Status:
Resolved
Health alert:
120007
Date Issued:
23 Jul 2012
Issued by:
Dr Rosemary Lester, Chief Health Officer
Issued to:
General practitioners (GPs)

Key messages

  • Notifications for M. ulcerans (Bairnsdale/Buruli ulcer) (BU) in Victoria have increased. There have been 33 notifications since January 2012, compared to 19 for the same period last year.
  • Think BU in any atypical ulcer in any patient who lives in or has visited endemic areas (even for a short period).
  • Test early with a dry swab if you suspect BU.
  • Encourage patients to avoid mosquito bites and seek early diagnosis of any ulcer or skin lesion that is slow to heal.

Background

Since January 2012 the Department of Health has received 33 notifications of M. ulcerans (Bairnsdale/Buruli ulcer) (BU) compared with 19 for the same period last year and 80 for the full year in 2011. Approximately 25 of these notifications have been in patients living on the Bellarine Peninsula, in particular the Point Lonsdale, Barwon Heads and Ocean Grove areas. Other areas where cases have been reported from in this or past years include:

  • Frankston / Langwarrin
  • Mornington Peninsula
  • Westernport Bay
  • East Gippsland

Holiday visitors to endemic areas

Five patients from the Melbourne metropolitan area have been diagnosed with the condition after visiting the Bellarine Peninsula or other coastal areas where BU has been described. The incubation period for BU is thought to be 6-9 months.

Clinical features

BU is an uncommon infection which causes chronic, progressive skin ulcers, usually on exposed parts of the body such as the arms or legs. The infection begins as a painless or itchy pimple which breaks down to form an ulcer which can become extensive if untreated. Mature lesions have characteristic undermined edges. When identified and excised early there is a high cure rate with minimal scarring. If left untreated the ulcer can continue to enlarge, sometimes requiring extensive surgical excision and skin grafts.

Transmission and prevention

Despite significant research into the infection, the mode of transmission remains uncertain. It is thought that biting insects, particularly mosquitoes may play a role. The most important public health message continues to be protection against insect bites and seeking early diagnosis for any ulcer or skin lesion that is slow to heal.

Is this atypical ulcer BU?

  • Think BU in any atypical ulcer in any patient who has visited (even for a short period) or is a resident of low lying coastal areas, particularly those known to have had cases of BU as listed above.
  • Test early with a dry swab sent for PCR to the Victorian Infectious Diseases Reference Laboratory (VIDRL) (either directly or via your usual pathology provider). Results can be available in 24 to 72 hours.
  • Call VIDRL on 9342 2600 for information on specimen collection.

Contacts

Victorian Infectious Diseases Reference Laboratory (VIDRL) 03-9342 2600 for information on specimen collection.