What is Buruli ulcer?

Buruli ulcer is a bacterial disease that causes damage to your skin and soft tissues. If it is not treated, it can spread over many months, leading to severe skin and limb damage.

In Australia, it's also sometimes called Bairnsdale ulcer, Daintree ulcer and Mossman ulcer.

Buruli ulcer has been reported in 34 countries — in Africa, the Americas, Asia and the Western Pacific.

Most cases occur in tropical and subtropical areas, except in Australia and Japan.

Where does Buruli ulcer occur in Australia?

In Australia, infections are geographically limited to:

• Coastal Victoria
• Far North Queensland
• The Capricorn coast of Queensland
• New South Wales — particularly around Batemans Bay

The number of people with Buruli ulcer in Australia has increased in the past few years.

What are the symptoms of Buruli ulcer?

Buruli ulcer starts like a small mosquito bite and forms a painless lump on the arms, legs or face.

The lump grows bigger over days, weeks or months. The skin around the lump might start to break down and form an ulcer. If not treated, the ulcer can grow and spread deeper into skin tissue including muscle and bone. Unlike other ulcers, this ulcer may happen with no pain or fever or other signs of infection.

Sometimes, Buruli infection may present with no ulcer, and cause a raised, rough patch on the skin, fever or swelling of the affected limb.

What causes Buruli ulcer?

Buruli ulcer is caused by the bacteria Mycobacterium ulcerans. It comes from the same family as the bacteria that cause tuberculosis and leprosy.

The bacteria produce a toxin (poison) that causes damage to your:

• skin
• small blood vessels
• fat layer under the skin

Mycobacterium ulcerans lives in the natural environment, usually in areas of swampy or still water.

For a long time, doctors did not know how Mycobacterium ulcerans spread to humans. Researchers have now confirmed that it is spread through mosquitoes.

Buruli ulcers happen more often in people who:

• have diabetes
• work outside and have contact with soil

Buruli ulcer is not spread from person to person.

When should I see my doctor?

See your doctor if you think that you may have a Buruli ulcer.

Early diagnosis and treatment are very important, as the ulcer gets bigger with time and can cause complications if not treated.

Buruli ulcer is a notifiable disease in Victoria, the Northern Territory, Queensland and New South Wales. If you have Buruli ulcer, your doctor will notify the Department of Health and Aged Care so they are aware of cases and can monitor the condition's spread and reduce its effect on the community.

How is Buruli ulcer diagnosed?

Your doctor will talk with you and examine your skin. They may ask you if you've recently been to places where Buruli ulcers more commonly occur.

Your doctor may do a swab test or take a biopsy of the affected area to test for Mycobacterium ulcerans.

How is Buruli ulcer treated?

Early identification of Buruli ulcer is essential for its successful treatment.

In Australia, the main treatment for Buruli ulcer is oral antibiotics. You will need to take them for 6 to 8 weeks. Treatment usually cures the infection.

You may need surgery to remove dead tissue and to close your wound. You may also need to have a skin graft.

What are the complications of Buruli ulcer?

Buruli ulcer can cause significant damage to the skin. It's important to get treatment early, to help prevent the spread of infection and complications.

Complications of Buruli ulcer may include:

• tissue damage (sometimes involving large areas of skin)
• secondary infections of the ulcer on your skin
• osteomyelitis (infection that spreads to the bone)
• metastatic lesions (ulcers appearing at distant sites on the body)
• scarring, which can lead to:
  • permanent changes in appearance
  • lymphoedema (swelling of limbs due to fluid build-up)
  • reduced movement in nearby joints
• long-term disability or changes in appearance
• emotional, social or financial difficulties from long treatment or reduced movement

While deaths from Buruli ulcer are rare, the disease can have a lasting effect on quality of life.

Sometimes antibiotics can cause a 'paradoxical reaction,' where the ulcer looks worse or more inflamed while it's healing. This is usually temporary and can be managed with extra care.

Can Buruli ulcer be prevented?

The best way to prevent Buruli ulcers is to protect yourself from mosquito bites:

• Wear loose, long-sleeved, light-coloured clothing. Remember to also wear socks and covered shoes. Mosquitoes will bite through tight clothing.
• Wear gloves when gardening.
• Use insect repellent on exposed skin that contains DEET, picaridin or oil of lemon eucalyptus.
• Empty containers of still water around your home, such as pot plant saucers —mosquitoes breed in still water.
• Fit insect screens to windows and doors in your home to keep mosquitoes out.

You should also:

• cover cuts and grazes with a bandage
• promptly clean new cuts and grazes that you get while working outside

The bacillus Calmette–Guérin (BCG) vaccine, which is used to prevent tuberculosis, may give some protection against Mycobacterium ulcerans.

The most important risk factor for getting Buruli ulcer is living in or visiting the areas where it occurs.

Resources and support

You can find out more from Health Victoria on Mycobacterium ulcerans infection.

The Victorian Department of Health has also published fact sheets on preventing mosquito bites in languages other than English.

You can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

The World Health Organization has a fact sheet on Buruli ulcer available in several community languages.