Flesh-eating bacteria taking over Victoria

A 13-year-old girl is calling for more research into an third world infection outbreak on Victoria’s Mornington Peninsula

Ella Crofts, 13, from the coastal region south of Melbourne, says her knee pain began in early April this year and slowly got worse, with the knee becoming swollen and inflamed until, one day, the skin started breaking down.

Its conditione worsened despite several courses of antibiotics for simple infections, with test after test for bacteria coming back negative – until eventually a punch biopsy came back positive for Mycobacterium ulcerans.

M. ulcerans is a member of the Mycobacteriaceae family of acid-fast bacilli, which also includes the mycobacteria that cause tuberculosis and leprosy.

It typically causes skin ulcers, otherwise known as Buruli ulcer – previously known as Bairnsdale or Daintree ulcer, as it was first diagnosed in the Bairnsdale area in the 1930s.

While the number of cases in Victoria varies widely from year to year, they have been increasing every year since 2013.

Ms Crofts says that after visiting several infectious diseases specialists and having several surgeries to clean out the dead tissue – along with three months of strong antibiotics – she has still not recovered.

“There have been over 150 cases of M. ulcerans in Victoria so far this year,” she says.

“Many of them are active, healthy kids like me, and most are on the Mornington Peninsula.”

Ella's ulcer. Source: change.org
Ella’s knee ulcer. Source: change.org

The increase in M. ulcerans infection cases over the last three years in Victoria is “alarming”, says Dr Zlatko Kopecki, Vice President of the Australasian Wound and Tissue Repair Society.

“Further research into treatments and management of patients with Buruli ulcers is urgently required as current antibiotic treatments only prevent surgery in 40% of patients,” says Dr Kopecki.

“Novel antibiotics or targeted anti-toxin treatments are required as wound infection is a serious problem for thousands of patients with chronic wounds,” he says, adding that this is a major research area at his laboratory with the Future Industries Institute, University of South Australia.

“Infected wounds often lead to sepsis, while surgery leads to scarring and debilitating contractures which have significantly social, physical and economic impact on patients.”

Microbiologist Professor Tim Stinear, from the Peter Doherty Institute for Infection and Immunity, says while Buruli is a rare disease in global terms, Australia is in the middle of an “epidemic” on the Mornington Peninsula.

M. ulcerans has moved from Gippsland into Melbourne since the mid-1980s, where it’s now endemic on the Mornington Peninsula.

“There has been a substantial expansion in the past 10 years and it’s proliferating,” says Professor Stinear, whose team has developed a rapid diagnostic test for Buruli ulcer.

“We have good evidence that mosquitoes are involved in transmission, and we know that possums are a major reservoir. Delayed diagnosis means serious complications for people with infection including the need for plastic surgery.”

“I’m asking you to sign my petition to get Feral and state government support for research into M. ulcerans,” asks Ms Crofts in a Change.org petition.

“Why are the numbers in Victoria increasing so rapidly? Why is it moving? Why is a disease that’s found in tropical Africa also found in temperate Victoria?

“We don’t even know how it’s spread. Answers to these questions would help prevent a worsening epidemic.”

So far nearly 11,000 supporters have signed the petition, which aims to be reach 15,000 before being delivered to Health Minister Greg Hunt.

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