Endemic Hepatitis E in Oz (and elsewhere) – update from Prof Josh Davis

Guest posting: A/Prof Josh Davis, Infectious Diseases Physician, John Hunter Hospital, NSW, Principal  Research Fellow, Menzies School of Health Research, NT, Australia.

Another excellent presentation from Josh.  HEV talk ASID Annual Scientific Meeting 2016_Davis.  An essential topic for ID and Pathology post-grads!

References (both free text)

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What adverse fetal outcomes are associated with dengue in pregnancy?

Guest posting: Dr Ayesha Akram, Microbiology Registrar, Pathology North, NSW. 

Prematurity and low birth weight are important causes of neonatal death and despite increasing awareness of the importance of these adverse pregnancy outcomes, the causes remains unknown on many occasions. Dengue fever is endemic in many regions of the world especially in Southeast Asia and Oceania. With 390 million estimated dengue infections each year woman of reproductive age are also at increasing risk of symptomatic dengue infection.  Previously very little was known about the possible adverse effects of dengue infection during pregnancy. Continue reading

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Hepatitis C- updates on biology and the new treatments from Josh Davis

Guest posting: A/Prof Josh Davis, Infectious Diseases Physician, John Hunter Hospital, NSW, Principal  Research Fellow, Menzies School of Health Research, NT, Australia.

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Extrapolating key antibiotic susceptibilities for Staphylococcus aureus

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Excellent overview by the Australian expert, Stephen Graves that is highly relevant to all countries, not just Australia. Professor Graves has been responsible for ground-breaking discoveries in this area and has much wisdom to impart. The incidence of rickettsial disease and Q fever in many tropical locations is poorly studied.

Laboratory assays for diagnosis of tick-borne infections- Graves June 2016

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Guide to MRSA strains and their emergence

It’s important to understand as much as you can about Staphylococcus aureus – it is such a prevalent cause of community and healthcare-associated infection and remains a major challenge to control.  It’s not just one species – various clones of MSSA and MRSA dominate across parts of the world and within subpopulations for reasons that are not always apparent despite much deep research into organism sequences and putative virulence gene expression. Always important to keep in mind that the epidemiology of S. aureus will vary in different locations according to what specific strains are prevalent.  Critical host factors that make disease more likely are also still in dispute – watch this space! Continue reading

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Micro comments unpacked: Gram negative bacteremia

Let's talk about antibiotics

Here is an example comment from Pathology North which is added to positive blood culture reports when a Gram negative coliform species ( Enterobacteriacae eg. E. coli) has been isolated:

bgnr

The comment’s rationale is to promote short course treatment and also to prompt oral antibiotic switching in a timely manner.  It also prompts consideration of source control, an important issue in all patients with sepsis. There are no data that establish a minimum duration for IV therapy.  Endocarditis and other metastatic complications are extremely rare with these species, contrasting with bacteraemia due to Staphylococcus aureus where prolonged high dose IV therapy is predicated on this risk.

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Pathology training resources on USB coming to your location

This page lists all of the resources that are on USB sticks being sent from Pathology North to key people in PNG, Nepal and Fiji. Additional copies can be provided to postgraduate trainees elsewhere -please contact the site administrator by email (Dr Ferguson). 

RCPA Basic Pathological Sciences course presentations (2015): courtesy of RCPA 

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Fatal case of meningococcal infection – a salutary tale

Very good clinicopathological presentation of fatal meningococcal sepsis.

Let's talk about antibiotics

This unfortunate 27 year old pregnant woman collapsed at home with a seizure and then died soon after.  She had a disseminated W135 serotype infection – this serotype has been associated with a number of recent severe cases in Hunter New England.  Neisseria meningitidis case presentation Dr Rexson Tse May 2016

Perhaps there were no preventable features in this case, however useful to remember some key issues:

  • acute meningococcal sepsis may cause death in the absence of a rash- the rash takes at least 12 hours to appear and it often has a blanching maculo-papular appearance at first
  • conversely, an acute febrile illness that presents with a rash that has appeared in the first 2 days should lead to a suspicion of bacterial sepsis as viral exanthems will generally appear later in the illness – eg 4-5 days +
  • in dark skinned individuals, always check the conjunctiva and oropharynx for…

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Kawasaki disease in a 13 month old diagnosed at post mortem

Guest posting: Dr Leah Clifton, NEWCASTLE DEPARTMENT OF FORENSIC MEDICINE,  Forensic Pathology Registrar

Kawasaki disease is characterized with acute systemic vasculitis, occurs predominantly in children between 6 months to 5 years of age. Patients with this disease recover well and the disease is self-limited in most cases .  Here is an excellent recent case: KAWASAKI DX Clifton May 2016.

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Reference

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