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Buruli ulcer and your skin – everything you need to know

The Buruli ulcer. Photo: Better Health Channel

This blog is written by Professor Damon Eisen, Medical Lead, Infection Prevention and Control Unit

Buruli ulcer is a skin infection caused by the bacterium Mycobacterium ulcerans (M. ulcerans) usually presenting as a slowly developing painless nodule or papule which can initially be mistaken for an insect bite.

Over time the lesion can progress to develop into a destructive skin ulcer which is known as Buruli ulcer or Bairnsdale ulcer.

Who is at risk?

Everyone is susceptible to infection. Disease can occur at any age, but Buruli ulcer notifications are highest in people aged 60 years and above in Victoria. Individuals who live in or visit endemic areas are considered at greatest risk. 

When recognised early, diagnostic testing is straightforward. If guidelines are followed prompt treatment can significantly reduce skin loss and tissue damage, as well as lead to more simplified treatment.

Because the highest risk is on the Mornington Peninsula in Rye, Sorrento, Blairgowrie and Tootgarook people living in these communities should be aware of what are early signs of this infection. The number of cases in Victoria varies widely from year to year, but numbers have been increasing each year from 2013 to a peak in 2018. 

There is also a low risk of the infection in the South Eastern Bayside suburbs. Other Victorian coastal locations around Port Phillip Bay and now Melbourne’s inner north are sources of infection.

Symptoms and transmission

In Victoria, case reporting peaks in between June and November each year but cases are also reported year-round.

The first sign of Buruli ulcer is usually a painless, non-tender nodule or papule. It is often mistaken for an insect or spider bite and is sometimes itchy. The lesion may occur anywhere on the body, but it is most common on exposed areas of the limbs. In one or two months the lesion may break down or ulcerate.

At this stage the characteristic ulcer with undermined edges can be recognized by GPs and specialists and investigated for Buruli ulcer.

Presentation can also include painful nodules. Some cases involving local swelling (oedema) and skin redness (cellulitis) can present with severe pain and fever.

Referral for treatment to doctors experienced in the management of this condition is recommended. The current mainstay of treatment is rifampicin-containing combination oral antibiotic therapy. Surgery may be used in combination with antibiotic therapy, where indicated. 

In patients with cellulitis that does not respond as expected to usual antibiotics, the diagnosis of Buruli ulcer should be considered, especially in those with reported exposure to an endemic area and cellulitis that has affected the ankle, wrist or elbow regions.

To learn more go to the Better Health Channel website.