Fairfield Infectious Diseases Hospital, Melbourne, Paul discussed on Science Friction
An ABC podcast today, doctor Paul Johnson is a Professor of medicine at the university of Melbourne, among other roles. But back in 1993, he was a young physician, working at the Fairfield infectious diseases hospital in inner Melbourne. And it was a personal connection that would set off everything that came next. Our family had just bought a holiday House in east cows in a region called silver leaves. And that's because, unfortunately, my dad died relatively young and he's leftovers sabbatical. My mom and my wife and myself got together and we bought this house as a memorial almost to him because he used to love going down there, but he only ever had the chance to rent. We weren't that well often we were kids. Cows is the main township on Philip island. A beach holiday spot two hours drive southeast of Melbourne. The island's usual claim to fame is the local population of little penguins. But this was a different story. All of a sudden, I was seeing people at the Fairfield infectious diseases hospital in the central Melbourne. Who seemed to have these rather horrible ulcers and their street addresses were quite similar or in the same area as we just bought this house. A handful of patients was presenting to the hospital with these severe skin lesions that refused to heal. These often appeared as a bull's eye wound, quite deep, red, and pustules at the center with weakens surrounding skin. Paul started to investigate these cases, more closely. I put a little group together and we started having a look around. And we found that there are clustering around the golf course, so all of the people who had cases, if you draw them on a map, they all seem to cluster around the golf course and that swampy area near the golf course. Whereas, on the other side of cows, which otherwise was similar, there was no cases at all. So it was extremely local. At the time, Paul had been searching around for a research project to sink his teeth into. And here it was. Mysterious ulcers, popping up in this one sleepy beach town. And as he soon finds out, this mysterious disease, it does have a name. Actually, it has a few. So it used to be called bean style also in Victoria. And it's been called daintree ulcer in mosman ulcer and far north Queensland. It's been called sick belong a cpac and New Guinea and the name beru also actually comes from East Africa. But the reason there are so many local names is because people realize this very local characteristic that you get it in certain places. And it's this last one that the World Health Organization would decide on as the diseases official name. Paul was going to investigate beru ulcer. And he wasn't going to do it alone. I'm Elizabeth cool ass, welcome to science friction. Are we seeing infinitesimally Mitchell for a couple more weeks? And today on the show, how a sideline research project would turn into a 25 year collaboration to figure out how brulee also functions and how it spreads. It's like a really interesting, almost murder investigation. And this Odyssey, it's really a parable for how science works. And often finding something isn't the way you thought it was, it's much more helpful. But now after a quarter century, two Melbourne scientists are getting very close to some answers. Okay, Paul, before we get into the mysteries of what we don't know, let's get into what we do know. Would you describe what it is we know about the bory ulcer and how it functions. So it's basically an environmentally acquired infection of the skin. Basically something happens to you when you go into an environment where the bacteria is and for many years it's been a mystery where it is in the environment and how you get it when you're there. And really interestingly, it seems to only take an afternoon or an hour even in what we call an endemic area to become at risk of acquiring it. And if you do acquire the infection, it can often be very hard to tell. It's got a very long incubation period. So it may be many months before you notice anything. And typically you notice a small growing thing that we call a lesion and it keeps growing. And it doesn't usually hurt too much. But it just relentlessly progresses. Over the years, doctors like Paul have pieced together the movements of people visiting endemic areas for short stretches of time. Things like going to Philip island for a day trip. And they figured out that there's usually a four or 5 month lag between assumed exposure to the bacteria, and the first presentation of an ulcer. In some cases, that can take 9 or ten months. So you've got no idea it's there, and it gives the infection heaps of time to grow. And now, if left, it can become very destructive slowly. It kind of spreads quite widely in the fat layer between the skin and the lining over the top of the muscles and the bone. So in that space between skin and the deeper structures. And also that you eventually see on the surface, which may not be there initially, is really like the middle of a donut, so you see a hole in your skin appearing, but the problem is already quite a lot bigger and gone well beyond what you can see. So what's on the surface is a kind of tip of the iceberg. It can be typically in the disease family trait, baruch also is closely related to leprosy and tuberculosis. Cases were usually found in tropical, rural areas of West African countries. Places like Ghana, Côte d’Ivoire, Benin. Left untreated, the legions can grow so be that people are left with terrible scarring or can lose the function of a limb. So when the disease presents in Victoria, it's something of a fantastic paradox as Paul puts it. Meanwhile, here we are in Victoria. We've now got one of the highest rates in the world. And we are seeing it in fully developed country in urban and suburban settings. And yet people are turning up in the winter to their doctors with a tropical disease occurring in a temperate part of the world. So that's the paradox. The reason it turns up in the winter is because of this long incubation period and people do get infected in the summer. But the fact that we've got a tropical rural disease in a temperate first world city is really interesting. In Australia, the first recorded case of beru ulcer occurred in the 1940s in bendale, a small town about 300 kilometers east of Melbourne. Not long after that, a group of Australian scientists, including sir Peter McCallum. They identify the bacterium that causes the disease. Mycobacterium ulcer or M also runs for short. They have also been small case clusters around the daintree river in far north Queensland, and some near rockhampton. But for decades, they were just a few cases each year. Then, across three years in the early 90s, 29 cases emerged around that one golf course in Phillip island. This had been an infectious disease, rare enough and dispersed enough, but no one had paid too much attention, except for a small number of dedicated researchers..