Media release

From: Medical Journal of Australia (MJA)

Treatment of Buruli Ulcer

Buruli ulcer is a tropical disease caused by the environment bacterium Mycobacterium ulcerans. The bacteria releases toxins that can destroy skin, blood vessels and subcutaneous tissue, resulting in ulceration.

Previously, outbreaks of Buruli ulcer have largely been localised to coastal regions in Victoria and north Queensland, but transmission has now been reported in suburbs of Melbourne and in Bateman’s Bay in New South Wales.

The rise in cases prompted infectious disease specialists to update the 2014 consensus guidelines, with a new consensus statement published this week in the Medical Journal of Australia.

“With increasing experience and emerging evidence, this consensus statement considers contemporary data to provide up-to-date recommendations to clinicians who may encounter this disease,” the authors wrote.

The recommendations

The main recommendations and changes in management are as follows:

• Diagnosis should be undertaken using polymerase chain reaction, with a dry swab under the edge of the ulcer or tissue sample via punch biopsy if the lesion is not ulcerated.
• The recommended treatment is eight weeks of rifampicin-based dual oral antibiotics, in combination with clarithromycin or a fluoroquinolone. Shorter durations of treatment may be suitable for individuals with small lesions who are at low risk of relapse.
• Patients should be advised that ulcers typically enlarge during antibiotic treatment, and will take four to five months to heal.
• Aggressive surgery is no longer recommended, but conservative surgery may assist with healing times or with reducing the duration of antibiotics.
• Paradoxical reactions, also known as immune reconstitution inflammatory reactions, must be identified and treated as soon as possible, as they are associated with increased tissue necrosis and delayed wound healing.
• Effective wound care is essential for healing and prevention of secondary infection. Patients who are unable to attend to wound dressing themselves may require dressing assistance from community and district nursing services.

The consensus statement also provides specific recommendations for management of Buruli ulcer in patients requiring special considerations, such as children and Aboriginal and Torres Strait Islander people.

Prevention

The consensus statement recommends the following measures to reduce the risk of a Buruli ulcer:

• Avoid mosquito bites by using mosquito repellents, protective clothing and fly screens in the home.
• Remove potential mosquito breeding environments around the home, such as standing water in pot plants.
• Clean and protect any cuts and abrasions.
• Minimise contact with possums and their excreta.

Read the [research/perspective] in the Medical Journal of Australia.

The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA or the MJA unless that is so stated.