Buruli Ulcer in Australia (BU)

Bairnsdale ulcer, Daintree ulcer, Mossman ulcer, Mycobacterium ulcerans infection, Flesh Easting Bug, Mornington Peninsula, Bellarine Peninsula

Short URL: goo.gl/h3a0b4


Outbreak ALERT: Victoria is experiencing a major Buruli ulcer outbreak.

Almost all cases are currently linked to the Mornington or Bellarine Peninsulas.

Click here for weekly updates of case numbers from DHHS Victoria (look for “Mycobacterium ulcerans”; page 2, 4th line from the top of the page).


“Beating Buruli in Victoria” is a major new government funded Buruli research and intervention program

 Click here for more information.


What is Buruli Ulcer?

Buruli ulcer (BU) is also called Bairnsdale ulcer in Victoria and Daintree ulcer in far north Queensland. BU is caused by the environmental pathogen Mycobacterium ulcerans. BU is an infection of skin and soft tissue acquired from the environment. The key risk factor is to spend time (as little as an hour in some cases) in an endemic area. The incubation period is long – averaging about 5 months (range 2 – 10 months). The mode of transmission is likely to include biting insects in Victoria. Also in Victoria infected possums appear to play a role as a reservoir and amplifier of M. ulcerans in the environment. In Australia the most active endemic areas currently are the Mornington and Bellarine Peninsulas and the Douglas Shire in far North Queensland between Mossman and just beyond the Daintree River.


Sketch map showing known endemic areas in Australia since 1948


Schematic map showing location of cases 2017 and 2018 combined

(n = 617).

Circle diameter is proportional to case numbers at that location.

(Presented at WHO Meeting on Buruli ulcer and other skin NTDs, 25-27 March 2019, Geneva).


Pictures (confirmed BU cases, Victoria; with permission)

Lower back ulcer - 12 year-old boy.

lower back.jpg


Buruli over the Achilles tendon on a 24-year-old before and after treatment with rifampicin plus clarithromycin

Buruli over the right forearm of a 30-year-old woman


Buruli ulcer over the left ankle of a 47-year-old man; this is a “cellulitic” presentation (no ulcer present)


How can I prevent BU?

BU is transmitted from the environment by penetrating trauma

Biting insects are suspected in Victoria.

· Wear shoes, long sleeves and trousers when outside (choose loose fitting, light coloured close-weaved materials to maximize mosquito protection).

· Avoid insect bites (cover up, use repellents); control mosquitoes on your property

· Clean and cover skin abrasions sustained outdoors

· Have a shower at the end of each day to remove dirt from the garden or beach.


Could I have Buruli ulcer?

BU is typically a slowly progressive single lesion that will not heal or respond to standard antibiotics. BU can occur anywhere but is typically located on exposed skin on lower or upper limbs. Multiple lesions occur occasionally. There are also less common “cellulitic” types of BU (see photo above) or rarely an “oedematous” type where a whole limb swells before an ulcer develops. People of any age including children can develop BU.


How is Buruli ulcer diagnosed and treated?

BU can be hard to diagnose if your doctor is unfamiliar with the condition. It helps to prompt your doctor and ask – could this be Buruli ulcer? Special tests are needed; see below. BU responds to specialized antibiotics and sometimes surgery is combined with antibiotics to ensure optimal healing with minimal scarring.


Notes on diagnosis for clinicians


If there is an ulcer already present, PCR can be performed straight from a swab

Make sure you can see biological material on the swab (see picture). Moisten and rub with saline if necessary.  

Specify “Mycobacterium ulcerans” or  “Bairnsdale/Buruli ulcer” and “PCR” clearly in clinical notes on the request slip.

BU cannot be diagnosed with routine “M,C,S”


NOTE If there is no ulcer yet a punch or incisional biopsy may be needed. You will need to ensure you sample the subcutaneous layer with your biopsy.

Send for histology but also fresh tissue for AFB smear, mycobacterial culture and M. ulcerans PCR.


MU swab for web.jpg



Microscopy: Acid-fast bacilli (Mycobacterium ulcerans) in a smear taken directly from a swab of an ulcer. 

The bacteria can be seen as red clumps on a blue background.  PCR confirmed this is M. ulcerans



This website is provided as a public service by Prof. Paul Johnson, Infectious Diseases Department, Austin Health. Infectious.Diseases@austin.org.au

Latest page update: 9th April, 2019


Professor Paul Johnson