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Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:EN-US;} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1045"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-AU link=blue vlink=purple style='tab-interval:36.0pt'> <div class=WordSection1> <p class=MsoNormal style='margin-left:1.0cm'><span lang=EN-US style='font-family: Helvetica;mso-bidi-font-family:Helvetica'>Mulcerans.htm</span><span style='mso-ansi-language:EN-AU'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span class=SpellE><b style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:24.0pt; font-family:Helvetica;mso-bidi-font-family:Helvetica;color:#E01F11'>Buruli</span></b></span><b style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:24.0pt; font-family:Helvetica;mso-bidi-font-family:Helvetica;color:#E01F11'> ulcer<i style='mso-bidi-font-style:normal'> </i>in Australia <o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span class=GramE><b style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:16.0pt; mso-bidi-font-size:24.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#E01F11'>(<span class=SpellE>Buruli</span> ulcer, Bairnsdale ulcer, <span class=SpellE>Daintree</span> ulcer, Flesh Eating Bug, <i style='mso-bidi-font-style: normal'>Mycobacterium <span class=SpellE>ulcerans</span></i> infection).</span></b></span><b style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:16.0pt; mso-bidi-font-size:24.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#E01F11'><o:p></o:p></span></b></p> <p class=MsoNormal style='mso-line-height-alt:13.0pt;mso-pagination:none; tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'>What is <i style='mso-bidi-font-style:normal'>Mycobacterium ulcerans</i> infection? </span><span lang=EN-US style='font-size:16.0pt; font-family:Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'>Buruli ulcer, Bairnsdale ulcer and <span class=SpellE>Daintree</span> ulcer are all local names given to the same disease that is caused by <i style='mso-bidi-font-style: normal'>Mycobacterium <span class=SpellE>ulcerans</span></i>, an environmental bacterium that produces a toxin that damages skin and underlying tissue. The infection occurs in humans in more than 32 countries. In the Australian state of Victoria but not so far elsewhere, Buruli ulcer has also been found in possums, koalas, <span class=SpellE>potoroos</span>, dogs, cats and horses. &nbsp;In the popular press the infection is sometimes called the  the flesh-eating bug . The toxin produced by <i style='mso-bidi-font-style:normal'>Mycobacterium ulcerans</i> (<span class=SpellE>mycolactone</span>) does kill tissue (flesh), the process is usually </span><span lang=EN-US style='font-size:16.0pt; font-family:Helvetica;mso-bidi-font-family:Helvetica'>slow<span style='color:#453B3B'> but can become very destructive if not diagnosed and treated.<o:p></o:p></span></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'>How do you get infected?</span><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'> </span><span class=SpellE><span lang=EN-US style='font-size: 16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'>Buruli</span></span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'> ulcer is a geographically restricted infection (GRI). The means it is transmitted from the environment only in specific  endemic areas. &nbsp;In Victoria (southeastern Australia) there is new evidence that mosquitoes transmit the infection but there may be more than one mode of transmission. <i style='mso-bidi-font-style:normal'>Mycobacterium ulcerans </i>does not appear to spread from person to person. Recent research in Victoria has shown that the gastrointestinal tract of possums and/or possums with chronic <span class=SpellE>Buruli</span> ulcer may be an important environmental reservoir of <i style='mso-bidi-font-style:normal'>Mycobacterium <span class=SpellE>ulcerans</span> </i>in Victoria. Whether an animal reservoir or mosquito transmission are involved in endemic areas outside Victoria is not known.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'>Which areas are endemic? </span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>In Australia cases occur most years in several Victorian coastal towns, in far north Queensland from just south of Mossman to just north of the <span class=SpellE>Daintree</span> <span class=GramE>river,</span> the Capricorn Coast of southern Queensland and at a much lower rate from some other Australian coastal areas. So far no cases have been linked to Tasmania, South Australia or the ACT.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'>How many cases?</span><span lang=EN-US style='font-size:16.0pt; font-family:Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'> In 2010 there were 42 confirmed cases of Buruli ulcer in Australia reported to WHO; 32 were from Victoria, 9 from Queensland and one from the Northern Territory (see graphs below). The disease is notifiable in Victoria and updated case numbers can be viewed on the Victorian Department of Health daily reports (see link to  Daily Reports below). So far in 2011 there have been 50 new cases diagnosed in Victoria, most were from the <span class=SpellE>Bellarine</span> Peninsula (see maps below). Overseas, <span class=SpellE>Buruli</span> ulcer is an emerging disease in rural West and central Africa where there have been tens of thousands of cases in the last 25 years. <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:red'>IMPOPTANT NOTE:</span><span lang=EN-US style='font-size:16.0pt; font-family:Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'> There has been a marked increase in cases in both coastal Victoria and far north Queensland during 2011, possibly secondary to heavy December/January/February rain in both states. For a sketch map of the endemic area in Far North Queensland, <a href="http://www.mja.com.au/public/issues/176_04_180202/jen10309.html">click here</a>. For Victoria, see below.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:16.0pt;font-family:Wingdings; mso-bidi-font-family:Helvetica;color:#453B3B'>ê</span></b><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica; mso-bidi-font-family:Helvetica;color:#453B3B'>Graph</span></b><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>: <b style='mso-bidi-font-weight:normal'>Confirmed cases in Australia by year and state, 2004-2010.</b> <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><!--[if gte vml 1]><v:shapetype id="_x0000_t75" coordsize="21600,21600" o:spt="75" o:preferrelative="t" path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f"> <v:stroke joinstyle="miter"/> <v:formulas> <v:f eqn="if lineDrawn pixelLineWidth 0"/> <v:f eqn="sum @0 1 0"/> <v:f eqn="sum 0 0 @1"/> <v:f eqn="prod @2 1 2"/> <v:f eqn="prod @3 21600 pixelWidth"/> <v:f eqn="prod @3 21600 pixelHeight"/> <v:f eqn="sum @0 0 1"/> <v:f eqn="prod @6 1 2"/> <v:f eqn="prod @7 21600 pixelWidth"/> <v:f eqn="sum @8 21600 0"/> <v:f eqn="prod @7 21600 pixelHeight"/> <v:f eqn="sum @10 21600 0"/> </v:formulas> <v:path o:extrusionok="f" gradientshapeok="t" o:connecttype="rect"/> <o:lock v:ext="edit" aspectratio="t"/> </v:shapetype><v:shape id="_x0000_i1025" type="#_x0000_t75" style='width:452pt; height:326pt'> <v:imagedata src="Mulcerans_files/image001.jpg" o:title="graph of MU in Australia"/> </v:shape><![endif]--><![if !vml]><img border=0 width=454 height=328 src="Mulcerans_files/image002.png" v:shapes="_x0000_i1025"><![endif]><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:16.0pt;font-family:Wingdings; mso-bidi-font-family:Helvetica;color:#453B3B'>ê</span></b><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica; mso-bidi-font-family:Helvetica;color:#453B3B'>Figures</span></b><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'>: <b style='mso-bidi-font-weight:normal'>Google Earth image</b>, confirmed cases Victoria, 2010. <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><!--[if gte vml 1]><v:shape id="_x0000_s1040" type="#_x0000_t75" style='position:absolute;left:0; text-align:left;margin-left:0;margin-top:0;width:414pt;height:247pt;z-index:251657216; mso-wrap-edited:f' wrapcoords="-39 65 -39 21468 21600 21468 21600 65 -39 65"> <v:imagedata src="Mulcerans_files/image003.png" o:title=""/> <w:wrap type="tight"/> </v:shape><![endif]--><![if !vml]><img width=416 height=249 src="Mulcerans_files/image004.png" align=left hspace=9 v:shapes="_x0000_s1040"><![endif]><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B;mso-no-proof:yes'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:16.0pt;font-family:Wingdings; mso-bidi-font-family:Helvetica;color:#453B3B'>ê</span></b><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica; mso-bidi-font-family:Helvetica;color:#453B3B'>Figures</span></b><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'>: <b style='mso-bidi-font-weight:normal'>Google Earth image</b>, confirmed cases on the <span class=SpellE>Bellarine</span> and <span class=SpellE>Mornington</span> Peninsulas, Victoria, 2010. <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><!--[if gte vml 1]><v:shape id="_x0000_s1041" type="#_x0000_t75" style='position:absolute;left:0; text-align:left;margin-left:0;margin-top:0;width:415pt;height:322pt;z-index:251658240; mso-wrap-edited:f' wrapcoords="-39 50 -39 21499 21600 21499 21600 50 -39 50"> <v:imagedata src="Mulcerans_files/image005.png" o:title=""/> <w:wrap type="tight"/> </v:shape><![endif]--><![if !vml]><img width=417 height=324 src="Mulcerans_files/image006.png" align=left hspace=9 v:shapes="_x0000_s1041"><![endif]><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B;mso-no-proof:yes'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'>What are the symptoms and signs? </span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>The&nbsp;infection usually starts as a small&nbsp;spot (lesion) attached to the skin that enlarges over days to weeks.&nbsp;&nbsp;Some patients describe a dry scab that won't heal which then breaks down into an ulcer.&nbsp; Sometimes an insect bite is remembered but this is not universal. Lesions are usually (but not always) painless, and fever or other symptoms are usually absent. Eventually the spot breaks down at the centre and a slowly enlarging undermined ulcer appears but appearances can be variable and can be difficult to diagnose. Lesions are typically solitary and mostly occur on the lower leg or arm. However, they can be anywhere. In Africa, a <b style='mso-bidi-font-weight: normal'>nodule</b> (mobile lump) beneath the skin&nbsp;may be the first sign. Some patients present with <b style='mso-bidi-font-weight:normal'>plaques</b> rather than ulcers or <b style='mso-bidi-font-weight:normal'>develop swelling of the whole limb</b> or whole abdominal wall, without there initially being an identifiable nodule, plaque or ulcer, at least initially. &nbsp;<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:red'>IMPOPTANT NOTE:</span><span lang=EN-US style='font-size:16.0pt; font-family:Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'> Some patients have said that the term  <span class=SpellE>Buruli</span> ulcer is misleading, as an ulcer is not always present, leading to delayed diagnosis. <span class=SpellE>Buruli</span> (ulcer) is an important diagnosis to consider when <b style='mso-bidi-font-weight:normal'>people in endemic areas present with swelling of a whole limb</b> even if no ulcer or necrotic area is initially apparent. Others have mentioned a scaly crusty lesion that doesn t heal or ulcerate.  <span class=SpellE>Buruli</span> disease may be a better descriptor than <span class=SpellE>Buruli</span> ulcer to remind clinicians of these variations in presentation.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:20.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'>How is Buruli ulcer treated? </span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>Buruli ulcer is slow moving and always curable although it can be quite destructive. A 2-month course of antibiotics appears able to kill the bacteria. Lesions may <a href="http://www.mja.com.au/public/issues/191_10_161109/obr10554_fm.html">paradoxically worsen</a> during antibiotic treatment. Surgery and antibiotics are often used in combination to achieve optimal outcomes. <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:20.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><span style="mso-spacerun:yes"> </span><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:20.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:25.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:21.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1E18F8'>Pictures (confirmed cases from Australia)<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:25.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Wingdings;mso-bidi-font-family:Helvetica; color:#453B3B'>ê</span><span lang=EN-US style='font-size:16.0pt;font-family: Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'>Ear: <span class=GramE>2 year old</span> child, coastal Victoria, Australia&nbsp;[Photo Clinical Photography, Royal Children s Hospital, Melbourne]<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><!--[if gte vml 1]><v:shape id="Picture_x0020_1" o:spid="_x0000_i1026" type="#_x0000_t75" alt="image003.jpg" style='width:395pt; height:291pt;visibility:visible'> <v:imagedata src="Mulcerans_files/image007.jpg" o:title="image003" cropright="2473f"/> <v:textbox style='mso-rotate-with-shape:t'/> </v:shape><![endif]--><![if !vml]><img border=0 width=397 height=293 src="Mulcerans_files/image008.png" alt=image003.jpg v:shapes="Picture_x0020_1"><![endif]></span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:15.0pt;font-family:Arial;color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span class=GramE><span lang=EN-US style='font-size:16.0pt;font-family:Wingdings;mso-bidi-font-family: Helvetica;color:#453B3B'>ê</span><span lang=EN-US style='font-size:16.0pt; font-family:Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'>Leg, adult&nbsp;female, early diagnosis.</span></span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>&nbsp; [Photo: Dr. Paul Flood, Phillip Island].<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><!--[if gte vml 1]><v:shape id="_x0000_i1027" type="#_x0000_t75" style='width:415pt;height:180pt'> <v:imagedata src="Mulcerans_files/image009.jpg" o:title="leg early diagnosis" croptop="10123f"/> </v:shape><![endif]--><![if !vml]><img border=0 width=417 height=182 src="Mulcerans_files/image010.png" v:shapes="_x0000_i1027"><![endif]></span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Wingdings;mso-bidi-font-family:Helvetica; color:#453B3B'>ê</span><span lang=EN-US style='font-size:16.0pt;font-family: Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'>Elbow ulcer, <span class=GramE>9 year old</span> girl, delayed diagnosis.&nbsp; [Photo:&nbsp;Clinical Photography, Royal Children s Hospital, <span class=GramE>Melbourne</span>]<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><!--[if gte vml 1]><v:shape id="Picture_x0020_11" o:spid="_x0000_i1028" type="#_x0000_t75" alt="elbow.jpg" style='width:396pt; height:264pt;visibility:visible'> <v:imagedata src="Mulcerans_files/image011.jpg" o:title="elbow"/> <v:textbox style='mso-rotate-with-shape:t'/> </v:shape><![endif]--><![if !vml]><img border=0 width=398 height=266 src="Mulcerans_files/image012.png" alt=elbow.jpg v:shapes="Picture_x0020_11"><![endif]></span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Wingdings;mso-bidi-font-family:Helvetica; color:#453B3B'>ê</span><span lang=EN-US style='font-size:16.0pt;font-family: Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'>Ankle - 23 <span class=SpellE>yo</span> woman, <b style='mso-bidi-font-weight:normal'>plaque</b> lesion (no ulcer apparent when diagnosed by biopsy) <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>[Photo:&nbsp;Dr. Paul Johnson, Austin Hospital, <span class=GramE>Melbourne</span>]<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><!--[if gte vml 1]><v:shape id="Picture_x0020_2" o:spid="_x0000_i1029" type="#_x0000_t75" alt="image009.jpg" style='width:396pt; height:264pt;visibility:visible'> <v:imagedata src="Mulcerans_files/image013.jpg" o:title="image009"/> <v:textbox style='mso-rotate-with-shape:t'/> </v:shape><![endif]--><![if !vml]><img border=0 width=398 height=266 src="Mulcerans_files/image014.png" alt=image009.jpg v:shapes="Picture_x0020_2"><![endif]></span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Wingdings;mso-bidi-font-family:Helvetica; color:#453B3B'>ê</span><span lang=EN-US style='font-size:16.0pt;font-family: Helvetica;mso-bidi-font-family:Helvetica;color:#453B3B'>Lower back ulcer - 12 <span class=SpellE>yo</span> boy. The markings show the area of palpable induration (swelling) that is more extensive than the ulcer itself.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>[Photo:&nbsp;Mr. John <span class=SpellE>Buntine</span>, Melbourne]<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><!--[if gte vml 1]><v:shape id="Picture_x0020_4" o:spid="_x0000_i1030" type="#_x0000_t75" alt="lower back.jpg" style='width:391pt; height:260pt;visibility:visible'> <v:imagedata src="Mulcerans_files/image015.jpg" o:title="lower back"/> <v:textbox style='mso-rotate-with-shape:t'/> </v:shape><![endif]--><![if !vml]><img border=0 width=393 height=262 src="Mulcerans_files/image016.png" alt="lower back.jpg" v:shapes="Picture_x0020_4"><![endif]></span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='line-height:29.0pt;mso-pagination:none;tab-stops: 28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:24.0pt;font-family:Helvetica; mso-bidi-font-family:Helvetica;color:#080701'><span style='mso-tab-count:1'>    </span>Links to guidelines, articles and useful sites<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:24.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='line-height:22.0pt;mso-pagination:none;tab-stops: 28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:#1918F8'><span style='mso-tab-count:1'>       </span>Publications about <span class=SpellE>Buruli</span> ulcer on the <span class=SpellE>Bellarine</span> peninsula, Victoria, Australia<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:#1918F8'><o:p>&nbsp;</o:p></span></b></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l7 level1 lfo2;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.cdc.gov/eid/content/13/11/1653.htm"><span style='color:windowtext'>Mycobacterium <span class=SpellE>ulcerans</span> and Mosquitoes (Point Lonsdale)</span></a></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l3 level1 lfo4;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.cdc.gov/eid/content/13/11/1661.htm"><span style='color:windowtext'>Risk factors of Mycobacterium <span class=SpellE>ulcerans</span> infection in southeastern Australia</span></a></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l5 level1 lfo6;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671447/"><span style='color:windowtext'>Mosquitoes, <span class=SpellE>Buruli</span> ulcer and other vector borne diseases in Victoria, Australia</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l5 level1 lfo6;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000791"><span style='color:windowtext'>Possums and <span class=SpellE>Buruli</span> ulcer in Victoria, Australia</span></a></span><span lang=EN-US style='font-size:14.0pt; font-family:Arial'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 22.0pt;mso-pagination:none;mso-list:l5 level1 lfo6;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp; </span></span></span><![endif]><span lang=EN-US style='mso-bidi-font-size:14.0pt'><span style='mso-tab-count:1'>   </span><a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001305"><span style='color:windowtext'>Mosquitoes and risk of <span class=SpellE>Buruli</span> ulcer on the <span class=SpellE>Bellarine</span> Peninsula, Victoria</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:22.0pt;mso-pagination:none;tab-stops: 28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l5 level1 lfo6;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.mja.com.au/public/issues/187_10_191107/que10395_fm.html"><span style='color:windowtext'>Mycobacterium <span class=SpellE>ulcerans</span> infection: factors influencing diagnostic delay</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l5 level1 lfo6;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.mja.com.au/public/issues/186_02_150107/obr10433_fm.html"><span style='color:windowtext'>Outcomes for Mycobacterium <span class=SpellE>ulcerans</span> infection with combined surgery and antibiotic therapy: findings from a southeastern Australian case series.</span></a></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l5 level1 lfo6;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.mja.com.au/public/issues/191_10_161109/obr10554_fm.html"><span style='color:windowtext'>Paradoxical reactions (apparent worsening) during antibiotic treatment</span></a></span><span lang=EN-US style='font-size:14.0pt; font-family:Arial;mso-bidi-font-family:Times'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l5 level1 lfo6;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><u><span lang=EN-US><a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001290"><span style='color:windowtext'>Spontaneous clearance of Mycobacterium <span class=SpellE>ulcerans</span> in a case of <span class=SpellE>Buruli</span> ulcer</span></a><o:p></o:p></span></u></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span class=SpellE><b style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:14.0pt; font-family:Arial;mso-bidi-font-family:Helvetica;color:#1918F8'>Buruli</span></b></span><b style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:14.0pt; font-family:Arial;mso-bidi-font-family:Helvetica;color:#1918F8'> ulcer in Far North Queensland</span></b><span lang=EN-US style='font-size:14.0pt;font-family: Arial;mso-bidi-font-family:Helvetica;color:#1918F8'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l5 level1 lfo6;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><u><span lang=EN-US><a href="http://www.mja.com.au/public/issues/176_04_180202/jen10309.html"><span style='color:windowtext'>A case of acute <span class=SpellE>odematous</span> <span class=SpellE>Buruli</span> ulcer (<span class=SpellE>Daintree</span> ulcer) in far north Queensland</span></a><o:p></o:p></span></u></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><u><span lang=EN-US><o:p><span style='text-decoration:none'>&nbsp;</span></o:p></span></u></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l5 level1 lfo6;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><u><span lang=EN-US><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1445-2197.2010.05338.x/pdf"><span style='color:windowtext'>Mycobacterium <span class=SpellE>ulcerans</span> infection in North Queensland:<span style="mso-spacerun:yes">  </span>the  <span class=SpellE>Daintree</span> ulcer </span></a><o:p></o:p></span></u></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><u><span lang=EN-US><o:p><span style='text-decoration:none'>&nbsp;</span></o:p></span></u></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:#1918F8'>World Health Organization</span></b><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l9 level1 lfo8;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='mso-bidi-font-family: Arial'><a href="http://www.who.int/buruli/en/"><span class=SpellE><span style='color:windowtext'>Buruli</span></span><span style='color:windowtext'> ulcer - WHO</span></a></span><span lang=EN-US style='mso-bidi-font-family:Times'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='mso-bidi-font-family:Times'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l9 level1 lfo8;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='mso-bidi-font-family: Helvetica'><a href="http://www.who.int/buruli/information/antibiotics/en/index.html"><span style='color:windowtext'>Provisional antibiotic treatment guidelines, WHO</span></a></span><span lang=EN-US style='mso-bidi-font-family:Times'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='mso-bidi-font-family:Times'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l9 level1 lfo8;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><u><span lang=EN-US style='mso-bidi-font-family: Helvetica'><a href="http://apps.who.int/whocc/Detail.aspx?cc_ref=AUS-95&amp;cc_contact=paul&amp;"><span style='color:windowtext'>WHO Collaborating Centre for Mycobacterium <span class=SpellE>ulcerans</span> (WHO website)</span></a><o:p></o:p></span></u></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><u><span lang=EN-US style='mso-bidi-font-family:Helvetica'><o:p><span style='text-decoration: none'>&nbsp;</span></o:p></span></u></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l9 level1 lfo8;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><u><span lang=EN-US style='mso-bidi-font-family: Arial'><a href="http://www.vidrl.org.au/labsandunits/mulcerans/mulcerans_idx.htm"><span style='color:windowtext'>WHO Collaborating Centre for Mycobacterium <span class=SpellE>ulcerans</span> (VIDRL, Melbourne)</span></a><o:p></o:p></span></u></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:#1918F8'><o:p>&nbsp;</o:p></span></b></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:#1918F8'>Emerging Infectious Diseases (Journal)<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l8 level1 lfo10;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.cdc.gov/eid/content/13/11/1653.htm"><span style='color:windowtext'>Mycobacterium <span class=SpellE>ulcerans</span> and Mosquitoes (Point Lonsdale)</span></a></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l8 level1 lfo10;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.cdc.gov/eid/content/13/11/1661.htm"><span style='color:windowtext'>Risk factors of Mycobacterium <span class=SpellE>ulcerans</span> infection in southeastern Australia</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l8 level1 lfo10;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671447/"><span style='color:windowtext'>Mosquitoes, <span class=SpellE>Buruli</span> ulcer and other vector borne diseases in Victoria, Australia</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:blue'><o:p>&nbsp;</o:p></span></b></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:blue'>Public Library of Science (Journal)<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:blue'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l1 level1 lfo12;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://medicine.plosjournals.org/perlserv/?request=get-document&amp;doi=10.1371/journal.pmed.0020108"><span class=SpellE><span style='color:black'>Buruli</span></span><span style='color:black'> ulcer (review)</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l1 level1 lfo12;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000791"><span style='color:black'>Possums and <span class=SpellE>Buruli</span> ulcer in Victoria, Australia</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family: Arial;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:blue'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 22.0pt;mso-pagination:none;mso-list:l1 level1 lfo12;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:blue'><span style="mso-spacerun:yes"> </span><span style='mso-tab-count:1'>  </span></span><u><span lang=EN-US><a href="http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000770"><span style='color:windowtext'>All oral antibiotics for the treatment of <span class=SpellE>Bairnsdale</span>/<span class=SpellE>Buruli</span> ulcer</span></a></span></u><b style='mso-bidi-font-weight:normal'><u><span lang=EN-US style='font-size:14.0pt; font-family:Arial;mso-bidi-font-family:Helvetica'><o:p></o:p></span></u></b></p> <p class=MsoNormal style='line-height:22.0pt;mso-pagination:none;tab-stops: 28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:blue'><o:p>&nbsp;</o:p></span></b></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:blue'>Medical Journal of Australia<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l2 level1 lfo14;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://mja.com.au/public/issues/186_02_150107/joh10634_fm.html"><span style='color:black'>Consensus statement on diagnosis, treatment and control of <span class=SpellE>Bairnsdale</span>/ <span class=SpellE>Buruli</span><span style="mso-spacerun:yes">    </span>ulcer in Victoria, Australia</span></a> </span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l2 level1 lfo14;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.mja.com.au/public/issues/176_04_180202/jen10309.html"><span style='color:black'>Mycobacterium <span class=SpellE>ulcerans</span> in far North Queensland</span></a> </span><span lang=EN-US style='font-size:14.0pt; font-family:Arial;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l2 level1 lfo14;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.mja.com.au/public/issues/185_03_070806/letters_070806_fm-4.html"><span style='color:black'>Mycobacterium <span class=SpellE>ulcerans</span> in central coastal Queensland</span></a> </span><span lang=EN-US style='font-size:14.0pt; font-family:Arial;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l2 level1 lfo14;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://mja.com.au/public/issues/186_02_150107/lav10784_fm.html"><span style='color:black'>First case in New South Wales</span></a> </span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l2 level1 lfo14;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.mja.com.au/public/issues/187_01_020707/letters_020707_fm-8.html"><span style='color:black'>What is in a name? Note on naming of <span class=SpellE>Buruli</span> ulcer</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family: Arial;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l2 level1 lfo14;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.mja.com.au/public/issues/186_02_150107/contents_150107.html"><span style='color:black'>Editorial, pictures, 3 articles (January 15th 2007 edition)</span></a><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='color:black'><span style="mso-spacerun:yes"> </span></span><span lang=EN-US style='font-size:14.0pt; font-family:Arial;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l2 level1 lfo14;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.mja.com.au/public/issues/187_10_191107/que10395_fm.html"><span style='color:black'>Mycobacterium <span class=SpellE>ulcerans</span> infection: factors influencing diagnostic delay</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l2 level1 lfo14;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.mja.com.au/public/issues/186_02_150107/obr10433_fm.html"><span style='color:black'>Outcomes for Mycobacterium <span class=SpellE>ulcerans</span> infection with combined surgery and antibiotic therapy: findings from a southeastern Australian case series.</span></a><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l2 level1 lfo14;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.mja.com.au/public/issues/191_10_161109/obr10554_fm.html"><span style='color:black'>Paradoxical reactions (apparent worsening) during antibiotic treatment</span></a></span><span lang=EN-US style='font-size:14.0pt; font-family:Arial;mso-bidi-font-family:Times;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times; color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times; color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:blue'>Proceedings of the National Academy of Science (Journal)<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l4 level1 lfo16;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.pnas.org/cgi/content/abstract/0305877101v1"><span style='color:black'>Virulence genes of Mycobacterium <span class=SpellE>ulcerans</span> are encoded on giant plasmid</span></a> </span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica; color:black'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:blue'>Stop <span class=SpellE>Buruli</span> (NGO)<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l4 level1 lfo16;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.stopburuli.org/index.php/Leiden-unter-Ausschluss-der-Offentlichkeit.html"><span style='color:black'>Stop <span class=SpellE>Buruli</span> Home Page</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica; color:black'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica; color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l4 level1 lfo16;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.stopburuli.org/index.php/buruli-beat.html"><span class=SpellE><span style='color:black'>Buruli</span></span><span style='color:black'> Beat  Newsletter on all things <span class=SpellE>Buruli</span></span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica; color:black'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica; color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l4 level1 lfo16;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='color:black'><a href="http://www.stopburuli.org/downloads/Buruli_Beat_December_2010.pdf"><span style='color:black'>Oral antibiotics for <span class=SpellE>Buruli</span> ulcer</span></a> </span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Times;color:black'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times; color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times; color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:blue'>Genome Research (Journal)<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l6 level1 lfo18;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.genome.org/cgi/content/full/17/2/192"><span style='color:windowtext'>Full genome sequence of Mycobacterium <span class=SpellE>ulcerans</span></span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:blue'>Other articles<o:p></o:p></span></b></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l6 level1 lfo18;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.theage.com.au/national/flesheating-ulcer-claims-new-species-20090107-7c0m.html"><span style='color:windowtext'>The Age (Newspaper) Flesh-eating ulcer claims new species</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family: Arial'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l6 level1 lfo18;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol;mso-ansi-language:EN-AU'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.theage.com.au/news/national/ulcers-linked-to-mosquito-bites/2007/10/06/1191091425299.html"><span style='color:windowtext'>The Age (Newspaper) Ulcer linked to Mosquitoes</span></a></span><span style='mso-ansi-language:EN-AU'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span class=MsoHyperlink><u style='text-underline:#1918F8'><span lang=EN-US style='color:windowtext;text-underline:#1918F8;text-decoration:none;text-underline: none'><o:p>&nbsp;</o:p></span></u></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l6 level1 lfo18;tab-stops:11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.ncbi.nlm.nih.gov/pubmed/18495511?ordinalpos=2&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum"><span class=SpellE><span style='color:windowtext'>Localised</span></span><span style='color:windowtext'> Mycobacterium <span class=SpellE>ulcerans</span> infection in a cat in Australia.</span></a></span><span lang=EN-US style='mso-bidi-font-family:Times'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span style='mso-bidi-font-family:Times;color:black;mso-ansi-language:EN-AU'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span style='mso-bidi-font-family:Times;color:black;mso-ansi-language:EN-AU'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:18.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family: Helvetica;color:blue'>Department of Health (Victorian State Government)<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;color:black'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l0 level1 lfo20;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US style='mso-bidi-font-family:Arial'><a href="http://www.dhs.vic.gov.au/health/ideas/downloads/daily_reports/rptVS_SNIDSVictorianSummary_GR.pdf"><span style='color:windowtext'>Victorian Department of Health Daily Reports</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:17.0pt;mso-pagination: none;tab-stops:1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace: none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l0 level1 lfo20;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.health.vic.gov.au/chiefhealthofficer/alerts/mycobacterium.htm"><span style='color:windowtext'>DHS Victoria Health Alert</span></a> </span><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Times'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 17.0pt;mso-pagination:none;mso-list:l0 level1 lfo20;tab-stops:1.0pt 11.0pt 36.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span lang=EN-US><a href="http://www.health.vic.gov.au/ideas/diseases/myco_facts.htm"><span style='color:windowtext'>DHS Victoria, Mycobacterium <span class=SpellE>ulcerans</span>: the facts</span></a></span><span lang=EN-US style='font-size:14.0pt;font-family: Arial'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:17.0pt;mso-pagination:none;tab-stops: 1.0pt 11.0pt 36.0pt;mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;text-indent:-18.0pt;line-height: 22.0pt;mso-pagination:none;mso-list:l0 level1 lfo20;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><![if !supportLists]><span lang=EN-US style='font-size:14.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp; </span></span></span><![endif]><span lang=EN-US style='font-size:14.0pt;font-family:Arial'><span style="mso-spacerun:yes"> </span></span><span lang=EN-US><a href="http://hnb.dhs.vic.gov.au/web/pubaff/medrel.nsf/0/73a089d145929a1cca256fc0001fe124?OpenDocument"><span style='color:windowtext'>Mycobacterium <span class=SpellE>ulcerans</span> and mosquitoes</span></a> </span><span lang=EN-US style='font-size:14.0pt; font-family:Arial;mso-bidi-font-family:Helvetica'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:22.0pt;mso-pagination:none;tab-stops: 28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:36.0pt;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:14.0pt;font-family:Arial;mso-bidi-font-family:Helvetica; color:#1918F8'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:24.0pt;font-family:Helvetica; mso-bidi-font-family:Helvetica;color:#1918F8'>Notes on diagnosis for clinicians<o:p></o:p></span></b></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>Rapid accurate diagnosis can be made by PCR directly from swab.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>(Photo: Dr. Paul Johnson, Austin Hospital, <span class=GramE>Melbourne</span>)<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:red'>Specify  <i style='mso-bidi-font-style:normal'>Mycobacterium ulcerans</i> or<span style="mso-spacerun:yes">  </span> Bairnsdale/Buruli ulcer and  PCR clearly in clinical notes on the request slip. <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:29.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><!--[if gte vml 1]><v:shape id="Picture_x0020_8" o:spid="_x0000_i1031" type="#_x0000_t75" alt="MU swab for web.jpg" style='width:397pt; height:347pt;visibility:visible'> <v:imagedata src="Mulcerans_files/image017.jpg" o:title="MU swab for web"/> <v:textbox style='mso-rotate-with-shape:t'/> </v:shape><![endif]--><![if !vml]><img border=0 width=399 height=349 src="Mulcerans_files/image018.png" alt="MU swab for web.jpg" v:shapes="Picture_x0020_8"><![endif]></span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='line-height:19.0pt;mso-pagination:none;tab-stops: 28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><span style='mso-tab-count:1'>       </span>Details--DIAGNOSIS FROM A SWAB...</span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica; mso-bidi-font-family:Helvetica;color:red'>PCR can be performed straight from the swab</span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica; mso-bidi-font-family:Helvetica;color:#453B3B'><o:p></o:p></span></p> <p class=MsoNormal style='line-height:19.0pt;mso-pagination:none;tab-stops: 28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>1. If there is an ulcer, obtain a smear for <span class=GramE>acid fast</span> bacilli (AFBs) using a swab that is run around the undermined edge (if present). Ensure there is some visible tissue material/fluid on the swab.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>2. Request routine microscopy and culture and an AFB stain and PCR culture for <i style='mso-bidi-font-style:normal'>M. ulcerans</i>. VERY important: specify <i style='mso-bidi-font-style:normal'>M. ulcerans</i> PCR or write  Bairnsdale ulcer in the clinical notes to ensure correct handling of the specimen.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>3. If there is a suspicious necrotic skin lesion that has <u>not ulcerated</u>, or an <a href="http://www.mja.com.au/public/issues/176_04_180202/jen10309.html">acute <span class=SpellE>oedematous</span> presentation</a> is being considered perform an incisional (punch), fine needle aspirate or excisional biopsy, and remember to ask for <i style='mso-bidi-font-style:normal'>Mycobacterium <span class=SpellE>ulcerans</span></i> PCR (and histology, microscopy and culture). <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>Histological sections show extensive necrosis, and there are often large numbers of AFBs.&nbsp; PCR and culture of the biopsy specimens confirms the diagnosis. Granulomatous inflammation is sometimes seen in lesions that have been present for&nbsp;some time, and may herald the onset of healing.&nbsp;Culture takes 8-12 weeks, but you will need to treat the patient before culture results are available. PCR is more sensitive and much faster than culture. <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>NOTE: Negative swabs, and even negative incisional biopsies do not absolutely exclude the diagnosis because the organisms may not be spread evenly through the lesion.&nbsp; If in doubt, repeat biopsies.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:16.0pt;font-family:Wingdings; mso-bidi-font-family:Helvetica;color:#453B3B'>ê</span></b><b style='mso-bidi-font-weight: normal'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica; mso-bidi-font-family:Helvetica;color:#453B3B'>Microscopy</span></b><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'>: <span class=GramE>Acid fast</span> bacilli (<i style='mso-bidi-font-style:normal'>M. ulcerans</i>) in a smear taken directly from a swab of an ulcer.&nbsp; The bacteria can be clearly seen as red clumps on a blue background. This result can be available within 2 hours from a swab; if smear-positive the diagnosis is likely; a negative smear result <b style='mso-bidi-font-weight:normal'>does not</b> rule it out. PCR is more sensitive than smear.<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>&nbsp; <o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B;mso-no-proof:yes'><!--[if gte vml 1]><v:shape id="Picture_x0020_10" o:spid="_x0000_i1032" type="#_x0000_t75" alt="afb smear.jpg" style='width:418pt; height:226pt;visibility:visible'> <v:imagedata src="Mulcerans_files/image019.jpg" o:title="afb smear"/> <v:textbox style='mso-rotate-with-shape:t'/> </v:shape><![endif]--><![if !vml]><img border=0 width=420 height=228 src="Mulcerans_files/image020.png" alt="afb smear.jpg" v:shapes="Picture_x0020_10"><![endif]></span><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family: Helvetica;color:#453B3B'><o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:22.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:18.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#1918F8'>About this website<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:28.0pt;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>This is a privately funded website provided as a community service. The information is intended as a guide only and should not replace <span class=SpellE>personalised</span> medical advice from your doctor. Latest update October 2011<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:15.0pt;font-family:Arial;color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'>If you have questions/concerns about the contents or accuracy of this website please contact Dr. Paul Johnson by email: Paul.JohnsonATaustin.org.au (this email address is disguised to avoid automated SPAM; it can be recreated by replacing AT with the @ symbol)<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:16.0pt;font-family:Helvetica;mso-bidi-font-family:Helvetica; color:#453B3B'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm'><span style='mso-ansi-language: EN-AU'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm'><span style='mso-ansi-language: EN-AU'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm'><span style='font-size:8.0pt; mso-ansi-language:EN-AU'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm'><span style='font-size:8.0pt; color:white;mso-ansi-language:EN-AU'>HTML Snippet for Google Analysis<o:p></o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm'><span style='font-size:8.0pt; color:white;mso-ansi-language:EN-AU'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:1.0pt;font-family:Times;mso-bidi-font-family:Times;color:#463C3C'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:1.0pt;font-family:Times;mso-bidi-font-family:Times;color:#463C3C'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm;line-height:19.0pt;mso-pagination: none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 252.0pt 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none'><span lang=EN-US style='font-size:1.0pt;font-family:Times;mso-bidi-font-family:Times;color:#463C3C'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='margin-left:1.0cm'><span style='mso-ansi-language: EN-AU'><o:p>&nbsp;</o:p></span></p> </div> <script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-18607261-1']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 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