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Title: The location of Australian Buruli ulcer lesions-Implications for unravelling disease transmission
Austin Authors: Yerramilli, Arvind;Tay, Ee Laine;Stewardson, Andrew J;Kelley, Peter G;Bishop, Emma;Jenkin, Grant A;Starr, Mike;Trevillyan, Janine ;Hughes, Andrew;Friedman, N Deborah;O’Brien, Daniel P;Johnson, Paul D R 
Affiliation: Medicine (University of Melbourne)
Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
Health Protection Branch, Department of Health & Human Services, Melbourne, Victoria, Australia
Infectious Diseases
Department of Infectious Diseases, Peninsula Health, Frankston, Victoria, Australia
Department of Infectious Diseases, Monash Health, Clayton, Victoria, Australia
Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
Department of Infectious Diseases, Alfred Health, Prahran, Victoria, Australia
Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
Issue Date: Aug-2017
Date: 2017-08-18
Publication information: PLoS Neglected Tropical Diseases 2017; 11(8): e0005800
Abstract: BACKGROUND: Buruli ulcer (BU), caused by Mycobacterium ulcerans, is increasing in incidence in Victoria, Australia. To improve understanding of disease transmission, we aimed to map the location of BU lesions on the human body. METHODS: Using notification data and clinical records review, we conducted a retrospective observational study of patients diagnosed with BU in Victoria from 1998-2015. We created electronic density maps of lesion locations using spatial analysis software and compared lesion distribution by age, gender, presence of multiple lesions and month of infection. FINDINGS: We examined 579 patients with 649 lesions; 32 (5.5%) patients had multiple lesions. Lesions were predominantly located on lower (70.0%) and upper (27.1%) limbs, and showed a non-random distribution with strong predilection for the ankles, elbows and calves. When stratified by gender, upper limb lesions were more common (OR 1·97, 95% CI 1·38-2·82, p<0·001) while lower limb lesions were less common in men than in women (OR 0·48, 95% CI 0·34-0·68, p<0·001). Patients aged ≥ 65 years (OR 3·13, 95% CI 1·52-6·43, p = 0·001) and those with a lesion on the ankle (OR 2·49, 95% CI 1·14-5·43, p = 0·02) were more likely to have multiple lesions. Most infections (71.3%) were likely acquired in the warmer 6 months of the year. INTERPRETATION: Comparison with published work in Cameroon, Africa, showed similar lesion distribution and suggests the mode of M. ulcerans transmission may be the same across the globe. Our findings also aid clinical diagnosis and provide quantitative background information for further research investigating disease transmission.
DOI: 10.1371/journal.pntd.0005800
Journal: PLoS Neglected Tropical Diseases
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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