Epidemiology and Infection

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

M. G. K. VEITCH a1c1, P. D. R. JOHNSON a2, P. E. FLOOD a3, D. E. LESLIE a4, A. C. STREET a5 and J. A. HAYMAN a6
a1 National Centre for Epidemiology and Population Health, Australian National University, Canberra and Infectious Diseases Unit, Health and Community Services Victoria
a2 Royal Children's Hospital, Parkville, Victoria, 3052; Infectious Diseases Physician, Monash Medical Centre, Clayton, Victoria, 3168; formerly Physician, Fairfield Hospital
a3 Cowes Medical Centre, Cowes, Victoria, 3922; Medical Officer of Health, Phillip Island
a4 Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Fairfield, Victoria, 3078
a5 Royal Melbourne Hospital, Parkville, Victoria, 3050; formerly Physician, Fairfield Hospital
a6 Box Hill Hospital, Box Hill, Victoria, 3128


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.

(Accepted August 1 1997)

c1 Author for correspondence. Current address: Microbiological Diagnostic Unit, Department of Microbiology, University of Melbourne, Parkville, Victoria, 3052.