Flesh-eating ulcer on the rise in Victoria

A tissue-destroying ulcer, commonly in the tropical regions of West or Central Africa, is on the rise in Victoria, medical experts have warned. Researchers are baffled as to why the densely populated state is affected, and not other Australian states.

The Mycobacterium ulcerans, internationally known as Buruli ulcer and as Bairnsdale ulcer or Daintree ulcer in Australia, causes severe destructive lesions of skin and soft tissue. It can affect the bone and can lead to permanent disfigurement and disability.

According to the World Health Organization, sufferers come from at least 33 countries with tropical, subtropical and temperate climates, most particularly in west and central Africa, with about 2,000 cases reported worldwide every year. In Victoria, there had been 182 new cases reported in 2016, the highest number ever reported. However, the number increased to 275, or 51 percent, in 2017. The cases are becoming more severe in nature and occurring in new areas.

According to Daniel O’Brien, associate professor in the University of Melbourne, treatment effectiveness has improved in recent years, but the antibiotics needed to cure the disease are not covered by the Pharmaceutical Benefits Scheme, making them expensive for patients. The antibiotics — such as rifampicin and clarithromucin — have severe side effects in up to one-quarter of patients, including hepatitis and allergy. Many patients also require reparative plastic surgery and prolonged hospital admissions.

Therefore, O’Brien said in the study published Monday in the Medical Journal of Australia, the disease is expensive to cure, averaging $14,000 per patient. It is not clear how it is transmitted exactly, although it is often associated with wetlands and stagnant water. Insects have also shown to contain the bacteria, which may mean that they play a role in the disease’s transmission.

Professor Paul Johnson, an internationally renowned Buruli ulcer expert, said the development of the infection along the coastal Bellarine and Mornington peninsulas in Victoria is baffling as the disease is mostly associated with swamps. “But what is it about the area that contains it, and what happens to you that means you pick the disease up from that area? Those are the big questions we’ve been asking,” he has been quoted by the Guardian as saying.

“As a community, we are facing a rapidly worsening epidemic of a severe disease without knowing how to prevent it,” the study concludes. “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.

“It is only when we are armed with this critical knowledge that we can hope to halt the devastating impact of this disease through the design and implementation of effective public health interventions. 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.”

The authors of the study are calling for urgent government funding for further research of the bacteria and examination of the environments where the infection is found.

What Buruli ulcer looks like

The first symptom of the disease is usually a painless sore nodule on the skin which looks like an insect bite. After up to a couple of months, the nodule begins to erode and form an ulcer.