부산대학교 도서관

Situation Buruli ulcer is a skin infection caused by the bacterium Mycobacterium ulcerans (M. ulcerans) presenting as a slowly developing painless nodule or papule which can initially be mistaken for an insect bite. Over time the lesion can progress to develop into a destructive skin ulcer which is known in Australia Bairnsdale ulcers. Buruli ulcer was first diagnosed in the Bairnsdale area a lakes district of Gippsland Victoria in the 1930s. Since then a growing number of cases have been reported in the Bellarine Peninsula and since 2012, the Mornington Peninsula. Although the areas with risk are slowly changing, there are three recognised levels of risk within the overall endemic parts of Victoria. Everyone is susceptible to infection. While it can occur at any age, people aged 60 years and over have a higher rate of notification of Buruli ulcer in Victoria. Individuals who live in or visit endemic areas are considered at greatest risk. The bacterium produces a unique toxin known as mycolactone that inhibits the immune response whilst continuing to damage tissue. If left untreated, extensive ulceration can occur, requiring surgical management. Action(s) taken/treatment(s) provided The Austin Hospital Melbourne is a major centre for the management of these wounds working in conjunction the Department of Infectious Diseases and the Wound clinic. A combination of rifampicin combined with clarithromycin oral antibiotic therapy for 8 weeks and topical DACC gel have been used. successfully heal these wounds. Outcome(s) We have successfully managed these wounds with complete healing. Lesson(s) learned The most important issues are the rapid diagnosis of a Buruli ulcer including the use of a PCR biopsy, the involvement of ID specialist and the use of evidence based treatment.