Biomedical subjects
Publications and source records attributed to F J Bowden.
Patients with HIV infection have a high risk of bacterial infection. A high index of suspicion for common and less common bacterial infections is needed, together with a flexible approach to diagnosis and therapy. Many infections are characterized by relapse after therapy; long-term treatment is frequently required.
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OBJECTIVES: To determine the effectiveness of azithromycin, an azalide antibiotic with long tissue half-life, in a pilot study of patients with genital donovanosis in the Northern Territory, Australia. DESIGN: Patients with histologically confirmed donovanosis were randomised to receive one of two open-label azithromycin dosage regimens: Regimen A--1.0 g once weekly for 4 weeks; or Regimen B--500 mg daily for 7 days. Patients were assessed at 6 weeks and classified as either "cured", "improved" or "failed". RESULTS: Seven patients received regimen A and 4 received regimen B. Six weeks after commencing treatment the genital ulcers of four patients receiving regimen A and one patient receiving regimen B had healed; the lesions of the other six patients (3 in each regimen) were "improved". No patient failed to respond and no significant adverse reaction was recognised. The eleven patients were reviewed after completing the six-week trial; all lesions had re-epithelialised without further antibiotic treatment, no relapses had occurred, the longest follow-up period being seven months. A further 17 patients with donovanosis who were unable to meet the entry criteria were also treated successfully with azithromycin during the study period. CONCLUSIONS: This is the first time that azithromycin has been shown to have clinical activity against donovanosis. Poor compliance with prolonged courses of antibiotics is one of the major barriers to control of the disease. Intermittent or short-course therapy, made possible by the long tissue half-life of the drug, could facilitate control of donovanosis in endemic populations if the high cost of medication can be addressed.
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BACKGROUND: Until recently Penicillium marneffei rarely caused human disease. It is now a frequently encountered opportunistic mycosis in HIV positive residents of, and travellers to, south-east Asia. AIMS: To review aspects of clinical presentation, pathology, treatment, epidemiology and ecology of P. marneffei. To report a case of disseminated P. marneffei occurring in the Northern Territory which illustrates many typical clinical and pathological features of this infection. CASE PRESENTATION: A Burmese immigrant presented to Royal Darwin Hospital, Australia with a non-specific, subacute, febrile illness and a diffuse papular rash. The etiological agent was Penicillium marneffei, disseminated in association with advanced HIV infection. The typical travel history and umbilicated papular rash were recognized on admission. Fungal stains of skin biopsies and touch smears facilitated rapid diagnosis, and early antifungal therapy resulted in clinical cure. CONCLUSIONS: Early distinction of penicilliosis from other opportunistic mycoses, tuberculosis, Leishmaniasis, and molluscum contagiosum is critical for effective management. The characteristic histological and mycological properties of P. marneffei are easily recognizable if the diagnosis is considered. In view of geographic proximity, travel and immigration from endemic areas, Australia should expect further imported penicilliosis as illustrated by this case report.
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OBJECTIVE: To determine the level of immunity to hepatitis A virus infection in rural Australian Aboriginal populations in the "Top End" of the Northern Territory. METHODS: A total of 344 sera, for which details of donors' age, sex and domicile were available, were collected and tested for hepatitis A total antibody in a delinked seroprevalence study. RESULTS: Overall, 337/344 samples (97.97%) tested positive for hepatitis A total antibodies--18/20 samples (90%) in the 1-5 year age group; 85/88 (96.6%) in the 6-10 year age group; 98/98 (100%) in the 11-15 year age group; 32/33 (97.0%) in the 16-20 year age group and 104/105 (99%) in the older than 20 year age group. CONCLUSION: Hepatitis A is hyperendemic in the rural Aboriginal communities studied and the virus is acquired predominantly in the first five years of life. Symptomatic hepatitis A infection is uncommon in this population. We suggest that hepatitis A vaccination for rural Aboriginal children is not indicated as it would not reduce clinical disease rates and may produce a cohort whose immunity could decrease over the following 10 years. Although vaccination is appropriate for non-immune individuals working in remote communities, emphasis must be placed on the inequities in health infrastructure and education underlying the high transmission rates in Aboriginal children.
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.
OBJECTIVE: To prospectively study occupational exposures to human immunodeficiency virus (HIV) and other blood-borne pathogens. DESIGN AND SETTING: Detailed clinical information was collected and follow-up was performed on all health care workers with occupational exposures to potentially infected substances at Fairfield Infectious Diseases Hospital during the period January 1985 to September 1991. RESULTS: There were 230 occupational exposures reported. One hundred and forty-one were considered "significant" or "potentially significant"; these involved exposure (or the potential for exposure) to blood or body fluids by the parenteral route or contamination of non-intact skin or mucous membranes. Needle/syringe assemblies accounted for 59% of the "significant" injuries, "butterfly" needles for 21% and lancets for 8%. "Butterfly" needles were over-represented relative to their degree of use. Seventy-seven of the 230 exposures were HIV-related and 27 of these were considered "significant". The number of HIV positive patients attending the hospital increased progressively over the survey period but the rate of HIV-related exposures fell during that time. After 1988, 13 individuals with "significant" exposure to HIV received a six-week prophylactic course of zidovudine. No health care workers seroconverted for HIV, hepatitis B or hepatitis C during the survey period. CONCLUSIONS: The risk of acquiring HIV (and other blood-borne diseases) through occupational exposure is very low and this risk can be further reduced by adopting safe work practices.
A homosexual man with histologically confirmed Kaposi's sarcoma remained seronegative for HIV-1, HIV-2, and HTLV-1 on conventional tests over a 4-year period. HIV cultures were also negative on thirteen separate occasions. However, serum antibodies to synthetic peptide analogues of the gp41 and nef regions of HIV-1 were consistently detected on an enzyme immunoassay. Tests with the polymerase chain reaction with primers directed to the gag and env regions were negative. The antigens to which the antibodies were produced might have come from a defective HIV mutant, another retrovirus, or a hitherto unknown "agent of Kaposi's sarcoma" with similar antigenic epitopes.
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Explore the source record for details and available documents.