Mycobacterium ulcerans is a slow-growing environmental bacterium that causes Buruli ulcer (also known as Bairnsdale ulcer in Victoria and Daintree ulcer in northern Queensland). We describe two patients with laboratory-confirmed Buruli ulcer who were infected either in New South Wales or overseas. A molecular epidemiological investigation demonstrated that, while one case was probably acquired in Papua New Guinea, the other was most likely to have been acquired in southern NSW. To our knowledge, this is the first case of M. ulcerans infection acquired in NSW.
A 50-year-old geologist was referred in April 2005 for assessment of chronic cellulitis and ulceration of the right hand, present for 11 weeks (Box 1). An intraoperative swab showed acid-fast bacilli on Ziehl–Neelsen staining. Buruli ulcer (Mycobacterium ulcerans infection) was confirmed by polymerase chain reaction (PCR) testing. Over the next 3 months, the patient received a combination of antibiotic and surgical therapy. At follow-up 1 week after ceasing antibiotic therapy (4 months after initial presentation), the skin graft had healed, and the patient remained well.
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