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Biomedical subjects

B Currie

Publications and source records attributed to B Currie.

At least 55 records · Page 3Linked to original sources
PubMed1994

An unusual presentation of secondary syphilis in the Northern Territory.

OBJECTIVE: To present a case which demonstrates the unusual clinical features of secondary syphilis that may be encountered in tropical Australia. CLINICAL FEATURES: A syphilitic aetiology was initially missed in a Caucasian female presenting with a rare form of syphilis, "lues maligna", characterised by nodulo-ulcerative skin lesions, fever, meningism and a relapsing course. CONCLUSION: Secondary syphilis is usually manifest in the Northern Territory by a characteristic palmo-plantar psoriasiform eruption with variable involvement of skin in other body areas. The disease is most commonly seen in the young adult Aboriginal population. However, atypical presentations can occur and vigilance must be maintained for a syphilitic aetiology in unusual skin lesions. The disease may produce significant individual morbidity and may be transmitted non-venereally to close contacts in the secondary stage. Genital lesions facilitate the transmission of HIV, making early diagnosis and treatment even more important.

Adult↗
PubMed1994

Sterol composition of Cryptococcus neoformans in the presence and absence of fluconazole.

Analysis of the sterol compositions of 13 clinical isolates of the pathogenic yeast Cryptococcus neoformans obtained from five patients with recurring cryptococcal meningitis showed that, unlike Candida albicans, the major sterols synthesized by this yeast were obtusifoliol (range, 21.1 to 68.2%) and ergosterol (range, 0.0 to 46.5%). There was considerable variation in the sterol contents among the 13 isolates, with total sterol contents ranging from 0.31 to 5.9% of dry weight. The isolates from the five patients who had relapses had different total sterol contents and compositions in comparison with those of the pretreatment isolates, indicating either that the sterols had been changed by therapy or that the patients were infected with new isolates with different sterol compositions. Growth of the cryptococcal isolates in the presence of subinhibitory concentrations of fluconazole (0.25x the MIC) significantly altered the sterol content and pattern. The total sterol content decreased in nine isolates and increased in four isolates in response to pretreatment with fluconazole. Fluconazole had no consistent effect on ergosterol levels. In contrast, fluconazole caused a decrease in obtusifoliol levels and an increase in 4,14-dimethylzymosterol levels in all isolates. These results indicate extensive diversity in sterol content, sterol composition, and sterol synthesis in response to subinhibitory concentrations of fluconazole in C. neoformans strains. We propose that fluconazole inhibits the sterol synthesis of C. neoformans by interfering with both 14 alpha-demethylase-dependent and -independent pathways. No correlation between the sterol compositions of C. neoformans isolates and their susceptibilities to fluconazole was found.

Cholestadienols↗
PubMed1993

Strongyloidiasis in the Northern Territory. Under-recognised and under-treated?

OBJECTIVE: To describe the clinical and laboratory features and management of Strongyloides stercoralis infection in the Top End of the Northern Territory. DESIGN: A 12-month retrospective review of clinical records of patients confirmed on stool microscopy to be infected with S. stercoralis. SETTING: The Royal Darwin Hospital (RDH), a 300-bed referral hospital servicing the tropical areas of the Northern Territory, which have a population of 120,000, 21% of which is Aboriginal. RESULTS: Potentially pathogenic gastrointestinal parasites were identified in 205 patients over the 12 months. Of these, 68 patients had strongyloidiasis--64 were Aboriginal, three were Caucasian and one was of New Guinean origin. Thirty-seven (54%) were under five years of age. Patients came from all regions served by RDH, including urban Darwin. Seventy-five per cent of adults had chronic underlying disease and 80% of children under five years old were below 80% of standard weight for age. Gastrointestinal symptoms were absent in 28%; occasionally, severe disease occurred. Eosinophilia with greater than 0.7 x 10(9) cells/L was present in 57% of patients. Only 57% of cases were treated with thiabendazole. CONCLUSION: In the Top End of the Northern Territory, Strongyloides infection is endemic in Aboriginal communities, but also occasionally occurs in non-Aboriginal people. It is likely that the infection is frequently not recognised. Current community-based anthelmintic regimens have succeeded in reducing the prevalence of hookworm infection, but strongyloidiasis still appears to be a prevalent condition. The possibility of hyperinfection or disseminated strongyloidiasis in immunocompromised patients such as renal transplant recipients and people infected with the human immunodeficiency virus needs consideration in this endemic area. The interaction in northern Australia of S. stercoralis with human T-lymphotropic virus type I and with undernutrition warrants further study.

Adolescent↗
PubMed1993

Medicine in tropical Australia.

In the unique environment of Australia's tropical north there are endemic diseases inherited from Gondwana, others introduced from the north and from Europe, and a wide range of particularly venomous animals. There is continuing disparity in morbidity and mortality between Aboriginal people and other Australians in tropical areas and elsewhere. This is being addressed by the National Aboriginal Health Strategy, which emphasises social, environmental and economic issues, as well as control and coordination of services by Aboriginal and Torres Strait Islander communities. While the re-introduction of malaria remains a potential threat, together with other infections, current diseases in tropical Australia are being better elucidated; melioidosis is now recognised as the commonest cause of fatal [corrected] community-acquired pneumonia in the Top End of the Northern Territory, and a new focus of scrub typhus has been found. Sexually transmitted diseases are an urgent issue, especially for Aboriginal communities, given the potential impact of the human immunodeficiency virus.

Animals↗
PubMed1993

An outbreak of epidemic polyarthritis (Ross River virus disease) in the Northern Territory during the 1990-1991 wet season.

OBJECTIVE: To describe the epidemiology of a large outbreak of epidemic polyarthritis in the Northern Territory during the wet season of 1990-1991. DESIGN, SETTING AND PARTICIPANTS: Arbovirus cases notified to the Northern Territory Department of Health and Community Services by general practitioners and local laboratories between 1 July 1990 and 30 June 1991. MAIN OUTCOME MEASURES: Date and place of infection, age, sex and symptoms. RESULTS: Doctors in the Northern Territory notified 368 cases; another 14 were infected interstate. The epidemic started in September, peaked in January and tailed off in April. The highest attack rates occurred in the rural areas of Jabiru, Litchfield Shire and Katherine. Those most affected were 30-34 year olds. Children, the elderly and Aboriginal people were under-represented. CONCLUSIONS: Epidemic polyarthritis is a wet season problem in the Northern Territory, affecting the rural towns and districts more than the cities. Pre-planned mosquito control measures (effective water drainage and larval control) limited the extent of the 1990-1991 epidemic in Darwin City and Palmerston. The low attack rate in children reflects asymptomatic and less clinically severe infections. The under-representation of Aboriginal people may be the result of infection occurring earlier in life. A related cross-sectional seroprevalence survey has shown that rural Aboriginal people across all age groups have a significantly higher seropositive rate than urban non-Aboriginal residents.

Adolescent↗
PubMed1993

Cryptococcus neoformans in tropical northern Australia: predominantly variant gattii with good outcomes.

BACKGROUND: Infection with Cryptococcus neoformans is common in the Northern Territory of Australia. Disease is life threatening and treatment is prolonged and often complicated by the need for surgery and difficulties with medical therapy. AIMS: To document incidence, demography, risk factors, clinical features and outcomes of infection and to determine differences between gattii and neoformans varieties. METHODS: Case records of all patients (n = 35) diagnosed with cryptococcal infection at the Royal Darwin Hospital between 1976 and 1992 were reviewed retrospectively. Current status of patients was ascertained. Variety identification of isolates was determined by growth in canavanine-glycine-bromthymol blue agar. RESULTS: Of the 35 patients, 23 had meningitis, ten had pneumonia, one had a dermal infection and one had fungaemia with no obvious focus. Twelve (52%) meningitis cases and two (20%) pneumonia cases had no predisposing disease. Thirteen (57%) meningitis cases had concomitant pulmonary cryptococcosis. Twenty-nine patients with Aboriginal and six were Caucasian, with a relative risk for Aboriginals compared with non-Aboriginals of 20.6 (95% CI 8.6-49.5). Arnhemland was the commonest location of infection, with an annual incidence in Aboriginals of 0.14/1000. Fourteen (78%) of 18 isolates tested were C. neoformans var. gattii. Management was characterised by the frequent need for adjunctive surgery and prolonged or repeat courses of systemic antifungal therapy. Despite this, long-term outcomes are encouraging with a mortality of 14% overall and 9% in meningitis patients. The river red gum (Eucalyptus camaldulensis) has a limited distribution in Arnhemland and ongoing studies are seeking alternative environmental sources of C. neoformans var. gattii.

Adolescent↗
PubMed1993

Acute hepatitis B infection in aboriginal Australians.

The apparent incidence of acute hepatitis B infection in the Top End of the Northern Territory was estimated from notification data and hospital data to be 12 per 100,000 per year, with a marked difference between Aborigines (42 per 100,000) and non-Aborigines (4 per 100,000), and an odds ratio of 9.7 (95 per cent confidence intervals 3 to 33). Sixty percent of Aboriginal cases of acute hepatitis B occurred in children under 10 years of age, whereas non-Aboriginal cases occurred in adults aged 20 to 29, most with behavioural risk factors. These findings confirm the importance of immunising Aboriginal children to reduce the future incidence of hepatitis B infection and hepatoma.

Acute Disease↗
PubMed1993

A dominant hereditary ataxia resembling Machado-Joseph disease in Arnhem Land, Australia.

A dominant ataxia among four families of the Arnhem Land Aboriginal people of Northern Australia has many clinical features in common with Machado-Joseph disease. Neuropathology on one case showed multiple system involvement, with sparing of the inferior olives and cerebellar cortex, consistent with Machado-Joseph disease. Portuguese ancestry is possible, although not proven.

Adult↗
PubMed1993

A new focus of scrub typhus in tropical Australia.

A new focus of scrub typhus (Rickettsia tsutsugamushi) is described in a remote rain forest region of the Northern Territory of Australia. Five serologically confirmed cases, two near fatal with multisystem involvement, have occurred since the area became accessible to tourists. As tourism increases, other remote foci of vectors and organisms may also be recognized in tropical Australia.

Adult↗
PubMed1993

The 1990-1991 outbreak of melioidosis in the Northern Territory of Australia: epidemiology and environmental studies.

From November 1990 to June 1991 33 acute cases of melioidosis occurred in the Northern Territory, Australia; 25 cases were reported in the capital city, Darwin. We carried out an epidemiological investigation to exclude a common source outbreak, describe the risk factors for disease, and develop and institute appropriate control measures. We compared population based attack rates among various risk groups using logistic regression, and the demographic, medical and behavioral risk factors for melioidosis by a matched case-control study. Environmental Health Officers collected soil, surface water and cooling tower water specimens for Pseudomonas pseudomallei culture. The crude attack rate of melioidosis during the outbreak was 52 per 100,000. Age, gender, race, diabetes and alcohol abuse were independent risk factors for disease. The relative risk of disease in diabetic patients was 12.9 (95% CI 5.1-32.7; p < 0.001) and 6.7 in alcoholic patients (95% CI 2.9-15.2; p < 0.001). We found no significant difference between cases and controls in matched pair analysis for any of several exposure factors studied. We isolated Pseudomonas pseudomallei from 4% of soil samples and 9% of surface water samples. Our study confirms the importance of host factors in the development of melioidosis, and attempts to quantify the risk of disease during the Darwin epidemic. Pseudomonas pseudomallei is widespread in the soil of urban Darwin.

Acute Disease↗
PubMed1993

The 1990-1991 outbreak of melioidosis in the Northern Territory of Australia: clinical aspects.

From November 1990 to June 1991, 33 cases of acute melioidosis were diagnosed in tropical Northern Territory, Australia during an exceptionally wet monsoon. Eighteen (55%) were alcoholic, 16 (48%) diabetic and only 4 (12%, all survivors) had no risk factors. Twenty-seven (82%) were considered recent infection, with an incubation period of 3-21 days (mean 14) documented in eight cases with presumed cutaneous inoculation. Fourteen patients presented with pneumonia (4 septicemic) and of 11 others with septicemia 4 had genitourinary foci. Three of 4 with splenic abscesses required splenectomy. Three had only skin/soft tissue infection. One patient with brainstem encephalitis needed prolonged ventilation. Overall mortality was 36% (12 cases, including three relapses), despite therapy with ceftazidime and intensive care facilities. Pseudomonas pseudomallei is the commonest diagnosed cause of fatal bacteremic pneumonia at Royal Darwin Hospital and emphasis is placed on early appropriate antibiotic therapy and compliance with maintenance therapy for at least three months.

Adult↗
PubMed1993

The diagnosis and treatment of malaria in Australia.

The number of reported malaria cases is increasing each year with several deaths reported recently. This article reviews the types of malarias, including their incidence, prevention, presentation and the standard treatment protocols.

Adult↗
PubMed1992

ECMO in newborn infants: the New South Wales experience.

Extracorporeal membrane oxygenation (ECMO) has been used at the Prince of Wales Children's Hospital, Sydney for the treatment of newborn infants with life-threatening respiratory or cardiac failure since August 1989. The main indications are that the disease is reversible, the surviving infant is likely to be normal and there is an 80% likelihood of death without ECMO. Eighteen of 19 newborn infants have survived at least 2 months after ECMO. The 15 infants receiving ECMO (nine with meconium aspiration, six with persisting pulmonary hypertension) who did not have a congenital diaphragmatic hernia were normal survivors. One death occurred at 5 months of age from chronic lung disease. Three of four infants with congenital diaphragmatic hernia were discharged following ECMO and appeared normal at 6, 9 and 18 months of age. These results are similar to results from other centres internationally. It appears that ECMO is a useful therapy for near-term newborn infants with otherwise fatal cardiorespiratory failure.

Extracorporeal Membrane Oxygenation↗