Early diagnosis vital in Bairnsdale ulcer treatment

Seaford resident Stephen Reed had just returned from Europe when his left ankle started to swell up. “I thought it must have just been due to the long flight,” Stephen says. “However, three to four days later it still wasn’t getting any better.”

Stephen sought medical treatment and was diagnosed with a Bairnsdale ulcer. 

Dr Peter Kelley says there has been a “massive” increase in Bairnsdale ulcer cases since 2015.

Dr Peter Kelley says there has been a “massive” increase in Bairnsdale ulcer cases since 2015.

“The Bairnsdale ulcer is an infection caused by a bacteria called Mycobacterium ulcerans,” explains Dr Peter Kelley, Head of Infectious Diseases at Peninsula Health. “It usually presents as a small lesion and looks a bit like an insect bite. If it gets left without treatment it can get bigger and cause ulcers and larger lesions.”

Stephen didn’t contract the Bairnsdale ulcer while holiday in Scandinavia; rather, he suspects he got it while he was gardening, cleaning up possum poo in the backyard in Seaford. 

The Bairnsdale ulcer is most commonly found in the Frankston region and on the Mornington and Bellarine peninsulas. “We’ve definitely been seeing an increase in the number of cases in Victoria,” Dr Kelley says. “We first started to notice it here in 2011/12 and it was gradually increasing up until 2015, and since then there has been a massive increase in the number of cases.”

From January to October 2018 there were 295 cases, compared with 277 for the whole of 2017.

Once Stephen was diagnosed, he was referred to the Infectious Diseases Clinic at Frankston Hospital and put on antibiotics. “Often, when the ulcers are small, they can be managed with just antibiotics,” Dr Kelley says. “However, some people require surgery to cut out the infected tissue.” 

Stephen’s ulcer wasn’t getting better with just antibiotics, so he had to have surgery to remove it. “I had the ulcer debrided and cleaned up by the plastic surgeons,” he says. “The ulcer is more than two inches (5cm) wide. They got rid of all the dead tissue and now I am waiting to find out whether I will need to have a skin graft. It was quite painful early on, but it’s not now. It seems to have settled down a bit.”

It is still not clear exactly what causes the Bairnsdale ulcer, but the bacteria has been detected in mosquitoes, vegetation and possum poo. 

Dr Kelley has some simple advice on how to best protect yourself from the Bairnsdale ulcer. 

“If you are outside in the summer months, cover up as much as possible and wear insect repellent. If you are gardening and get a cut or scratch, go inside and wash the area with soap and water as soon as possible to try to wash off any of the bacteria.” 

Stephen agrees. “Wear long pants if you’re gardening; I always wore shorts but not anymore.” 

If you do get a spot on your skin that looks like a mosquito or spider bite and keeps growing bigger — potentially forming a crusty, non-healing scab or an ulcer — go straight to your doctor. “Early diagnosis is key,” Dr Kelley says. “If you have an ulcer that is not getting better you need to see your GP as soon as possible. Ask them to do a special test for the Bairnsdale ulcer. The sooner treatment is started, the better chance we have of minimising skin loss and stopping the infection without the need for surgery.” 

For more information about the Bairnsdale ulcer, go to peninsulahealth.org.au/2018/11/05/what-is-the-bairnsdale-ulcer

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