What is Buruli ulcer?

Buruli ulcer is a bacterial disease that causes damage to your skin and soft tissues. If left untreated, it can spread over many months, leading to severe skin and limb damage. This is where it gets its “flesh-eating’ name.

In Australia, it’s also sometimes called Bairnsdale ulcer, Daintree ulcer and Mossman ulcer.

The infection was first recognised in the late 1930s by a doctor working in Bairnsdale, regional Victoria.

Buruli ulcer has been reported in 33 countries — in Africa, the Americas, Asia and the Western Pacific.

Most cases occur in tropical and subtropical areas, except for Australia and Japan.

Where does Buruli ulcer occur in Australia?

In Australia, infections are geographically limited to:

• Coastal Victoria
• Far North Queensland
• The Capricorn coast of Queensland — sometimes

In 2023, cases were seen in New South Wales for the first time.

The number of people with Buruli ulcer in Australia has increased in the past few years.

What are the symptoms of Buruli ulcer?

Buruli ulcer starts like a small mosquito bite and forms a painless lump on the arms, legs or face.

The lump grows bigger over days, weeks or months. The skin in the area of the lump might start to break down and form an ulcer. If not treated, the ulcer can grow and spread deeper into skin tissue including muscle and bone. Unlike other ulcers, this ulcer may happen with no pain or fever or other signs of infection.

Sometimes, Buruli infection may present with no ulcer, but cause a raised, rough patch on the skin, fever or swelling of the affected limb.

What causes Buruli ulcer?

Buruli ulcer is caused by the bacteria mycobacterium ulcerans. It comes from the same family as the bacteria that cause tuberculosis and leprosy.

The bacteria produce a toxin (poison) that causes damage to your:

• skin
• small blood vessels
• fat under your skin

Mycobacterium ulcerans lives in the natural environment, usually in areas of swampy or stagnant water.

For a long time, we did not know what how the mycobacterium ulcerans spread to humans. However, researchers have now confirmed that it is spread through mosquitoes.

Buruli ulcers happen more often in people who:

• have diabetes
• work outside and have contact with soil

Buruli ulcer is not spread from person to person.

When should I see my doctor?

See your doctor if you think that you may have a Buruli ulcer.

Early diagnosis and treatment are very important, as the ulcer gets bigger with time.

How is Buruli ulcer diagnosed?

Your doctor will talk with you and examine your skin. They may ask you if you’ve recently been places where Buruli ulcers occur.

Your doctor may take a biopsy of the affected area. This will be sent away for testing for mycobacterium ulcerans.

How is Buruli ulcer treated?

Early identification of Buruli ulcer is essential for its successful treatment.

In Australia, the main treatment for Buruli ulcer is oral (by mouth) antibiotics. These will need to be taken for 6 to 8 weeks. Cure rates with treatment are nearly 100%.

You may need surgery to remove dead tissue and to close your wound. You may also need to have a skin graft.

Can Buruli ulcer be prevented?

The best way to prevent Buruli ulcers is by protecting yourself against mosquito bites. You can do this by:

• Wearing loose, long-sleeved, light-coloured clothing. Remember to also wear socks and covered shoes. Mosquitoes will bite through tight clothing.
• When gardening, wear gardening gloves
• Use a mosquito repellent on exposed skin that contains DEET, picaridin or oil of lemon eucalyptus.
• Regularly check and empty any containers of still water around your home such as pot plant saucers. Mosquitos breed in still water.
• Mosquito proof your home with insect screens

You should also:

• cover cuts and grazes with a bandage
• promptly clean new cuts and grazes that you get while working outside

The bacillus Calmette–Guérin (BCG) vaccine, which is used to prevent tuberculosis, gives some protection against mycobacterium ulcerans.

Doing more than one protective behaviour lowers your chance of Buruli ulcer.

The most important risk factor for getting Buruli ulcer is living in or visiting the areas where it occurs.

Resources and support

You can find out more from Health Victoria on Mycobacterium ulcerans infection.

The Victorian Department of Health has also published fact sheets on preventing mosquito bites in languages other than English.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.