AMA VICDOC Summer 2024 - Magazine - Page 46
Classified by the WHO as a ‘neglected tropical
disease’, Buruli ulcer is in the same family as
TB and Leprosy. However, in contrast to these
more famous diseases, it is transmitted from the
environment, rather than person to person.
—
B
uruli ulcer is a slowly progressive
infection of skin and soft tissue caused
by the bacterium Mycobacterium
ulcerans. Infection usually begins as a
painless nodule or plaque but progresses
and eventually ulcerates. If left untreated
or diagnosis is delayed permanent functional
or cosmetic deformity may result.
“Classified by the WHO as a ‘neglected
tropical disease’, Buruli ulcer is in the same
family as TB and Leprosy. However, in
contrast to these more famous diseases,
it is transmitted from the environment,
rather than person to person,” says Prof
Paul Johnson (MBBS, PhD, FRACP), an
infectious diseases physician at Austin
Health and the University of Melbourne.
In Australia, Buruli ulcer’s geographical
restrictedness means it is only acquired
in specific locations – initially around
Bairnsdale in East Gippsland (where
the causative organism, M. ulcerans, was
discovered in the 1930s and 40s) to Phillip
Island and Westernport in the 1990s, the
Mornington and Bellarine peninsulas in the
2000s and, most recently, inner Melbourne
and Geelong. There are also endemic areas
in far North Queensland and occasionally
elsewhere in the wet tropics.
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Overseas, Buruli ulcer occurs in 33
countries, but again only within very
specific sub-regions. From a public health
perspective, it is currently a significant
problem in rural west and sub-Saharan
Africa, in temperate southeastern Australia
and at times in Far North Queensland.
For clinician-scientists like Paul, Buruli’s
prevalence in Victoria, which now has the
highest incidence of the disease in the
world, is an ongoing puzzle.
“In 1998, in response to a growing
epidemic of Buruli ulcer in West African
children, WHO launched the Global Buruli
Ulcer Initiative. This highly successful
group, now absorbed under Neglected
Tropical Skin Diseases, mapped and
identified cases, worked to de-stigmatise
Buruli and led the paradigm shift
from plastic surgery to curative
antibiotic therapy.”
A diagnostic PCR test, first developed
in Melbourne in a research team Paul
led, has become the gold standard for
environmental screening and
diagnosis worldwide.
