title: Risk of Buruli ulcer and detection of Mycobacterium ulcerans in mosquitoes in southeastern Australia.
abstract: BACKGROUND
  Buruli ulcer (BU) is a destructive skin condition caused by infection with the environmental bacterium, Mycobacterium ulcerans. The mode of transmission of M. ulcerans is not completely understood, but several studies have explored the role of biting insects. In this study, we tested for an association between the detection of M. ulcerans in mosquitoes and the risk of BU disease in humans in an endemic area of southeastern Australia.
  
  
  RESULTS
  Adult mosquitoes were trapped in seven towns on the Bellarine Peninsula in Victoria, Australia, from December 2004 to December 2009 and screened for M. ulcerans by real-time PCR. The number of laboratory-confirmed cases of BU in permanent residents of these towns diagnosed during the same period was tallied to determine the average cumulative incidence of BU in each location. Pearson's correlation coefficient (r) was calculated for the proportion of M. ulcerans-positive mosquitoes per town correlated with the incidence of BU per town. We found a strong dose-response relationship between the detection of M. ulcerans in mosquitoes and the risk of human disease (r, 0.99; 95% CI, 0.92-0.99; p < 0.001).
  
  
  CONCLUSIONS
  The results of this study strengthen the hypothesis that mosquitoes are involved in the transmission of M. ulcerans in southeastern Australia. This has implications for the development of intervention strategies to control and prevent BU.
authors.affiliation: Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Lavender
authors.forename: Janet A M
authors.initials: JA
authors.lastname: Fyfe
authors.forename: Joseph
authors.initials: J
authors.lastname: Azuolas
authors.forename: Karen
authors.initials: K
authors.lastname: Brown
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Evans
authors.forename: Lyndon R
authors.initials: LR
authors.lastname: Ray
authors.forename: Paul D R
authors.initials: PD
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D054312:Buruli Ulcer / Q000453:epidemiology* / Q000635:transmission*; D002648:Child; D009033:Culicidae / Q000382:microbiology*; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019911:Mycobacterium ulcerans / Q000235:genetics / Q000302:isolation & purification*; D060888:Real-Time Polymerase Chain Reaction; D018570:Risk Assessment; D013223:Statistics as Topic; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial