Doctors in Australia are warning that a mysterious flesh-eating skin disease has become a "worsening epidemic" in one part of the country, and they are calling for help to learn how to stop it.
The third edition of Tropical Infectious Diseases describes Mycobacterium ulcerans infection - otherwise known as the Buruli ulcer - as a "necrotizing infection of the skin, subcutaneous tissue, and bone".
The bacteria that causes the ulcers attaches to its host and causes "severe destructive lesions of skin and soft tissue, resulting in significant morbidity", the report states. Every year, around 2,000 new cases of the disease are diagnosed, which affects all age groups and can lead to long-term disability, cosmetic deformity, and severe emotional and psychological trauma.
Buruli ulcer itself is not a new disease. "Victoria" where "the community is facing a worsening epidemic, defined by cases rapidly increasingly in number, becoming more severe in nature and occurring in new geographic regions". It has been reported in 33 countries in Africa, Asia, the Western Pacific, and South America, according to the World Health Organization.
The bacterium that causes the disease belongs to the same family of organisms that cause tuberculosis and leprosy. Until a few years ago, infections were more commonly reported from tropical regions in Queensland with occasional cases in other states.
"It is hard to prevent a disease when it is not known how infection is acquired", write the authors, led by Dr. Daniel O'Brien, an associate professor of infectious diseases at the University of Melbourne.
"Despite being recognised in Victoria since 1948, efforts to control the disease have been severely hampered because the environmental reservoir and mode of transmission to humans remain unknown".
One theory is that the disease is spread by mosquitoes or aquatic insects.
The report declares six urgent questions need to be answered.
"It is only when we are armed with this critical knowledge that we can hope to halt the devastating impact of this disease through the design and implementation of effective public health interventions".