The location of Australian Buruli ulcer lesions-Implications for unravelling disease transmission

• Published in: PLoS neglected tropical diseases 2017-08, Vol.11 (8), p.e0005800-e0005800
• Main 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
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age composition; Aged; Aged, 80 and over; Ankle; Ankle - microbiology; Ankle - pathology; Biology and Life Sciences; Buruli ulcer; Buruli Ulcer - epidemiology; Buruli Ulcer - microbiology; Buruli Ulcer - pathology; Buruli Ulcer - transmission; Calves; Cameroon - epidemiology; Care and treatment; Child; Child, Preschool; Development and progression; Diagnosis; Disease transmission; Diseases; Distribution; Ecology; Elbow - microbiology; Elbow - pathology; Extremities - microbiology; Extremities - pathology; Female; Gender; Genomes; Health aspects; Hospitals; Humans; Incidence; Infant; Infections; Infectious diseases; Lesions; Limbs; Male; Medicine; Medicine and Health Sciences; Men; Middle Aged; Mosquitoes; Mycobacterium ulcerans - isolation & purification; Mycobacterium ulcerans - pathogenicity; Neglected Diseases - epidemiology; Neglected Diseases - microbiology; Neglected Diseases - pathology; Observational studies; Patients; Prognosis; Retrospective Studies; Seasons; Software; Spatial analysis; Studies; Supervision; Temperature; Transmission; Tropical diseases; Ulcers; Victoria - epidemiology; Women; Young Adult
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0005800

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. 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. 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