Experts fear an epidemic of ‘flesh-eating’ ulcers

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  Last updated April 26, 2018 at 10:17 am


Tissue-destroying disease growing in intensity and reach in Australia.

Mycobacterium ulcerans, the bacterium that causes Buruli ulcers.

Infectious disease experts are calling for an “urgent scientific response” to avoid an epidemic of Buruli ulcers, which cause severe destructive lesions of skin and soft tissue.

A team from Barwon Health in Geelong, led by Professor Daniel O’Brien, says the problem is increasing in several areas of the country but is particularly severe in regional Victoria, which saw a 51 per cent increase (from 156 to 236) between 2016 and 2017.

They believe the disease is becoming “more severe in nature and occurring in new geographic areas”.

“Despite being recognised 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,” they say in an article in the Medical Journal of Australia.

“It is difficult to prevent a disease when it is not known how infection is acquired.”

Risk of infection

Buruli  ulcers are caused by “flesh eating” bacteria called Myobacterium ulcerans  and are  associated with  wetlands,  especially  those  with  slow  flowing  or  stagnant  waters.

Theories  about  the organism’s epidemiology  include dissemination  via  spray  irrigation,  environmental  disturbances  such  as  floods  and  road construction, transmission via infected mosquitoes, biting aquatic insects, and transmission via possum faeces.

However, specifics are hard to nail down because it is very hard to culture from the environment.

“The risk of infection appears to be seasonal, with an increased risk in the warmer months,” the authors say.

“Lesions most commonly occur on exposed body areas, suggesting that bites, environmental contamination or trauma may play a role in infection, and that clothing may protect against disease.

Recent evidence indicates that human-to-human transmission does not occur, although cases are commonly clustered among families.”

O’Brien and colleagues say six critical questions need to be answered urgently if effective public health interventions are to be developed and implemented.

“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,” they write.

The paper is published in the Medical Journal of Australia.

About the Author

Nick Carne
Nick Carne is the Editorial Manager for the Royal Institution of Australia.