Is flesh-eating bacteria that disfigure the body likely to spread in Australia?

Australians are gripped in fear, as a flesh-eating bacteria known as Buruli ulcer, continues to spread, raising fears of its potential arrival in major cities.

Previously considered rare in Australia, the ulcer has previously been reported across multiple regions, including North Queensland, the Northern Territory, and Victoria. However, its recent appearance in the coastal town of Batemans Bay, New South Wales (NSW), has become a growing concern.

Questions as to why ulcer cases in humans are popping up in areas hundreds of kilometres apart are leaving researchers puzzled, as they work to unravel the mystery behind the bacteria’s transmission.

Here’s what we know about this flesh-eating bacteria and its cases in Australia.

What we know about Buruli ulcer

Buruli ulcer, also known as Bairnsdale ulcer, is a bacterial infection caused by Mycobacterium ulcerans. It leads to a progressive infection that damages the skin and soft tissue.

The infection typically begins as a painless lump on the skin, often mistaken for an insect bite. However, it slowly spreads, burrowing into the layer of fat between the skin and the muscle lining. From there, it progresses through the body, eventually breaking through the skin to form an ulcer.

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If untreated, the ulcer continues to grow and leaves a gaping sore, which is why it’s often referred to as a “flesh-eating” disease.

Fortunately, Buruli ulcer is treatable. A six to eight-week course of specific antibiotics can effectively combat the infection, often combined with surgery to remove affected tissue.

The World Health Organization (WHO) classifies Buruli ulcer as a neglected tropical skin disease. While most cases are reported in 33 countries across West and Central Africa, the disease has gained attention in Australia.

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Rise in cases in Australia

Since the early 2000s, Buruli ulcer has increasingly been detected in coastal areas of Victoria, including suburbs around Melbourne and Geelong, putting the spotlight on this flesh-eating infection.

According to the Australian Associated Press, researchers are especially intrigued by a recent surge in Victoria, where a case is reported nearly every day. The coastal state has reported 347 cases confirmed in 2024 alone.

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However, its discovery in the NSW town of Batemans Bay, 110 km southeast of the capital Canberra has generated significant interest from local and interstate authorities.

“We were surprised to find Buruli ulcer in Batemans Bay, as there had been no previous cases reported in the region,” Mehrab Hossain, lead researcher of a peer-reviewed journal PLOS Neglected Tropical Diseases told AAP.

The coastal town has detected two cases: One of a 94-year-old man in 2023, who developed an ulcer on his finger, that led to the amputation of his finger another of a  71-year-old man who developed an ulcer on his arm, the Sydney Morning Herald reports.

“The new cases we report here in Batemans Bay could be a harbinger of a disease expansion in NSW similar to Victoria,” the group of Australian researchers said in their analysis.

Researchers from Victoria and NSW have proposed in the PLOS Neglected Tropical Diseases that Bateman’s Bay is a “new endemic focus” of human transmission of the disease.

Possums linked to flesh-eating bacteria

Prof Tim Stinear, scientific director of the Doherty Applied Microbial Genomics Centre, told The Guardian there is mounting evidence that possums and mosquitoes play a significant role in transmitting Buruli ulcer to humans.

“Possums seem to be susceptible to this infection, but they also shed the bacteria in their faeces in very high numbers. That bacteria can then enter mosquito-breeding sites,” he explained. Mosquitoes subsequently transfer the infection to humans.

Researchers conducted tests in Batemans Bay and found 27 samples of possum droppings that tested positive for the bacterium.

“The detection of positive possum excreta samples from Batemans Bay establishes beyond doubt that (the bacteria) is present in local possums,” the study stated.

Exercise caution

Although the risk remains low, NSW residents are advised to take precautions to prevent mosquito bites, according to Professor Paul Johnson, a Buruli ulcer expert at Austin Health and Melbourne University, who spoke to the Sydney Morning Herald.

Experts recommend using insect repellents containing DEET, wearing protective clothing outdoors, and practising proper hygiene by washing scratches and cuts. Additionally, people should mosquito-proof their homes with insect screens and avoid mosquito-prone areas, particularly during dawn and dusk.

“We don’t know if Buruli is going to spread in NSW, but it certainly is a possibility we need to be prepared for,” said Dr Anton Forsyth, senior medical advisor at Murrumbidgee Local Health District, which includes Batemans Bay, in an interview with the newspaper.

With input from agencies