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Online Discussion: Tracking new emerging diseases and the next pandemic

AUSTRALIA’S FLESH-EATING BUG OUTBREAK NEEDS URGE

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    Posted: April 15 2018 at 2:19pm

AUSTRALIA’S FLESH-EATING BUG OUTBREAK NEEDS URGENT RESEARCH

A localised epidemic in temperate Australia of the rare tropical Buruli ulcer has exposed a major gap in scientific knowledge that needs filling – now

By Andrew Trounson, University of Melbourne

You might mistake it for an innocuous insect bite – a small painless lump on your arm or leg. But within weeks it’s eating away the skin and tissue underneath, and unless treated with strong antibiotics, it could grow into a gaping ulcerated wound that may take a year to heal and even need surgical reconstruction.

It is the Buruli ulcer, a rare tropical disease caused by bacteria related to leprosy and tuberculosis. But in parts of Australia’s temperate south eastern Victoria state it is now neither rare nor tropical.

Mycobacterium ulcerans is the “nasty and clever” bug that causes the Buruli ulcer. Picture: Pathology of Infectious Diseases

Localised outbreaks in the Mornington and Bellarine coastal peninsulas south of Melbourne are suddenly at epidemic levels with 275 new infections in Victoria last year. And scientists have no clear idea of how people are catching it.

“We are now in an urgent situation where we have a huge scientific gap that we need to fill,” says Associate Professor Daniel O’Brien, a clinician and researcher on the frontline treating the disease. He is now leading the call for urgent research into how to prevent it spreading and infecting more people.

RISING INFECTION AND SEVERITY

A few years ago, Associate Professor O’Brien was typically treating about 10-30 cases a year. In 2017 he saw 110. And the cases are becoming more severe.“This is a terrible disease that is just getting worse, but how do I tell people how to avoid it if I can’t tell them how they are catching it in the first place?”

He knows of one family who simply fled the area after one of their loved ones contracted the disease.

“We have lots of ideas and theories but it is now getting out of control,” says Associate Professor O’Brien, an infectious disease expert based at Geelong Hospital’s Barwon Health and the Royal Melbourne Hospital. He is also an honorary researcher at the University of Melbourne. “If we are to design effective prevention strategies and health messages, we need answers now.”

In an article published in the Medical Journal of Australia (MJA), Associate Professor O’Brien and colleagues are calling on Australia’s federal and state governments to respond to the epidemic with immediate new funding for research into where the bacteria lives and how it spreads.

The Buruli ulcer is usually associated with wetlands, especially slow moving and stagnant waters. Picture: Brotherlywalks/Flicker

The Buruli ulcer (also called the Bairnsdale or Daintree ulcer in Australia), is associated with wetland and coastal areas and there are theories that it spreads into new areas through infected water, possibly via irrigation and flooding.

AUSTRALIA AN OUTLIER

There is evidence that human-to-human transmission can’t occur, but exactly how people become infected is still unclear. There are suggestions the bacteria might be breathed in, or that it invades the skin through cuts and insect bites. There are also theories that insects like mosquitoes might carry it and that animals, possibly possums, may act as hosts. In 95 per cent of cases, infections occur in people’s arms or legs, which suggests that insect bites and/or environmental contamination plays a role.

Globally about 2,000 people are infected with the disease every year, mostly in West and Central Africa, and in most affected countries the incidence is declining. But in Australia it is getting worse.

The global distribution of Buruli ulcer in 2015. Infections are concentrated in central and west Africa, but Australia is one of the few places where the number is rising. Picture: World Health Organization

In 2016 the number of new infections in Victoria jumped by 72 per cent to 182 and increased by a further 51 per cent in 2017. While some infections occur in tropical parts of Australia’s north and occasionally elsewhere in the country, the great bulk are appearing across these two adjacent temperate peninsulas in Victoria.

And this disease isn’t new to Australia.

The bacteria was first diagnosed in Victoria in the 1930s in the Bairnsdale area on the south east coast. It later emerged in the Bellarine Peninsula, but as recently as 2012 it spread to the nearby Mornington Peninsula.

CURABLE BUT TRAUMATIC

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The bacteria that causes the disease mycobacterium ulcerans, is a particularly “nasty and clever” one, says Associate Professor O’Brien. It produces a toxin that not only kills the skin, it suppresses the immune system and contains an anaesthetic that means the initial infection is often painless and can go unnoticed.

The good news is that it is readily treatable, and the need for amputation in severe cases is very rare. However, the cure and recovery can be highly traumatic. The antibiotic treatment takes two months and comes with significant possible side effects such as inflammation of the liver, rashes, nausea and diarrhoea. It can take six months to a year for serious wounds to heal, and surgery and rehabilitation is needed in severe cases.

“Overall a patient faces significant psychological and material costs, so prevention is very much better than the cure,” says Associate Professor Daniel O’Brien.

In the MJA, he and his colleagues write that the direct and indirect cost of treating each infection averages about A$14,000, and that the total cost of the disease in Victoria in 2016 was likely more than A$2.5 million.

KEY QUESTIONS

They argue that urgent research is needed to analyse soil, water, insects and animal excreta as well to measurement population movements, housing developments and landscape disturbances.

Mornington Peninsula, one of the two adjacent temperate peninsulas in Victoria in which the bulk of Buruli ulcers appear. Picture: Cafuego/Flickr

Genomic sequencing of the bacteria is also needed as part of a molecular analysis that could shed light on what factors make the bacteria more virulent.

In particular, they argue there are six key research questions that need to be answered:

  • Where does the bacteria natural live and multiply?
  • How is it transmitted to humans?
  • What role do animals and insects play?
  • What environmental factors allow the bacteria to grow?
  • Why is the disease spreading into new areas?
  • Why are cases becoming more severe?

Tuberculosis - still a major killer

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For Associate Professor O’Brien, he’s now gone past his 500th patient with the disease, and he says the time for just focusing on treatment is well and truly past.

“It has always been a neglected disease in terms of research, and it is a complex one that needs resources if we are to understand it. Until recently it had been highly localised with few cases so there hadn’t been an urgent need investigate it in detail.

“But we are now facing a worsening epidemic and we lack the knowledge and tools to address it. We’ve haven’t got time anymore, we need action.”

Banner Image: Nigel Hallett, News Corp Australia. Used with Permission.

12 Monkeys...............
1995 ‧ Science fiction film/Thriller ‧ 2h 11m a must for AFT
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: April 15 2018 at 7:57pm

Boy, 11, requires plastic surgery after getting ulcer

Professor O'Brien said people of all ages were being affected.

"I don't think you'd meet any patient that doesn't say this has had a significant impact on their life," he said.

One 11-year-old boy who visited the Mornington Peninsula developed a severe lesion on his knee that required plastic surgery.

It took the boy six months to heal. He was unable to play sport and had to stay home from school.

Victoria's Deputy Chief Health Officer, Brett Sutton, said more than $1 million had been spent on researching the ulcer.

He said work had been done to raise awareness of the bacteria with GPs, and a prevention campaign had been run to warn people about mosquitoes in affected areas.

"Certainly it's a serious illness, I'm acutely aware of the rising cases," he said.

"Our attention's absolutely on it and we're well aware of what an issue it is."

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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: April 15 2018 at 8:29pm
decided to post picture even though its not nice ,

 truth is this is, this is the  reality of post antibiotic era, 

Technophobes post on typhoid should send shivers down your backs.................
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Post Options Post Options   Thanks (0) Thanks(0)   Quote EdwinSm, Quote  Post ReplyReply Direct Link To This Post Posted: April 16 2018 at 2:12am
More of this from the front page of the BBC

(warning includes graphic pictures of the ulcers - I found one worse than the picture Carbon posted DeadDeadDead)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: April 16 2018 at 4:07am
As does this, Carbon!  BIG SHIVERS!

In the long run it is possible (not probable, just remotely possible) that antibiotics may do us a dissfavor.  They have made us complacent.  Now they are failing.  Hopefully we will find many more new ones alongside virusides and new anti-fungals, but I am not holding my breath for those and there is nothing on the horizon for prions.  Instead of improving our infection control methods we have added air travel into the mix.

For an intelligent species, we can be rather stupid.
Absence of proof is not proof of absence.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: April 16 2018 at 5:11am
[Technophobe:  Here is an illustration of my point.  It is just about pigs but the process applies to any animal feed - even ours.  Economically globalisation is a good thing, but diseases find it usefull too.]


Study: Animal Feed Could Be Carrying The Next Deadly Livestock Virus

By Amy Mayer 1 hour ago
nimal feed mixed from ingredients sourced around the world could be carrying more than the vitamins and nutrients livestock need. Seven different viruses that could cause widespread illness and big economic losses for meat producers in the United States can survive in certain imported feed products.

study published in March in the journal PLOS One looked at 11 viruses that are not yet in the U.S. but infect herds in other places, such as African swine fever and foot and mouth disease.

Lead researcher Scott Dee of Pipestone Veterinary Services in Minnesota and colleagues from various universities and laboratories mixed samples of each virus with several frequently imported feed ingredients, such as soybean meal, certain vitamins and even pet food.

Those samples were subjected to simulated temperature and humidity conditions for journeys to the U.S. from an origin country — say from China across the Pacific and then over land to Des Moines, Iowa.

Seven of the viruses could survive in at least two of the tested ingredients, according to the study.

“I think what the feed did was, it protected the virus from our environmental conditions that we created during the study,” Dee told Harvest Public Media.

Each virus was also put through the test without an ingredient and they didn’t fare as well.

“Except for Africa swine fever virus, it seemed that all the other viruses need a feed ingredient to kind of protect them if they were going to survive,” he said.

The study started with pigs — following the 2015 porcine epidemic diarrhea virus (PEDv) that wiped out six million piglets and came from China. Funding came largely from the Swine Health Information Center, but Dee said many of the viruses affect other animals as well.

“We realized, gosh, we were working with diseases of other species, too, such as ruminants, poultry and people,” Dee said, though the two that could infect people, influenza A and nipah virus, didn’t survive the trial.

Foot and mouth disease did. It’s been absent from the United States since the early decades of the 20th century, and officials would like to keep it out as it has the potential to spread rapidly and kill large numbers of cattle, hogs, sheep and other animals.

Iowa State professor and veterinarian Jim Roth helped developed an emergency preparedness plan for the pork industry in the event that a fast-spreading foreign disease is detected here. Though he was not involved with the study, he says the results are interesting because they demonstrate that feed imports could be a source of infectious disease.

“Now, on balance, we’ve been bringing in feed from China, the same feed ingredients, for many years,” he said. “China has had FMD — foot and mouth disease — all of those years and it hasn’t gotten here in the feed.”

The risk is there, he said, but it’s not imminent, and more research is needed.

Dee said he’s next looking at safe ways to prevent potentially infectious ingredients from arriving. For now, though, he says importers should be on alert, suggesting that those importing feed may want to look beyond getting the cheapest price and consider the disease-status of other countries.

The current work builds on a similar study Dee and colleagues published in 2016 to understand how PEDv arrived in this country. And the new study is getting attention beyond the pork industry.

“It’s in the hands of USDA, the FDA, APHIS (USDA’s Animal Plant Health Inspection Service), FBI even. People are very interested in it.,” Dee said, adding that he’s met with members of the FBI.

“(It’s) pretty hard to refute the fact that this could be a significant risk factor for pathogen transport between countries,” Dee said.

The study included research from South Dakota State University, Kansas State University, Iowa State University and other labs.


Source:   http://iowapublicradio.org/post/study-animal-feed-could-be-carrying-next-deadly-livestock-virus#stream/0


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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: April 16 2018 at 2:28pm
i'v been watching the antibiotic thing for  30 years ,

i heard about Phages the same time ,watched a docco on ,now the "iron curtain" was down western doctors could hopefully use phages to fight Germs..............

30 years on ,

the only thing thats happend is we lost more Antibiotics ,

and now we down to the Wire........Cry


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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: April 17 2018 at 3:58pm
I saw this on the BBC and thought you should see it:

Australia flesh-eating ulcer 'epidemic' a mystery, doctors say - http://www.bbc.co.uk/news/world-australia-43779187
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: April 17 2018 at 4:00pm
Indemic in Africa....

Why has it suddenly appeared in Victoria,(state in Australia)

I don't suppose it's got anything to do with the large intake of Africans migrants into Australia.......

Mosquitoes,blood borne disease......

Ring a bell.....
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