria
In the published paper on Monday, the scientists stated that the annual number of Buruli ulcer cases in Australia increased from 182 in Victoria in 2016 to 236 cases by November 2017, a spike of 72 percent. However, O'Brien added that cases reported until November 11, 2017, had further increased by 51 percent compared with the same period in 2016, from 156 cases to 236 cases.
“Despite being recognized in Victoria since 1948, efforts to control the disease have been severely hampered because the environmental reservoir and mode of transmission to humans remain unknown,” O’Brien said, according to The Guardian. “It is difficult to prevent a disease when it is not known how infection is acquired.”
And this is one aspect of the disease that is stumping the experts. Buruli infections are usually associated with swamplands and environmental changes. And Buruli is also considered a geographically restricted infection, which means it only occurs following contact with specific “endemic” areas.
A typical Buruli ulcer on the left hand of a 17-year-old boy in Nigeria.
A typical Buruli ulcer on the left hand of a 17-year-old boy in Nigeria.
CDC/Emerging Infectious Diseases, Volume 13, Number 5.
But that is not exactly how the disease has been acting in Australia. While the infection is most common on the Bellarine and Mornington Peninsulas, cases have also been reported in Melbourne, the country’s second-largest city. Another issue hampering scientists is that the main vector of transmission for Mycobacterium ulcerans remains unknown.
However, according to Andres Garchitorena, a researcher at the Institute of Research and Development in France and an expert on Buruli ulcers, who was not involved in the most recent report, the Australian cases are often linked to specific modes of transmission such as mosquitoes and possums
“In Australia, it seems more to be a terrestrial transmission whereas in Africa, for example, the strain is very different and is mostly transmitted through aquatic ecosystems,” Garchitorena said, according to WTVR-Richmond.
More about Buruli ulcer, Mycobacterium ulcerans, mycolactone, mosquitoes and possums, Health
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