Consensus recommendations for the diagnosis, treatment and control of Mycobacterium ulcerans infection (Bairnsdale or Buruli ulcer) in Victoria, Australia

Abstract

Mycobacterium ulcerans causes slowly progressive, destructive skin and soft tissue infections, known as Bairnsdale or Buruli ulcer (BU). Forty‐six delegates with experience in the management of BU attended a 1‐day conference in Melbourne on 10 February 2006, with the aim of developing a consensus approach to the diagnosis, treatment and control of BU. An initial draft document was extended and improved during a facilitated round table discussion. BU is an environmental infection that occurs in specific locations. The main risk factor for infection is contact with an endemic area. Prompt cleaning of abrasions sustained outdoors, wearing protective clothing, and avoiding mosquito bites may reduce an individual's risk of infection. BU can be rapidly and accurately diagnosed by polymerase chain reaction testing of ulcer swabs or biopsies. Best outcomes are obtained when the diagnosis is made early. To aid early diagnosis, health authorities should keep local populations informed of new outbreaks. BU is best treated with surgical excision, which, if possible, should include a small rim of healthy tissue. For small lesions this may be all that is required. However, there is a role for antibiotics for more extensive disease, and their use may allow more conservative surgery.

Mycolactone Gene Expression Is Controlled by Strong SigA-Like Promoters with Utility in Studies of Mycobacterium ulcerans and Buruli Ulcer

“…Cases of BU are usually clustered around swamps and slow-flowing water and while the mode of transmission of M. ulcerans is unknown, evidence to date suggests, fish [5], snails [6] and certain carnivorous aquatic insects [7],[8] can all harbour the bacterium. Recent studies in Australia suggest mosquitoes may play a role in transmission [9],[10].…”

Ecology and Transmission of Buruli Ulcer Disease: A Systematic Review

“…However, country-wide data can obscure local variation in climate and the issue of seasonal trends needs to be more closely investigated at the local level. The unknown incubation period for Buruli ulcer, which may vary from 2 weeks to 7 months [92], [93], also makes it difficult to analyze seasonal factors with Buruli ulcer occurrence. Duker et al [4], and more recently Marion et al [94], discussed seasonal variations and M. ulcerans infections reported from different countries and concluded that there may be a temporal relationship between BU incidences and relatively dry periods; however, it also has been reported that M. ulcerans infections occurred mainly after flooding events [9], [16], [33], [34], [95].…”

“…However, in Marion et al [93], only one endemic area and one non-endemic area were evaluated, suggesting no replication, and thus, a limitation to testing how variable M. ulcerans is among endemic versus non-endemic areas/villages. This makes it difficult to compare to studies by Williamson et al [67] and Benbow et al [68] where multiple replicate sites were evaluated to test for M. ulcerans variability in standardized ecological samples.…”

Adequate Wound Care and Use of Bed Nets as Protective Factors against Buruli Ulcer: Results from a Case Control Study in Cameroon

“…This hypothesis is consistent with several results from environmental studies. In Australia, M. ulcerans infection is now considered a zoonosis transmitted from possum to human by mosquitoes [21], [22].…”