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Microbiology Australia Microbiology Australia
Issue 5




Vertical Transmission, November 2009
In the last VT, I mentioned the new look website. Since then we have introduced the ability to join and rejoin the society online, with the new site being the launch point for this. This process has been some time in the making as it required major upgrades of the databases in the national office. Thanks to all the staff in the national office for helping to make this possible, most notably Lina Raco. Most members will have come into contact with or had help from Lina at some point as she has been with the Society since 2003. Lina left the ASM in September to take up another position in the hospital sector in Melbourne. On behalf of all members, I wish her all the best in her new job.
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Indigenous Health
This issue of Microbiology Australia is devoted to Microbes that cause disease particularly in our Indigenous populations. We have for example the worldwide highest rates of Rheumatic Fever and Heart Disease in Aboriginal and Torres Strait Islander people. These follow streptococcal infections mostly as a result of skin damage through primary infections with pathogens such as parasitic scabies mites.
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The research road less travelled
If there is one thing that should be clear by now to anyone working in the area of Aboriginal and Torres Strait Islander health, it is that biomedical research carried out in isolation from the Aboriginal and Torres Strait Islander community will not significantly improve health outcomes for Australia’s Indigenous peoples.
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Epidemiology of group A streptococcus in Australia
The Australian population experiences the extremes of group A streptococcal (GAS) disease. The majority of our population lives an affluent, middle class existence and experiences the same types and rates of GAS disease as are found in most industrialised countries. By contrast, the Aboriginal and Torres Strait Islander populations, particularly those living in remote and rural settings, experience a developing-country profile of GAS disease, which is almost entirely attributable to poverty, particularly as it is manifest by overcrowded housing, poor environmental health and reduced access to health care.
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Scabies and bacterial skin infections at a molecular level
Aboriginal and Torres Strait Islander peoples are nearly 20 times more likely to die from acute rheumatic fever (ARF) and rheumatic heart disease (RHD) than individuals from the wider Australian community. ARF and RHD as well as high rates of renal disease have been clearly linked to scabies infestations as the major driving force of streptococcal pyoderma in children of Indigenous communities, underlying 50 to 70% of all skin infections. In addition, patients are facing mite resistance against current anti-scabetic therapeutics. Community-based initiatives have been recently expanding and today form the major existing body of knowledge surrounding scabies. Critical biological questions, however, remain unanswered, due to the lack of biomedical research in the area. In the context of the current failure to overcome the social dimensions of Indigenous health issues, molecular approaches that have only now become possible may well lead to vaccines or other clinical interventions and hence to an improvement of the situation.
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Otitis media: an ongoing microbial challenge
Young Australian Indigenous children in remote Northern Territory communities suffer excessively high rates of otitis media (OM) and remain at high risk of suppurative complications with poor audiological and educational sequelae. Efforts to effectively treat this condition are confounded by the frequent failure of standard antibiotic treatment regimens, despite good therapeutic compliance and susceptibility of the major pathogens. OM has a complex, polymicrobial aetiology. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the recognised major pathogens; however, bacteria from at least 15 other genera have been identified in middle ear effusions. It is often unclear whether detection of many of these bacteria is circumstantial, or if they are contributing to the infection either directly, or through competitive or cooperative processes. While culture remains the gold standard for detecting the major pathogens, molecular methods are changing the ways we explore the complex polymicrobial dynamics of OM.
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CA-MRSA: emerging remotely
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was first described in remote Indigenous populations in Australia over 20 years ago. The burden of staphylococcal disease, including S. aureus bacteraemia, disproportionately affects Indigenous populations and is likely related to socio-economic disadvantage. Factors such as domestic crowding, poor hygiene and high rates of scabies, skin sores and antibiotic use contribute to the transmission and emergence of CA-MRSA. Studies focusing on two clones, sequence type (ST) 93 and clonal complex (CC) 75, provide supportive evidence for the emergence of methicillin-resistance in Indigenous communities.
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Progress towards a vaccine for Streptococcus pyogenes
Infection with Streptococcus pyogenes (group A streptococcus, GAS) can lead to rheumatic fever (RF) and rheumatic heart disease (RHD), which are significant health concerns in the Indigenous populations of developed countries, including Australian Aboriginal people. The global burden of GAS diseases had been recently reviewed 1 and multiple studies have demonstrated the high burden of these diseases in Australia. RF and RHD are autoimmune type diseases, in which T-cells and antibodies targeting the bacteria may also cross-react with human tissues, therefore rendering a whole cell vaccine impractical.
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Continued challenges for TB control in Australia
Australia ranks as having one of the lowest rates of tuberculosis (TB) worldwide. Multi-drug resistant TB (MDR-TB), however, presents new challenges. With a recognised history of having one of the best TB control programs in the world, we need to maintain it, assure the most at-risk groups have comprehensive and supported screening and treatment programs and share our experience and expertise in our region and globally.
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Fungal infection in Australian Aborigines
Australian Aborigines are disproportionately affected by both superficial cutaneous and systemic fungal infections.
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Dangerous bacteria in unexpected locations; Burkholderia pseudomallei and melioidosis in Australia
There are 25-50 human cases of melioidosis annually in Australia. While the vast majority occur in the tropical north, sporadic cases have been documented from unexpected temperate locations and, each year, several cases are diagnosed in southern hospitals in patients infected in and returned or travelling from northern Australia or southeast Asia.
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Chlamydial infections and Indigenous health
Chlamydia are obligate, intracellular, bacterial pathogens that cause three main diseases in humans worldwide: sexually transmitted disease (infertility and pelvic inflammatory disease), trachoma and respiratory infections. Rates of sexually transmitted infections (STIs) due to C. trachomatis are increasing (a 61% increase in notifications in Australia between 2003 and 2007) and the levels in Indigenous Australians continue to be unacceptably high: nearly five times higher than in non-Indigenous people. C. trachomatis also causes the ocular disease trachoma and, unfortunately, this condition continues to be common in Indigenous Australians, a situation that is unacceptable in a developed country. The other chlamydial species that infects humans is C. pneumoniae. While clinically less severe, the Australian Aboriginal population in the Top End have high rates of serologically diagnosed C. pneumoniae infection, which may contribute to the higher rates of respiratory disease observed in this group.
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Control of intestinal helminths in Indigenous communities
Parasite infections, like most other infectious diseases disproportionately affect people living in poverty. Thus, it is no surprise that the prevalence of intestinal helminth infections has remained higher in Indigenous communities in Australia, compared to that observed in more affluent groups in the population.
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Challenging STIs in remote Central Australia
Sexually transmitted infections (STIs) are endemic in remote Central Australia in Aboriginal communities, but usually don’t prompt individuals to seek testing or treatment. Untreated, a proportion of such infections result in ectopic pregnancies, miscarriages, infertility and enhanced transmission of HIV. The majority of STIs in Central Australia can be diagnosed with current nucleic acid amplification test (NAAT) technologies and treated with single-dose antibiotic treatment. Successful long-term STI control has been achieved in some areas of remote Central Australia by increasing access to testing and treatment for STIs as part of a comprehensive program. Successful control of gonorrhoea also depends on adequate antimicrobial surveillance, which is particularly difficult to achieve in remote areas of Australia.
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HPV-related disease in Indigenous health
Cervical cancer is the second most common cancer in women worldwide, with the majority of cases occurring in the developing world. With effective high-quality cervical cytology screening programs, with wide coverage of target populations, precursor lesions can be detected and treated, ultimately preventing progression to the development of cervix cancer.
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Rotavirus diarrhoea and Aboriginal Children
Rotavirus is the most common cause of paediatric gastroenteritis worldwide. In Australia, Aboriginal children are at the greatest risk of severe disease. The continual changes in dominant strains pose challenges to vaccine success. However, early evidence suggests that rotavirus vaccination will be successful in reducing the impact of rotavirus disease on Australia’s most susceptible population.
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Detecting the dual presence of AmpC and ESBL enzymes
Inducible-chromosomal AmpC cephalosporinase enzymes have been recognised for several years in the ESCAPPM (Enterobacter spp., Serratia spp., Citrobacter freundii, Acinetobacter spp., Proteus vulgaris, Providencia spp. and Morganella morganii) group of gram-negative organisms, which result in the potential resistance to third-generation cephalosporin drugs. More recently several non-ESCAPPM Enterobacteriaceae (particularly E coli, Klebsiella and Proteus mirabilis) have been found to harbour a non-inducible-plasmid form of AmpC. This is particularly important when found in bacteremic patients where third-generation cephalosporins are often the first line drugs of choice.
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From the Editors
This is the last Microbiology Australia issue for 2009. The Editorial Board works hard to ensure that there is an array of topics of interest for ASM members and this year’s issues provide examples of the diversity of our discipline. The first issue (March) focused on the Microbiology of water reuse and alternative supplies. This topic not only remains a high priority for Australia, but its importance continues to increase, as our population grows and our water supplies decrease in many areas.
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ASM Affairs, November 2009
2009 FASM Michael Caffery; Women in Science Breakfast and Workshop
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Volume 35

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Issue 4 (November 2013)
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