The first sign of Buruli ulcer is usually a painless lump on the skin often dismissed as an insect bite. The slow-moving infection then burrows into a layer of fat located between the skin and the lining that covers muscles. It is in this fatty layer that the infection takes hold, spreading sideways and through the body, destroying tissue along the way, before eventually erupting back through the skin in the form of an ulcer. Those with the infection often have no idea the infection has taken hold until the ulcer appears. But when the ulcer does erupt, the pain can be extreme.
In 2016, there were 182 new cases of the ulcer in Victoria and in 2017 this number increased to 236 cases.
GP Dr Chowdhury Beg. Source: GP Dr Chowdhury Beg
While the infection responds to a roughly eight-week course of antibiotics, in rare cases surgery to remove skin or even amputation is needed.
Prof Paul Johnson is an internationally renowned Buruli ulcer expert and has been studying the infection since 1993. He led the development of a highly-accurate diagnostic test for the bacteria that causes the disease and is now based at Austin Health in Victoria, where he is trying to understand why the infection is most common on the coastal Bellarine and Mornington peninsulas.
“It seems to occur in very specific areas of Victoria,” Johnson said. “If you don’t enter an endemic area, you don’t get the disease. 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.”
Johnson believes it is most likely the bacteria that causes the ulcer, Mycobacterium ulcerans, is being spread by mosquitos and possums. His research team caught a large number of mosquitos in affected areas and found a small proportion did carry the bacteria.
They then found ring-tail possums in affected areas excreted the bacteria in their feaces.
Brush-tail Possum (Trichosurus vulpecula) Source: Ardea Picture Library
The authors of the called for urgent government funding to research the bacteria and to carry out an exhaustive examination of the environments it is found, including looking at local animals and any interaction with people.
The Medical Journal of Australia (MJA) is Australia’s leading peer-reviewed general medical journal.
Listen to Dr Chowdhury Beg’s full interview (in Bangla) with SBS Bangla in the audio player above.
