Epidemic of African flesh-eating ‘Buruli ulcer’ is spreading through Australia experts at a loss

A flesh-eating ulcer epidemic is spreading rapidly, and experts have no idea what is causing the massive spike in infections or how to prevent the disease.

The Buruli ulcer epidemic in Victoria is now so serious the Medical Journal Of Australia is calling for an urgent scientific response.

Numbers of infected victims are on the rise in regional areas of the state, with 275 new reported cases last year and 30 already this year.

A flesh-eating ulcer epidemic is spreading rapidly, and experts have no idea what is causing the massive spike in infections or how to prevent the disease (severe Mycobacterium ulcerans lesion on the knee of an 11-year-old boy)

The Buruli ulcer epidemic in Victoria is now so serious the Medical Journal Of Australia is calling for an urgent scientific response (stock image)

The Buruli ulcer epidemic in Victoria is now so serious the Medical Journal Of Australia is calling for an urgent scientific response (stock image)

In the Bayside region confirmed infections have seen a 400 per cent spike in the last four years,News.com.au reported.

Also known as as Bairnsdale ulcer or Daintree ulcer, it causes severe destructive lesions of skin and soft tissue which affects all age groups, including young children.

It often results in significant morbidity, loss of limbs, long-term disability and cosmetic deformity.

Although the disease was first detected in Victoria in the 1930s, cases have risen rapidly in the last five years.

Infectious diseases consultant Associate Professor Daniel O’Brien from Geelong-based health care provider Barwon Health authored the report, and said most cases have occurred on the Mornington and Bellarine peninsulas.

Native and domestic mammals including possums, dogs, cats and koalas have also developed the disease in Victoria, according to Professor O’Brien.

‘In Australia, cases are frequently reported from the Daintree region (95 cases between 2009 and 2015) and, less commonly, the Capricorn Coast in Queensland, and occasionally from the Northern Territory, New South Wales and Western Australia,’ he wrote.

‘However, most cases are reported from the temperate south-eastern state of Victoria. The risk of infection appears to be seasonal, with an increased risk in the warmer months.’

Epidemic of flesh-eating Buruli ulcer : what we know

WHAT IS A BURULI ULCER?

* It’s a skin infection caused by a bacteria known as Mycobacterium ulcerans

* The organism belongs to the family of bacteria that causes tuberculosis and leprosy

* It typically causes skin ulcers, otherwise known as Buruli ulcer

* It is also known as Bairnsdale or Daintree ulcer

* It can affect the bone and can lead to permanent disfigurement and long-term disability

WHERE DOES IT OCCUR?

* According to WHO, at least 33 countries, including Australia, with tropical, subtropical and temperate climates have reported Buruli ulcer, but mainly in west and central Africa

WHO IS AFFECTED?

* About 2000 cases are reported worldwide each year

* All age groups, including young children, can be infected

HOW IS IT TRANSMITTED?

* The exact method remains unclear, but the disease is often associated with wetlands, especially stagnant water

* Evidence indicates it can not be transmitted from person to person

* Insects, such as mosquitoes, have been shown to contain the bacteria and they may play a role in transmission

* Use of repellent and mosquito nets have been linked to a reduction in occurrence

WHAT DOES IT LOOK LIKE?

* The first sign of Buruli ulcer is usually a painless, non-tender blister-like nodule on the skin, often thought to be an insect bite

* A lesion may occur anywhere on the body but is most common on the limbs

* After one to two months, the nodule may begin to erode, forming a characteristic ulcer

HOW IS IT TREATED?

* In Australia and Japan, most lesions are detected early and diagnosed as a Category 1

* Treatment involves a combination of antibiotics, depending on the patient

* Many sufferers require plastic surgery

Source: AAP – Health Victoria, World Health Organisation, Medical Journal of Australia

Numbers of infected victims are on the rise in regional areas of the state, with 275 new reported cases last year and 30 already this year (stock image)

Numbers of infected victims are on the rise in regional areas of the state, with 275 new reported cases last year and 30 already this year (stock image)

It costs an estimated $14,000 per patient to treat with a ‘substantial’ emotional and psychological impact on patients and their carers. 

‘Although treatment effectiveness has improved in recent years, with cure rates approaching 100 per cent using combination antibiotic regimens such as rifampicin and clarithromycin,’ wrote Professor O’Brien.

‘These antibiotics are not covered by the Pharmaceutical Benefits Scheme for this condition and are, therefore, expensive to patients.

‘Moreover, these antibiotics have severe side effects in up to one-quarter of patients, and many people also require reparative plastic surgery, sometimes with prolonged hospital admissions.’

Professor O’Brien called on governments to inject funding into research to find out why the disease was growing in Victoria.

Buruli ulcers are on the rise in Victoria with 30 reported cases so far in 2018 (stock image)

Buruli ulcers are on the rise in Victoria with 30 reported cases so far in 2018 (stock image)

Cases and incidence of Mycobacterium ulcerans disease in Victoria from 2004–2016, with cases so far and projected cases for 2017 (pictured)

Cases and incidence of Mycobacterium ulcerans disease in Victoria from 2004–2016, with cases so far and projected cases for 2017 (pictured)

He believes understanding risk factors is key to defining the source and transmission route of the disease.

 ‘As a community, we are facing a rapidly worsening epidemic of a severe disease without knowing how to prevent it,’ Professor O’Brien wrote.

‘We therefore need an urgent response based on robust scientific knowledge acquired by a thorough and exhaustive examination of the environment, local fauna, human behaviour and characteristics, and the interactions between them. 

‘The time to act is now, and we advocate for local, regional and national governments to urgently commit to funding the research needed to stop Buruli ulcer.’

Melbourne youngster Gus Charles started complaining of a lump on his knee not long after a family holiday in Sorrento on the Mornington Peninsula.

Around 2000 Buruli ulcer cases per year are reported worldwide, most commonly from the tropical regions of West or Central Africa

Around 2000 Buruli ulcer cases per year are reported worldwide, most commonly from the tropical regions of West or Central Africa

The family saw two GPs and visited the hospital three times before he got a correct diagnosis when a surgeon sliced into the lump and discovered a huge pus-filled abscess.

Gus was unable to play sport and missed a large amount of school in the six months it took to heal.

‘The issue is no one in Melbourne could diagnose it,’ Gus’ mother Sally told The Age.

‘Had we got it earlier, it would have made a huge difference. It was horrible. He’s a tough kid, but he was rocked by this.’ 

Department of Health and Human Services spokesman said it was monitoring the disease and that almost $800,000 had been spent on research in Victoria over the past decade. 

The spokesman said possum faeces from several locations in the Mornington Peninsula were currently being analysed in the hope of isolating the bacterium.

Most cases are reported from the temperate south-eastern state of Victoria, the Medical Journal of Australia report states

Most cases are reported from the temperate south-eastern state of Victoria, the Medical Journal of Australia report states



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