title: Mycobacterium ulcerans infection: factors influencing diagnostic delay.
abstract: OBJECTIVE
  To document the epidemiology, clinical characteristics and diagnosis of an outbreak of Mycobacterium ulcerans infection (Bairnsdale or Buruli ulcer [BU]) during the period 1998-2006, and compare delays in diagnosis between residents of endemic and non-endemic regions.
  
  
  METHODS
  Retrospective case study of patients identified through infectious disease physicians on the Bellarine Peninsula and the Victorian Department of Human Services notifiable diseases database.
  
  
  METHODS
  Description of events leading to diagnosis of BU.
  
  
  RESULTS
  Eighty-five BU patients recalled their experience. Fifty-three patients were older than 60 years, and 61 permanently resided on the Bellarine Peninsula. The onset of symptoms occurred most frequently in mid winter. Twenty-eight patients had lesions on the arm and 51 on the leg. The median time between onset of symptoms and first medical contact was shorter for those living in the endemic area (3.0 weeks; interquartile range [IQR], 1.0-5.0 weeks) compared with non-endemic areas (5.3 weeks; IQR, 2.0-9.5 weeks) (P = 0.05). Patients who resided in the endemic area had a shorter median time from their first medical appointment to diagnosis (1.0 week; IQR, 0.0-3.9 weeks) than those who resided in non-endemic areas (5.0 weeks; IQR, 1.3-8.0 weeks) (P = 0.001).
  
  
  CONCLUSIONS
  Delay in presentation and time to diagnosis of BU are longer in non-endemic than endemic areas. Measures should be taken to raise awareness of the disease in non-endemic areas.
authors.affiliation: Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong, VIC.
authors.forename: Tricia Y J
authors.initials: TY
authors.lastname: Quek
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Henry
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Brien
authors.forename: Paul D R
authors.initials: PD
authors.lastname: Johnson
authors.forename: Andrew
authors.initials: A
authors.lastname: Hughes
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
authors.forename: Jane
authors.initials: J
authors.lastname: Redden-Hoare
authors.forename: Eugene
authors.initials: E
authors.lastname: Athan
mesh_terms: D000328:Adult; D000368:Aged; D054312:Buruli Ulcer / Q000175:diagnosis* / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology