Buruli Ulcer in Australia (BU)

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

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

Almost all cases are currently linked to the Mornington or Bellarine Peninsulas, the Geelong suburb of Belmont and the Melbourne suburbs of Brunswick West, Essendon, Moonee Ponds, Pascoe Vale South and Strathmore.


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

 Click here for more information.


ABC Science Friction podcasts “Breaking Buruli” in Australia

Breaking Buruli, part one.

Breaking Buruli, part two


Pictures (confirmed BU cases, Victoria; with permission)

Lower back ulcer - 12 year-old boy.

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

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

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What is Buruli Ulcer?

Buruli ulcer (BU) is also called Bairnsdale ulcer in Victoria and Daintree ulcer in far north Queensland. BU is caused by the environmental pathogen Mycobacterium ulcerans. BU is an infection of skin and underlying soft tissue acquired from the environment. The key risk factor is to spend time (as little as an hour in some cases) in an endemic area. The incubation period is long – averaging about 5 months (range 2 – 10 months). In Australia the most active endemic areas currently are the Mornington and Bellarine Peninsulas and the Douglas Shire in far North Queensland, and now inner north Suburbs of Melbourne and Geelong. In Victoria, possums act as a reservoir and amplifier of Mycobacterium ulcerans and mosquitos are the main vector to humans.


Sketch map showing known endemic areas in Australia since 1948



How can I prevent BU?

There is now compelling evidence that in Victoria Buruli is transmitted by mosquitos

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

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


Could I have Buruli ulcer?

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


How is Buruli ulcer diagnosed and treated?

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


Notes on diagnosis for clinicians


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

Make sure you can see biological material on the swab (see picture).

Specify “Mycobacterium ulcerans” or  “Bairnsdale/Buruli ulcer” and “PCR” clearly in clinical notes on the request slip. (BU cannot be diagnosed with routine “M,C,S” )


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Microscopy: Acid-fast bacilli (Mycobacterium ulcerans) in a smear taken directly from a swab of an ulcer.  The bacteria can be seen as red clumps on a blue background.  PCR confirmed this is M. ulcerans


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NOTE If there is no ulcer yet a punch or incisional biopsy may be needed (see below). You will need to ensure you sample the subcutaneous layer with your biopsy. Send for histology but also fresh tissue for AFB smear, mycobacterial culture and M. ulcerans PCR.


Buruli ulcer over the left ankle of a 47-year-old man (no ulcer present)


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The discovery of mycolactone – the lipid toxin of the Buruli bacterium

Mycolactone production is encoded by a plasmid

Possums are reservoirs in Victoria

Mosquitos are vectors in Victoria

Location of 649 Buruli lesions on a human body map


This website is provided as a public service by Prof. Paul Johnson

North Eastern Public Health Unit

Latest page update: 9th May, 2022


Professor Paul Johnson  


Key words:

Bairnsdale ulcer, Buruli ulcer, Flesh Easting bug, mosquitos, possums, Mycobacterium ulcerans