Flesh-eating bug epidemic: what we know

WARNING - GRAPHIC IMAGES: A flesh-eating bug on the rise in regional Victoria has experts calling for government funding to fight it and researchers scratching their heads as to how it’s spreading.

But studies by Health Victoria, the World Health Organisation and the Medical Journal of Australia have explained what the Buruli ulcer is, how it could be spreading and how to treat it.

The ulcers start out small but can grow rapidly. Source: University of Melbourne

What is it?

The organism, Mycobacterium ulcerans, which leads to the ulcers belongs to the family of bacteria which causes tuberculosis and leprosy.

It can affect the bone and can lead to permanent disfigurement and long-term disability and is also known as Bairnsdale or Daintree ulcer.

According to WHO, at least 33 countries, including Australia, with tropical, subtropical and temperate climates have reported Buruli ulcer, but mainly in west and central Africa.

Health Victoria states the first case was diagnosed in the Bairnsdale area of East Gippsland in the 1930s with more reported in years afterwards in Western Port, Phillip Island, the Frankston-Seaford area, the Bellarine Peninsula, the Mornington Peninsula and other bay side areas in south eastern Melbourne. The ulcer also occurs in the Daintree region of Far North Queensland, albeit less commonly.

About 2000 cases are reported worldwide each year and all age groups can be infected.

Victoria is facing a worsening epidemic, with 182 new cases in 2016 and 275 last year.

About 2000 cases are reported worldwide each year. Source: Health Victoria

How does it spread?

How it spreads is unknown but the disease is often associated with wetlands, especially stagnant water.

But evidence indicates it cannot be transmitted from person to person.

Insects, such as mosquitoes, have been shown to contain the bacteria and they may play a role in transmission.

Use of repellent and mosquito nets have been linked to a reduction in occurrence.

Health Victoria advises to wear gardening gloves, long-sleeved t-shirts and trousers when working outdoors, and to cover cuts or abrasions with bandaids.

Cases and incidence of Mycobacterium ulcerans disease in Victoria from 2004–2016. Source: Medical Journal of Australia

How do you treat it?

The first sign of Buruli ulcer is usually a painless, non-tender blister-like nodule on the skin, often thought to be an insect bite.

A lesion may occur anywhere on the body but is most common on the limbs.

After one to two months, the nodule may begin to erode, forming a characteristic ulcer.

Treatment involves a combination of antibiotics, depending on the patient but many sufferers have to get plastic surgery. In Australia, a combination of rifampicin and moxifloxacin is routinely used with good results but its effectiveness has not been proven by randomised trial.

Most cases in Victoria are occurring on the Mornington and Bellarine peninsulas. Source: Getty

The ulcer can also return after surgery, requiring more antibiotics and or another operation.

In one case reported in the Medical Journal of Australia, an 11-year-old boy who visited the Mornington Peninsula required six months of treatment to heal after receiving a lesion on his leg. He required plastic surgery.

In Australia and Japan, most lesions are detected early and diagnosed as a Category 1 – the least severe.

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