A warning has been issued to NSW residents after a rare and exotic flesh-eating condition, Buruli ulcer, was detected the state's south.
Buruli ulcer is a skin infection caused by the bacterium Mycobacterium ulcerans, which causes deterioration of the skin and bone that could lead to permanent disfigurement and long-term disability.
There have only been three cases in the state between 2021 and 2023, but a fourth has just been confirmed in the Eurobodalla region, south-east of Canberra.
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The Southern NSW Local Health District is urging the community to keep an eye out for symptoms, typically painless swelling, and to avoid mosquito bites.
"Buruli ulcers typically appear as a painless red spot and progress over several weeks into an ulcer," the district said in a statement.
"Anyone with a non-healing skin ulcer should see a doctor."
"While the precise transmission method for Buruli ulcer is not fully understood, there is increasing evidence that mosquitoes play a role in transmitting the infection.
"As mosquito bites are implicated in transmission, people can reduce their risk of Buruli ulcer by wearing loose, light-coloured clothing with long sleeves and pants and applying mosquito repellent that contains DEET."
Buruli ulcera has been reported in parts of Queensland, the Northern Territory and Victoria but is uncommon in New South Wales.
Cases have been rising by about 200 to 360 cases per year since 2017 in Victoria.
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Buruli ulcer is within the same family of germs that cause tuberculosis and leprosy.
It begins with painless swelling typically on the arms and legs and can progress without pain or fever. In many cases, it may not even appear until four to five months or longer after exposure.
How the infection is transmitted is still unknown but it is not believed to be contagious.
The infection can be treated with antibiotics and is curable but early intervention and diagnosis is important to minimise the damage caused.
According to the World Health Organisation, Buruli ulcer has been reported in 33 countries in Africa, the Americas, Asia and the Western Pacific.
Most cases have been reported in tropical and subtropical regions except for Australia and Japan.
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