Buruli ulcer surveillance in south-eastern Australian possums: infection status, lesion mapping and internal distribution ofMycobacterium ulcerans

Abstract

Buruli ulcer (BU) is a neglected tropical disease of skin and subcutaneous tissues caused by Mycobacterium ulcerans. BU-endemic areas are highly focal, and M. ulcerans transmission dynamics vary in different settings. In the south-eastern Australian state of Victoria, BU is an endemic vector-borne zoonosis, with mosquitoes and native possums implicated in transmission, and humans as incidental hosts. Despite the importance of possums as wildlife reservoirs of M. ulcerans, knowledge of BU in these animals is limited. Opportunistic necropsy-based and active trap-and-release surveillance studies were conducted in and around Melbourne and Geelong, Victoria, to investigate BU in possums. Demographic data and biological samples were collected, and when present, cutaneous lesions suggestive of BU were mapped. Samples were tested for the presence of M. ulcerans DNA by IS2404 qPCR. The final dataset included 26 possums: 20 necropsied; 6 trapped and released. Most possums (77%) were common ringtails from inner Melbourne. Nine possums (eight ringtails, one brushtail) had skin lesions, ranging from single and mild, to multiple and severe, exposing bones and tendons in three cases. M. ulcerans was confirmed in 78% (7/9) of clinically affected possums and 65% of possums without lesions (11/17). Possums with moderate and severe disease had widespread systemic internal bacterial dissemination and were shedding M. ulcerans in their faeces. The anatomical distribution of cutaneous lesions and PCR positivity of biological samples suggests possums may be contracting BU from bites of M. ulcerans-harbouring mosquitoes, traumatic skin wounds, ingestion of an unknown environmental source, and/or during early development in the pouch. Ringtail possums appear highly susceptible to infection with M. ulcerans and are important reservoirs of the bacteria in Victoria. A One Health approach is needed to design and implement integrated interventions that reduce M. ulcerans ZeroWidthSpace; transmission in Victoria, thereby protecting wildlife and humans from this emerging zoonotic disease.