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SORRENTO, Australia – To Rob Courtney, it looked like sunburn. But after a few days, the redness and inflammation got worse. Soon the skin on her right foot was split open, the wound oozing. His doctor sent him directly to the emergency room.
Then came the horrific diagnosis: Courtney was infected with a species of carnivorous bacteria.
In recent years, cases of the disease, known as Buruli ulcer, have exploded in the seaside area where Courtney, 80, lives in southeast Australia.
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As he would learn, he’s a formidable intruder.
The ulcer left the flesh of his foot corroded and gangrenous. He devoured a skin graft. Eventually, doctors prescribed the same strong antibiotics that are used to treat leprosy and tuberculosis. The drugs made him feel nauseous and tired, and turned his sweat and tears to orange. He spent almost 50 days in the hospital.
“It’s been a bit of a trip,” Courtney said recently as he lay on an examination table at his local clinic, where he underwent daily dressing for several weeks. “I would not recommend it.”
Buruli ulcer has been reported in 33 countries, mostly in Africa, where lack of access to health care can mean cases last for months, sometimes leading to disfigurement and disability.
In Australia, where ulcer cases have been recorded since the 1940s, the recent increase in infections has drawn new attention to the neglected disease. That, combined with a growing global interest in infectious diseases, raised hopes that scientists could finally have the resources to crack its code.
The hardest hit area in Australia is the Mornington Peninsula in the state of Victoria. More than 180 cases per year have been reported in the state since 2016, peaking in 2018 at 340. In February, the disease crept further into the suburb of Melbourne, a city of 5 million people.
No one knows exactly how the infection spreads or why it broke out in the Mornington Peninsula, an affluent area less than 50 miles from Melbourne where cafes line the leafy boulevards and thousands of tourists visit each year.
Scientists believe Buruli ulcer – and up to 75% of emerging diseases, including the coronavirus – is zoonotic, which means it passes from animals to humans. They say zoonotic diseases are increasingly common in part because of human encroachment on wild environments.
As for the peak in the cases in Victoria, the main theory is that opossums, a marsupial native to Australia, carry the bacteria, which are then transmitted to humans by mosquitoes that have come in contact with the feces of the ‘animal.
The bacteria have been around for a long time, but “what we did stumbled upon it and maybe helped it grow and become unintentional victims,” said Dr Paul Johnson, physician and professor of infectious diseases at Austin Health in Melbourne. “We have created situations in which it can grow rapidly and cause human illness.”
In recent years, as attention to the disease has increased research funding, Johnson and others have tried to understand exactly how Buruli ulcer is transmitted. To test their theory, scientists are working to reduce the number of mosquitoes on the Mornington Peninsula to see if Buruli ulcer cases are decreasing as well.
One Saturday in late February, Johnson and Tim Stinear, professor of microbiology at the University of Melbourne’s Doherty Institute, led a troop of more than a dozen researchers – dressed in “Beating Buruli in Victoria” yellow vests – then that they were setting up mosquito traps on the outskirts of the Mornington Peninsula.
The researchers also looked for possum dung, which they said gave them a crucial map of hot spots where bacteria are present. “Once you start looking for this stuff, you see it everywhere,” Stinear said, kneeling in an aisle, using a stick to scoop up the scats in a sandwich bag. “Because it’s everywhere.”
Despite the ubiquity of possums, they are protected as creatures native to Australia. This has tended to block research and prevent slaughter programs that could reduce the spread of the disease. (Vaccinating animals, however, is a possibility.) Efforts to eliminate mosquitoes with an insecticide have also met with rejection from environmentalists.
The opposition is hardly a surprise, say the researchers, given the global wave of mistrust in science. But funding work on obscure diseases like Buruli ulcer is essential to stem epidemics. “We never know when they’re going to become important,” Stinear said. “It’s a lesson we learned with the coronavirus.”
For those who contract Buruli ulcer, the journey can be arduous, leading to serious illness and sometimes even amputation and death in older and vulnerable patients. Injuries can take months to heal, scarring patients both physically and psychologically.
“It’s a huge disease to treat,” said Dr Daniel O’Brien, an infectious disease specialist based in Geelong, 50 miles southwest of Melbourne. “It becomes quite confusing for members of the community.”
One Friday in March, O’Brien, masked and in glasses, treated Courtney and more than a dozen other patients at a clinic in Sorrento on the Mornington Peninsula. When O’Brien started going there about ten years ago, he was seeing a handful of patients every week. Now he sees up to 50.
He has treated over a thousand patients, in Australia and abroad, for the disease. Many of those in Australia are older, but others are young teachers, laborers and even children.
He gently measures their lesions with a ruler, marking them to track their progress. Although ulcers look like nightmares – some eat to the bone – most patients describe them as painless. The carnivorous toxin produced by bacteria presents a particular horror: it weakens both the immune response and numbs the flesh it consumes. It is “quite an extraordinary organism, really,” O’Brien said of the bacteria, “and a formidable foe.”
In Courtney’s case, the ulcer had ravaged the top half of her foot before doctors could give a diagnosis. They have since performed surgeries to remove the concrete-like necrotic tissue. “Unless you get rid of that dead flesh, the skin will never heal,” said Dr. Adrian Murrie, a doctor at the clinic who treated Courtney.
Other patients with less severe cases sometimes refuse treatment, opting instead for natural remedies such as the application of heat and clay. Although the body can sometimes fight off smaller ulcers, such treatments can be dangerous in severe cases, O’Brien said.
In most cases, treatment consists of antibiotics. Previously, much of the disease was treated with surgery, but with better medications the prognosis has improved dramatically in recent years. “We thought the antibiotics didn’t work,” said O’Brien, “because it gets worse before it gets better.”
Yet, for now, prevention is almost impossible.
“We don’t know how to stop it,” he said. But if the answer is anywhere, he said, it is in Australia.
For Courtney, her battle with the disease is far from over. Doctors expect her treatment to last at least another six months.
“When you’re 80 and lose a year,” he says, “you get really wild about it.”
This article originally appeared in The New York Times.
© 2021 The New York Times Company
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