Loading Until recently, the nasty ulcers which can spread to the bone if untreated have been mostly contained to the Mornington and Bellarine peninsulas, where there have been 163 cases this year alone. But infections have begun creeping closer to Melbourne through the south-eastern bayside suburbs including Frankston. This week health authorities confirmed two recent cases in people living on the other side of the city, in the western suburbs, though the department is yet to establish if the victims travelled into affected areas, as has been the case with previous infections. If they were locally-acquired, they would be the first such cases for Melbourne’s west. There have been 17 previous cases in the west, but all have been linked back to travel to the Bellarine or Mornington peninsulas.

Seddon resident Zhoe Jess is one of the new victims, diagnosed last week after living for months with a growing lump near her elbow that doctors, specialists and a barrage of expensive tests were unable to identify. “I went to three different GPs and they were just calling me an enigma,” the communications manager said. The developing lump on Zhoe's upper arm . “They were saying ‘you’re a mystery … we don’t know what this is’.” The mother-of-two is certain she has not travelled to impacted areas in the past year, and has been unable to pinpoint the moment when she might have caught the infection, via an insect bite or cut.

Ms Jess said she first noticed a small lump above her left elbow about six months ago. In July it grew significantly and began showing signs of an infection, appearing red and growing hot. Oral antibiotics had no effect and by the time she was eventually booked in with a surgeon to have the lump drained, it was the size of a small lemon. “It was like another elbow above my elbow,” she said. The saga continued after surgery, with Ms Jess bedridden for 10 days after the operation suffering nausea and dizziness. Then the two holes that had been used to drain the puss-filled lump started inexplicably growing. The holes were stitched up, but the stitches burst, revealing a new infection.

Ms Jess said it wasn’t until she asked if doctors if they were sure that she didn’t have the flesh-eating bacteria, that a swab for the Buruli ulcer was taken. It came back positive. Infectious diseases physician Associate Professor Daniel O’Brien said as far as he was aware the bacteria that caused the gruesome ulcers, Mycobacterium ulcerans, had not yet spread past Black Rock or Brighton. The ulcers on Zhoe's arm But he said it was possible the cases in the west were the first of their type. “It’s moving around so we have to be vigilant and aware it could appear in new places,” Professor O’Brien said.

“There is no doubt that when you live outside these [endemic] areas there is often a slight delay in the diagnosis because people are not aware or do not think of the disease.” As health authorities grapple with how to contain cases, Professor O’Brien forecast that within two years Victoria would be experiencing 500 cases a year, an increase from just 32 cases in 2010. There have been 317 cases so far this year. The ulcer. “It is very likely it will appear in new areas," Professor O’Brien said. "It is not going to remain static. Everyone needs vigilance … no matter where they live."

It comes as scientists begin work on a new project they hope will deliver answers on how to stop the spread of the infection, which is thought to have links to mosquitoes, infected possums and certain soil types. Loading Replay Replay video Play video Play video CSIRO infectious diseases scientist Dr Kim Blasdell said while a lot was known about risk factors for the Buruli ulcer, experts were still trying to establish the exact chain that of events that leads to infection, and how to avoid it. “Certainly from a scientific perspective, it’s a puzzle,” Dr Blasdell said. “We can make possible suggestions to people [such as] wear gardening gloves, wear long-sleeve tops and things like that, but we can’t say for sure that it will protect people.”

It has been a trying recovery for Zhoe Jess. Credit:Joe Armao Hundreds of questionnaires are being sent to residents in problem areas in a bid to establish why some people have been infected and not others. Meanwhile, field studies will be used to pinpoint which areas with live bacteria should be sprayed for mosquitoes. Ms Jess has just begun a gruelling regime of antibiotics she said left her unable to get out of bed at the weekend. She wants to ensure doctors and the public are better informed about the possibility of infection. “I think people may be a little complacent because they don’t understand it is spreading and there are a lot of unknowns with it,” she said.

The Australian Medical Association said it would like to see more regular updates about the number and location of Buruli ulcer cases, so that the issue was more front of mind for doctors. For people in affected areas, the department of health is recommending they wear protective clothing when gardening or “undertaking recreational activities” and that they use insect repellent to reduce mosquito bites. “Cuts and abrasions should be cleaned promptly and exposed skin contaminated by suspect soil or water should be washed following outdoor activities,” a spokesman said.