What GPs need to know about the flesh-eating Buruli ulcer

Doug Hendrie

16/04/2018 1:55:07 PM

With Buruli ulcer now at epidemic levels in parts of Australia, the RACGP has developed a new educational activity for GPs.

Ulcers can initially present as relatively minor before exhibiting more severe symptoms.
Ulcers can initially present as relatively minor before exhibiting more severe symptoms.


Australian cases of the rare flesh-eating Buruli ulcer are rising rapidly, leading experts to call for an equally rapid scientific response.
The ulcer, caused by bacterium mycobacterium ulcerans, can cause large, destructive lesions of skin, soft tissue and even bone.
Statistics in a new Medical Journal of Australia (MJA) article show that case numbers have grown to their highest ever level, with 236 cases recorded between November 2016 and November 2017. The bacterial infection, which has been known to exist in Australia since 1948, is said to be particularly devastating on Victoria’s Mornington Peninsula, with confirmed infections increasing by around 400% in the last four years.
‘[In Victoria], the community is facing a worsening epidemic, defined by cases rapidly increasing in number, becoming more severe in nature, and occurring in new geographic areas,’ the MJA authors write, led by Associate Professor Daniel O’Brien, an infectious diseases consultant with Barwon Health in Geelong.
Buruli ulcer is associated with wetlands, particularly those with stagnant water, but the exact method of transmission is still unknown. Theories include floods, mosquitoes, possum faeces or spray irrigation.
The disease can strike people who have visited affected areas even for a single day.

The Buruli ulcer can cause large, destructive lesions of skin, soft tissue and even bone. (Image: Medical Journal of Australia/AAP)

In response, the RACGP has produced targeted information and a professional educational activity aimed at helping GPs identify and manage the ulcer. ‘Identifying and managing Buruli ulcer’ is designed to help GPs with the diagnostic challenge of distinguishing the rare Buruli ulcer from far more common skin ulcers.
Early identification of the Buruli ulcer is essential for successful management. Cure rates approach 100% on combination antibiotic regimens such as rifampicin and clarithromycin. However, these drugs are not listed on the Pharmaceutical Benefits Scheme (PBS) and can have severe side effects. Many patients also need plastic surgery to repair the damage.
According to the RACGP, ‘Identifying and managing Buruli ulcer’ is one of the first educational activities made by GPs for GPs in the diagnosis and management of Buruli ulcer.
The most important risk factor for acquiring Buruli ulcer is having lived in or visited an endemic region. These regions include the Mornington and Bellarine peninsulas near Melbourne – where the ulcer is sometimes dubbed the Bairnsdale Ulcer. In Queensland, it is known as the Daintree Ulcer.
The lesions are most frequently found on exposed body areas and infection may be linked to many factors, including insect bites, environmental contamination or trauma.

Buruli-ulcer flesh-eating-ulcer mycobacterium-ulcerans

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cameron hoare   17/04/2018 8:38:10 AM

like always, when something is common to North QLD it gets ignored, but have a few Victorians struck down, and it makes headlines

Deborah Curtis   4/08/2019 2:07:06 AM

There are simply more people located in Victoria than north Queensland, and the increase in numbers of people being diagnosed is very high.
It's a waste of energy to take offence at the natural consequence of both of these factors. Also the leading research is being conducted in the south as well.

All lives are important and the authorities have been monitoring this and researching it. So far it's baffling them as to direct cause.
This is the greater worry and we all can benefit from greater awareness about prevention methods, and how to detect the disease in the early stages.

Severini Serena   15/02/2021 12:50:39 PM

Unfortunately, the therapies of the past that may debel Covid 19 and proven ALSO to debel and heal (BU), are not legal in Australia. Some doctors practice them, but I know one that was suspended to practice medicine, because four chroocks sent from an Authority of Q.ld in his practice, Suspended such doctors that saved lots of people with natural therapies. Carefully, Natural compounds, not PATENTED DRUGS. SEVY

Julie   10/11/2022 9:56:32 AM

If this presents itself as exactly as the description and photo images BUT No Bacteria pathology found by the Hospital, does this mean that the hospital needs to adjust testing or could there be another variant? I had exact same infection on my patella. Dr's couldn't grow anything from swab and was required to undergo two surgeries discharged with Vac Pac for 7 weeks, looking at then skin graft. The cells grew over the knee cap thankfully and skin graft not required. Does this mean that the 'Bacteria cells' are still in the body or once healed, it is indeed gone.

Elizabeth   3/03/2024 5:04:59 AM

If extreme heat is applied to the nodule before the site grows further it appears to extinguish the infection. Heat was applied before taking prescribed antibiotics and the swelling disappeared within hours. It was discovered that some Africans apply heat also when afflicted. It's believed the course of action is needed in the very early stages.