Mycobacterium ulcerans, the organism which causes Buruli or Bairnsdale ulcer, has never been isolated in culture from an environmental sample. Most foci of infection are in tropical regions. The authors describe the first 29 cases of M. ulcerans infection from a new focus on an island in temperate southern Australia, 1992-5. Cases were mostly elderly, had predominantly distal limb lesions and were clustered in a small region in the eastern half of the main town on the island. The authors suspected that an irrigation system which lay in the midst of the cluster was a source of infection. Limitation of irrigation was associated with a dramatic reduction in the number of new cases. These findings support the hypothesis that M. ulcerans has an aquatic reservoir and that persons may be infected directly or indirectly by mycobacteria disseminated locally by spray irrigation.

OBJECTIVE:To document the emergence of new foci of Mycobacterium ulcerans infection (Bairnsdale ulcer) in Victoria.METHODS:From data kept by one of us (JAH) and records from the Mycobacterium Reference Laboratory, Fairfield Hospital, we reviewed cases of M. ulcerans infection in Victoria between 1980 and 1995, and identified those apparently acquired outside the east Gippsland endemic region. A case was defined as a person with a lesion suggestive of M. ulcerans infection, from which the organism had been cultured or, in the absence of culture information, from which a histological specimen characteristic of M. ulcerans infection had been obtained.RESULTS:We identified 45 people who appeared to have acquired their infections in Victoria but outside the east Gippsland region. A new focus appeared on the northern shores of Western Port, near Melbourne, in 1982, and there was a dramatic increase in cases between 1991 and 1994 associated with foci on Phillip Island, and in the Frankston-Langwarrin area of outer suburban Melbourne. Single cases came from Crib Point, Narre Warren and Bendigo.CONCLUSIONS:There have been at least three new foci of M. ulcerans infection within 80 km of Melbourne since 1982. Victorian clinicians should consider the possibility of Bairnsdale ulcer when dealing with unusual skin lesions.

Pseudoepitheliomatous hyperplasia of the epidermis occurring with Mycobacterium ulcerans skin infection may result in localization of the infected area with discharge of necrotic material, followed by healing leaving a depressed scar. The process represents more than simple re-epithelization of an ulcerated skin surface; it is a mechanism which produces active extrusion of necrotic material containing viable mycobacteria and should be seen as part of a protective physiological response to the infection.

Medical Journal of AustraliaVolume 162, Issue 4 p. 221-222 Letter Mycobacterium ulcerans infection on Phillip Island, Victoria Paul D R Johnson, Paul D R Johnson Infectious Diseases Physician, Research Officer Fairfield Hospital, Department of Microbiology, Royal Children's Hospital, Fairfield Hospital, Fairfield, VIC, 3078Search for more papers by this authorMark G K Veitch, Mark G K Veitch Epidemiology Registrar National Centre for Epidemiology and Population Health, Department of Health and Community Services, VICSearch for more papers by this authorPaul E Flood, Paul E Flood General Practitioner Cowes Medical Centre, Cowes, VICSearch for more papers by this authorJohn A Hayman, John A Hayman Director of Pathology National Centre for Epidemiology and Population Health, Department of Health and Community Services, VIC Box Hill Hospital, Box Hill, VICSearch for more papers by this author Paul D R Johnson, Paul D R Johnson Infectious Diseases Physician, Research Officer Fairfield Hospital, Department of Microbiology, Royal Children's Hospital, Fairfield Hospital, Fairfield, VIC, 3078Search for more papers by this authorMark G K Veitch, Mark G K Veitch Epidemiology Registrar National Centre for Epidemiology and Population Health, Department of Health and Community Services, VICSearch for more papers by this authorPaul E Flood, Paul E Flood General Practitioner Cowes Medical Centre, Cowes, VICSearch for more papers by this authorJohn A Hayman, John A Hayman Director of Pathology National Centre for Epidemiology and Population Health, Department of Health and Community Services, VIC Box Hill Hospital, Box Hill, VICSearch for more papers by this author First published: 01 February 1995 https://doi.org/10.5694/j.1326-5377.1995.tb126034.xCitations: 19AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume162, Issue4February 1995Pages 221-222 RelatedInformation

Medical Journal of AustraliaVolume 160, Issue 3 p. 160-160 Letter to the Editor Mycobacterium ulcerans infection on Phillip Island, Victoria Paul Flood MB BS, DRCOG, DipRACOG, Paul Flood MB BS, DRCOG, DipRACOG General Practitioner Warley Avenue Medical Centre Cowes, VIC, 3922Search for more papers by this authorAlan Street MB BS, FRACP, Alan Street MB BS, FRACP Infectious Diseases Physician Fairfield Hospital, PO Box 65, Fairfield, VIC, 3078Search for more papers by this authorPaul O'Brien MD, FRACS, Paul O'Brien MD, FRACS Professor of Surgery Alfred Hospital, Commercial Road, Prahran, VIC, 3181Search for more papers by this authorJohn Hayman MD, FRCPA, FACTM, John Hayman MD, FRCPA, FACTM Director of Pathology Box Hill Hospital PO Box 94, Box Hill, VIC, 3128*Author to whom correspondence may be addressed.Search for more papers by this author Paul Flood MB BS, DRCOG, DipRACOG, Paul Flood MB BS, DRCOG, DipRACOG General Practitioner Warley Avenue Medical Centre Cowes, VIC, 3922Search for more papers by this authorAlan Street MB BS, FRACP, Alan Street MB BS, FRACP Infectious Diseases Physician Fairfield Hospital, PO Box 65, Fairfield, VIC, 3078Search for more papers by this authorPaul O'Brien MD, FRACS, Paul O'Brien MD, FRACS Professor of Surgery Alfred Hospital, Commercial Road, Prahran, VIC, 3181Search for more papers by this authorJohn Hayman MD, FRCPA, FACTM, John Hayman MD, FRCPA, FACTM Director of Pathology Box Hill Hospital PO Box 94, Box Hill, VIC, 3128*Author to whom correspondence may be addressed.Search for more papers by this author First published: 01 February 1994 https://doi.org/10.5694/j.1326-5377.1994.tb126569.xCitations: 26 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume160, Issue3February 1994Pages 160-160 RelatedInformation