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A Buruli ulcer epidemic has broken out in Australia and is rampant in West Africa
Australia has been warned of a “rapidly worsening epidemic” of the terrifying disease which gnaws away at its victims to cause oozing lesions and skin ulcers.
The Mycobacterium ulcerans infection, commonly known as Buruli ulcer, is an infectious disease present in at least 33 countries across Africa, South America, the West Pacific and Australia. Until recently it was most commonly found in rural farming communities in certain parts of West African countries, however the rising cases in suburban Australia is a new pattern.
An article in The Medical Journal of Australia warned: “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 bug is related to leprosy and TB, but is different because it makes a unique toxic chemical which destroys the skin tissue. According to the World Health Organisation (WHO), no one quite knows how the infection is spread.
The main burden of the disease has been felt in West Africa for many years, but the increase in cases of a genetically different strain of the bacteria in Australia has concerned their medical community.
So far the disease has been reported in coastal areas in Victoria, including the Bellarine and Mornington peninsulas, but reports of the infection creeping into Melbourne’s suburbs have popped up.
Many scientists have now called for more research, funding and public awareness of the “Neglected Tropical Disease” as the number of infections rise.
Dr Rachel Simmonds, an expert in Buruli ulcer from the University of Surrey who has spent the last fourteen years studying the bacterial infection, has spoken to Express.co.uk to share everything she knows about the disease.
Can Buruli ulcer spread to the UK?
Luckily for the British Isles, there is a myriad of reasons why the harmful bacteria is incredibly unlikely to spread into the UK.
Dr Simmonds explained: “There are two main reasons why the people in the UK shouldn’t be alarmed.
“Firstly Buruli ulcer is not contagious – it is not spread from person to person. Instead it is acquired from the environment, and probably needs to be transferred into the deep layers of the skin to take hold. However, we don’t actually know what the route of transmission is, and that’s one of the key research priorities.”
“Secondly, because the bacteria likes to grow at around 30ºC it is not thought that the UK is hot enough for them to survive in the environment. Of course, nobody knows what might happen in the future should global warming change the environmental conditions, but that is a complete unknown.”
But what about the risk of the infection being unwittingly carried over to the UK via tourists flying home from Australia?
Thankfully according to Dr Simmonds, there is no risk of Buruli ulcer being spread between travellers like other contagious diseases such as the flu.
In fact the Hospital for Tropical Diseases at UCHL, London, only sees about one case per decade of people who have travelled abroad and returned with Buruli.
How is Buruli ulcer spread?
Unfortunately this remains the source of much debate in the medical and scientific community – particularly in the case of Australia.
The mode of environmental transmission appears to be different in Australia and Africa, perhaps because the bacteria have genetic differences and each make a slightly different toxin.
There are two main reasons why the people in the UK shouldn’t be alarmed
In Australia it is thought Buruli is spread via mosquitos and possums.
Dr Simmonds said: “The idea is that the bacteria is in possum poo and mosquitos landing on it collect bacteria which can then be transferred when that mossie bites a person. But there’s no evidence of a link with mosquitos in Africa. If this was the case, the disease would almost certainly be an even bigger problem there than it is.”
But what is clear at the moment is Buruli ulcer is not spread from person to person.
In Africa, the infection is probably spread through contaminated water, water bugs and plants, which Dr Simmonds said is big concern for young teenage children who are the most common victims in West Africa, and has a big impact on families caring for them.
Buruli ulcer infections have been reported in 33 countries from Africa to South America
Buruli ulcer is an environmental pathogen which causes skin ulcers
What are the symptom of Buruli ulcer infection?
Dr Simmonds said: “It’s a tricky bacteria to work with and research because it grows so slowly. It can be weeks or months between being infected and seeing any clinical appearance at all.
“The initial symptom is what is called a ‘nodule’ under the skin. It’s a lump in-between the skin and the connective tissue underneath, but you can move it around and it feels rather hard.”
“But of course many people wouldn’t immediately be concerned about something like that.”
However the expert said there is a good diagnostic tool which is uses a skin sample to determine whether a patient has contracted the infection. The problem is, Buruli ulcer is not the first thing GPs might think of when a patient arrives with certain symptoms.
“It is important to increase awareness, so that people who have been to affected regions know to ask for help if they have a nodule or a painless ulcer” Dr Simmonds added.
The risk of Buruli ulcer spreading to the UK is extremely low
Buruli ulcer experts have called for more research funding and awareness of the disease
Is Buruli ulcer treatable?
Treating the disease is possible but the treatment is long and unpleasant, and ulcers can take up to year or more to heal. The WHO advises a strong combination of antibiotics and complimentary treatments over several months to minimise the symptoms. Some people with large ulcers may need skin grafts; amputations used to be common but are now rare.
Unfortunately there are no currently known preventative methods which can be applied prior to infection – instead victims rely on early detection and antibiotic treatment.
According to Dr Simmonds, patients need to be given strong antibiotics for a period of two months.
She said: “My research has discovered how the toxin functions, and we are now working to use this information to enhance existing treatments and develop new antibiotics that can heal the ulcers more quickly”
“Stronger antibiotics are needed for a longer time to make sure all the super-tough bacteria are killed. A short course of penicillin would not clear the infection, so it is very important to get the right diagnosis and the right treatment as quickly as possible.”