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16th Apr 2018

Rare flesh-eating ulcer leaves scientists bewildered as it hits epidemic proportions

Michael Lanigan

Mosquitoes and possums are believed to be the reason it has spread quickly among humans.

A rare flesh-eating ulcer has been rapidly spreading across various regions in the Australian state of Victoria, and its precise causes continue to baffle scientists.

The Buruli ulcer, also known as Bairnsdale ulcer, has previously caused considerable damage across Africa with reported cases in 32 countries. However, despite 2,000 cases being reported annually, the disease typically spreads in swampland areas of tropical countries, so the rising number of instances reported in Victoria, as well as New South Wales, South Australia and Tasmania has proven startling.

In 2014, there were a reported 89 new cases, which rose to 107 the following year. The first signs of a possible epidemic were sighted in 2016, when new cases reached 182 before hitting 275 by 2017.

This issue was raised in an article published in the Medical Journal of Australia, whose lead author, associate professor Daniel O’Brien from Barwon Health said: “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 remains unknown.

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

The ulcer is said to begin as a lump on the skin, which is painless and could easily be dismissed as an insect’s bite. Next, the bacteria burrows into the fatty layer between skin and the lining of the muscle.

Spreading sideways, it gradually destroys tissue and erupts back through the skin again, this time as the ulcer. Causing extreme pain, the main form of treatment is an eight week course of antibiotics. However, skin removal and amputation have also been required in a small number of instances.

One of the leading experts in the Buruli ulcer, Professor Paul Johnson told the Guardian about his own theory behind why this typically tropical and swamp-based infection is spreading along coastal areas such as Bellarine and Mornington.

Having studied the ulcer since 1993, while developing an accurate diagnostic test, Johnson said the two noteworthy means of its transmission are via mosquitoes and possums.

The bacteria, which causes the ulcer, is spread by both mosquitoes and ringtail possums, and the former have been found to carry it in small portions.

Furthermore, traces of the bacteria have been detected in the faeces of possums, so Professor Johnson has speculated that such possums are the main source of contamination, since it can be picked up by either the insect or from humans coming directly into contact with the marsupial.

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