AMA VICDOC Summer 2024 - Magazine - Page 48
WHAT DO AMA MEMBERS NEED TO KNOW?
THE RESEARCH CONTINUES
Paul reckons Victorian GPs are well versed
in Buruli ulcer, particularly in places where
it is active. But it can take clinicians
in other locations by surprise, and its
long incubation period can also catch
people out.
“A person only needs to spend a few
hours in an endemic area to get infected,
but the disease has a long incubation
period with a median of five months,”
says Paul.
Once a surgical disease, Buruli is now
predominantly treated with antibiotics and
dressings, but may take months to heal.
Specific anti-mycobacterial antibiotics
are highly effective. Paul stresses the
importance of accurate diagnosis, as Buruli
will not get better with standard treatment
and can have long-term consequences if
misdiagnosed or left untreated.
“Diagnosis can be made with a swab
that samples the undermined edge of the ulcer
or if an ulcer is not yet present, with a biopsy.
Clinicians also need to make sure they
order the right test – the key one to order
is the Mycobacterium ulcerans-specific
PCR. It’s very sensitive and specific, and
the result is available in just a few days.”
Victoria is on track for another record
year of Buruli ulcer diagnoses, with over
350 cases expected. It must be notified
within five days of diagnosis.
“Infections transmitted this summer
will mostly be diagnosed next winter
and early spring because of the long
incubation period. This makes now the
time for prevention, particularly if you or
your patients are in an area where Buruli
is prevalent. Wearing protective clothing,
insect repellent and avoiding mosquito
bites can help.”
Along with Professor Tim Stinear, Paul
is a lead investigator for Beating Buruli,
a research project launched in 2018
with funding from the NHMRC and
the Victorian Department of Health.
It is a multidisciplinary and collaborative
partnership between the Department of
Health, Doherty Institute, University of
Melbourne, Barwon Health, Austin Health,
CSIRO, Agriculture Victoria and the
Mornington Peninsula Shire Council.
The groups current focus includes mosquito
lab work, possum faecal surveys, possum
surveillance studies, and a field trial of a
new mosquito trap.
There are still many questions that remain
unanswered, such as how do possums get
Buruli ulcer? Where does M. ulcerans come
from? How have continuous outbreaks
in possums all along the Mornington
Peninsula happened? How have isolated
new outbreaks in possums in inner suburban
Melbourne and Geelong happened? What
exactly is going on in sub-Saharan Africa
(where there are no possums) – what is the
reservoir and mode of transmission there?
Why does Buruli sometimes go away, as it
seems to have done in Phillip Island, and
some former endemic areas in East Africa?
Beating Buruli were finalists for a 2024
Australian Museum Eureka Prize, and the
Victorian Public Healthcare Awards.
“Working on a local problem of
international significance has been very
fulfilling,” says Paul. “It’s been a privilege to
work closely with skilled scientists who have
helped me translate clinical observations
and hypotheses into hard evidence. I hope
that together we have made contributions
to science and medicine that will outlast us.”
There will be new Australian treatment
guidelines for Buruli ulcer published soon.
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