Clinical, microbiological and pathological findings of Mycobacterium ulcerans infection in three Australian Possum species

Background

Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans, with endemicity predominantly in sub-Saharan Africa and south-eastern Australia. The mode of transmission and the environmental reservoir(s) of the bacterium and remain elusive. Real-time PCR investigations have detected M. ulcerans DNA in a variety of Australian environmental samples, including the faeces of native possums with and without clinical evidence of infection. This report seeks to expand on previously published findings by the authors' investigative group with regards to clinical and subclinical disease in selected wild possum species in BU-endemic areas of Victoria, Australia.

Methodology/Principal Findings

Twenty-seven clinical cases of M. ulcerans infection in free-ranging possums from southeastern Australia were identified retrospectively and prospectively between 1998–2011. Common ringtail possums (Pseudocheirus peregrinus), a common brushtail possum (Trichosurus vulpecula) and a mountain brushtail possum (Trichosurus cunninghami) were included in the clinically affected cohort. Most clinically apparent cases were adults with solitary or multiple ulcerative cutaneous lesions, generally confined to the face, limbs and/or tail. The disease was minor and self-limiting in the case of both Trichosurus spp. possums. In contrast, many of the common ringtail possums had cutaneous disease involving disparate anatomical sites, and in four cases there was evidence of systemic disease at post mortem examination. Where tested using real-time PCR targeted at IS2404, animals typically had significant levels of M. ulcerans DNA throughout the gut and/or faeces. A further 12 possums without cutaneous lesions were found to have PCR-positive gut contents and/or faeces (subclinical cases), and in one of these the organism was cultured from liver tissue. Comparisons were made between clinically and subclinically affected possums, and 61 PCR-negative, non-affected individuals, with regards to disease category and the categorical variables of species (common ringtail possums v others) and sex. Animals with clinical lesions were significantly more likely to be male common ringtail possums.

Conclusions/Significance

There is significant disease burden in common ringtail possums (especially males) in some areas of Victoria endemic for M. ulcerans disease. The natural history of the disease generally remains unknown, however it appears that some mildly affected common brushtail and mountain brushtail possums can spontaneously overcome the infection, whereas some severely affected animals, especially common ringtail possums, may become systemically, and potentially fatally affected. Subclinical gut carriage of M. ulcerans DNA in possums is quite common and in some common brushtail and mountain brushtail possums this is transient. Further work is required to determine whether M. ulcerans infection poses a potential threat to possum populations, and whether these animals are acting as environmental reservoirs in certain geographical areas.

Mycobacterium ulcerans causes skin disease predominantly in sub-Saharan Africa and southeastern Australia. The mode of transmission and the environmental reservoir(s) of the bacterium are unknown. Investigations have detected M. ulcerans DNA in a variety of Australian environmental samples, including the faeces of native possums. This report expands on these studies by detailing the clinical, pathological and microbiological findings in affected wild possum species in endemic areas. Twenty-seven clinically and 12 subclinically affected individuals were identified. Most clinical cases were adults with skin ulcers of the face, limbs and/or tail. The disease was mild and self-limiting in both Trichosurus spp. possums. In contrast, many of the common ringtail possums had multiple skin ulcers and in some there was evidence of internal disease. There were also significant levels of M. ulcerans DNA throughout the gut. Comparisons were made with regards to disease category, species and sex; with clinical cases more likely to be male common ringtail possums. Asymptomatic gut carriage of M. ulcerans DNA is quite common and may be transient in some individuals. Further work is needed to determine whether M. ulcerans infection poses a potential threat to possum populations, and whether these animals are acting as reservoirs in some areas.

Older adults and healthy lifestyle issues: results of a community study

AIM

To discover sources of information about, levels of understanding of, and degrees of commitment to a healthy lifestyle on the part of elderly people in the community as a preliminary to mounting health promotion and education initiatives.

METHOD

In 1992 500 people aged 60 and over were surveyed anonymously using a 33 item questionnaire. This sought information on a wide range of health and lifestyle issues in older age. The material in this paper refers to only four of the questions asked, namely those relating to sources of, knowledge of, and interest in information on health and ageing.

RESULTS

Doctors were perceived to be the most important sources of health information (89% of respondents rating them as "very" or "moderately" important). Relatives/friends and books/magazines were the next most important sources (56 and 55% respectively). High levels of misinformation about lifestyle issues were revealed. Whilst 85+% of respondents answered correctly that smoking was deleterious and strong social ties advantageous to good health in old age there was confusion about causes of osteoporosis, use of vitamins, likelihood of developing dementia and even the importance of exercise. This has implications for the content of health promotion programmes. Contrary to previously published research, we found no correlation between educational or socioeconomic status or gender, and knowledge about health issues and healthy lifestyles.

CONCLUSION

Studies of this type clearly have the ability to provide a range of information which ought to be available to those responsible for the planning of health promotion and education initiatives for older adults.

Sparganosis in the monotremes Tachyglossus aculeatus and Ornithorhynchus anatinus in Australia

Sparganosis in the echidna, Tachyglossus aculeatus, is characterized by large subcutaneous masses that may be confused with neoplasms. Plerocercoids, believed to be Spirometra erinacei, were found in the ventral or lateral subcutaneous tissues of three echidnas. In each case there was a prominent fibrous mass < or = 12 cm in diameter enclosing plerocercoids, which were surrounded by an intense inflammatory infiltrate dominated by plasma cells and lymphocytes, with focal suppuration. Multiple, small (< or = 2 mm) plerocercoids were present in the lungs and pleural cavity of a fourth echidna that died due to severe pneumonitis. Several plerocercoids also were found in the lung of a platypus (Ornithorhynchus anatinus) associated with parenchymal compression and focal pneumonia.