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A large localized outbreak of Mycobacterium ulcerans infection on a temperate southern Australian island


M. G. K. VEITCH1*, P. D. R. JOHNSON2, P. E. FLOOD3, D. E. LESLIE4, A. C. STREET5 and J. A. HAYMAN6


1National Centre for Epidemiology and Population Health, Australian National University, Canberra and Infectious Diseases Unit, Health and Community Services Victoria
2Royal Children’s Hospital, Parkville, Victoria, 3052; Infectious Diseases Physician, Monash Medical Centre, Clayton, Victoria, 3168; formerly Physician, Fairfield Hospital
3Cowes Medical Centre, Cowes, Victoria, 3922; Medical Officer of Health, Phillip Island
4Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Fairfield, Victoria, 3078
5Royal Melbourne Hospital, Parkville, Victoria, 3050; formerly Physician, Fairfield Hospital
6Box Hill Hospital, Box Hill, Victoria, 3128

ABSTRACT
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.

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