Mycobacterium ulcerans is a slow-growing environmental bacterium that causes Buruli ulcer (also known as Bairnsdale ulcer in Victoria and Daintree ulcer in northern Queensland). We describe two patients with laboratory-confirmed Buruli ulcer who were infected either in New South Wales or overseas. A molecular epidemiological investigation demonstrated that, while one case was probably acquired in Papua New Guinea, the other was most likely to have been acquired in southern NSW. To our knowledge, this is the first case of M. ulcerans infection acquired in NSW.
A 50-year-old geologist was referred in April 2005 for assessment of chronic cellulitis and ulceration of the right hand, present for 11 weeks (Box 1). An intraoperative swab showed acid-fast bacilli on Ziehl–Neelsen staining. Buruli ulcer (Mycobacterium ulcerans infection) was confirmed by polymerase chain reaction (PCR) testing. Over the next 3 months, the patient received a combination of antibiotic and surgical therapy. At follow-up 1 week after ceasing antibiotic therapy (4 months after initial presentation), the skin graft had healed, and the patient remained well.
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We thank Professor W R Faber of the University of Amsterdam, The Netherlands, for providing details of Patient 2. We wish to acknowledge Dr Christopher Gilpin from the Queensland Mycobacterium Reference Laboratory for performing the polymerase chain reaction testing for Patient 1, and Ms Jessica Porter from Monash University for assistance with sodA sequencing. This work was supported by a Victorian State Government Department of Human Services Public Health Research Grant (2004–2005).
Caroline Lavender’s position is funded by a Victorian State Government Department of Human Services Public Health Research Grant (2004–2005).