What is Buruli ulcer?

Buruli ulcer is a bacterial disease that causes damage to the skin. If left untreated, it can lead to severe skin and limb damage, so early treatment is vital. Researchers are still working on how best to prevent the disease.

Buruli ulcer is mainly found in tropical and subtropical areas. It has been reported in 33 countries around the world, mostly countries in central and west Africa. However, cases have also been reported in Australia, China, Japan and countries of the Western Pacific and the Americas.

Where does Buruli ulcer occur in Australia?

Victoria reports some of the highest numbers of Buruli ulcer cases in the world each year.

Cases of Buruli ulcer have been reported in southern areas of Victoria, in coastal regions of East Gippsland and on the Bellarine and Mornington Peninsulas. In Melbourne, cases have also been reported in the south-eastern bayside areas and in Essendon, Moonee Ponds and Brunswick West. The area with the highest risk of infection is the Mornington Peninsula.

There have also been cases in far north Queensland, around the Mossman area.

The number of people with Buruli ulcer in Australia has increased in the past few years.

What are the symptoms of Buruli ulcer?

A painless lump, often mistaken for an insect bite, is usually the first sign of Buruli ulcer. This lump, known as a nodule, might be itchy and usually appears on the arms and legs, often over joints.

After 1 to 2 months, the skin in the area of the lump might start to break down and form an ulcer. If not treated, the ulcer can grow and destroy other tissues, including muscle and bone.

Sometimes, Buruli ulcer might cause a raised, rough patch on the skin, or the affected limb might become very swollen.

What causes Buruli ulcer?

Buruli ulcer is a chronic bacterial infection that mainly affects skin, and sometimes deeper tissues like muscle and bone.

It is caused by the bacteria Mycobacterium ulcerans, which is related to the bacteria that causes tuberculosis and leprosy. In Australia, it is sometimes called 'Bairnsdale ulcer', because it was first detected in that region almost 100 years ago.

Mycobacterium ulcerans is found in the natural environment, usually in areas of swampy or stagnant water.

It is not known how the Mycobacterium ulcerans transmits to humans. Researchers are investigating whether mosquitoes play a role. It can't be transmitted from one person to another.

How is Buruli ulcer diagnosed?

Early diagnosis is critical so as to prevent the problem from getting worse.

Buruli ulcer is diagnosed by taking swabs from the ulcerated area. If there are no ulcers, the skin can be biopsied. These samples are then tested for Mycobacterium ulcerans.

How is Buruli ulcer treated?

• Early treatment is vital. The primary treatment for Buruli ulcer is antibiotics.
• Other treatments include surgery to remove infected tissue and apply skin grafts, and wound and swelling management to speed up healing.
• In severe cases, physiotherapy and other support might be needed to help maintain movement and prevent disability.

Can Buruli ulcer be prevented?

It is not clear whether there is a way to prevent Buruli ulcer. However, health authorities advise, as a precaution, that people in affected areas:

• wear gloves and protective clothing when gardening
• clean cuts and grazes promptly
• wash skin that comes into contact with stagnant water

Recent increases in the number of cases of Buruli ulcer in Australia have led to more research into how to treat and prevent the disease.

The BCG vaccine used to prevent tuberculosis does not work against Mycobacterium ulcerans.

However, researchers are currently investigating 3 main areas:

• how Mycobacterium ulcerans is transmitted
• how the disease can be diagnosed faster
• which antibiotics provide the most effective treatment

Resources and support

Find out more here from Health Victoria on Mycobacterium ulcerans infection.