Health experts are warning residents on the NSW south coast to be vigilant after confirming the fourth case of a flesh-eating ulcer.
Warning: This story contains images some readers may find distressing.
Buruli ulcer is a rare bacterial infection that causes progressive skin and soft tissue infections.
Three people in southern NSW were diagnosed with the illness between 2021 and 2023.
A fourth case — the first since 2023 — was detected in a resident of the Eurobodalla shire in January and is being treated in Canberra Hospital by plastic surgeons and infectious disease specialists.
It comes after research published in PLOS Neglected Tropical Diseases in 2024 identified Batemans Bay, in the Eurobodalla shire, as a potential new hotspot for the ulcer.
The threat has arrived
Southern NSW Local Health District public health physician Dr Anton Forsyth said the latest case was evidence the infection was present along the south coast.
“It’s uncommon, but we do know that it’s there now,” he said.
“What we don’t know is what’s going to happen with the number of cases over the next few years.”
Dr Forsyth said the infection was spread from possums to humans via mosquitoes and could go undetected for many months.
“It’s got a long incubation period, normally around five months, so [January’s infection] would have been acquired some time last year,” he said.
Buruli ulcers typically appear as a painless red spot and progress over several weeks into an ulcer.
While it is curable with the right treatment, early detection is important in treating the infection.
Dr Forsyth said there were still a lot of unknowns about the infection and how it spread.
Tracing the spread
Canberra Hospital infectious diseases unit director Dr Ian Marr said one case in the region would likely lead to more.
“It does raise the level of suspicion that we will see further cases. We do need to be on our toes,” he said.
“It’s an early signal that we need to be vigilant.”
He said researchers were attempting to grow the organism detected in the latest case in order to learn more about its source and movement.
“We can use the DNA inside the organism to track where it has been and whether it’s linked to the other cases,” he said.
“It helps us get a hold on whether we’re dealing with one pocket, one outbreak source, or a wider spread.”
Dr Marr said the large time gaps between cases in NSW, as well as the limited number of cases, was less concerning than the outbreak of the infection in Victoria where more than 350 people were diagnosed in 2024.
Researchers in Victoria are attempting to limit the amount of mosquitoes that could spread the infection from possum to human.
Dr Marr said it was a positive sign that the NSW south coast could handle the ulcer.
“We’ve got a lot more knowledge now and we’ve got a better understanding of how these things spread,” he said.
“It puts us in good stead.”
