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Biomedical subjects

R Speare

Publications and source records attributed to R Speare.

At least 19 recordsLinked to original sources
PubMed2006

The argument for integrating vector control with multiple drug administration campaigns to ensure elimination of lymphatic filariasis.

BACKGROUND: There is a danger that mass drug administration campaigns may fail to maintain adequate treatment coverage to achieve lymphatic filariasis elimination. Hence, additional measures to suppress transmission might be needed to ensure the success of the Global Program for the Elimination of Lymphatic Filariasis. DISCUSSION: Vector control successfully eliminated lymphatic filariasis when implemented alone or with mass drug administration. Challenges to lymphatic filariasis elimination include uncertainty of the exact level and duration of microfilarial suppression required for elimination, the mobility of infected individuals, consistent non-participation of some infected individuals with mass drug administration, the possible development of anti-filarial drug resistance and treatment strategies in areas co-endemic with loasis. Integration of vector control with mass drug administration can address some of these challenges. The potential benefits of vector control would include: (1) the ability to suppress filariasis transmission without the need to identify all individual 'foci of infection'; (2) minimizing the risk of reestablishment of transmission from imported microfilaria positive individuals; and (3) decreasing the risk of dengue or malaria transmission where, respectively, Aedes or Anopheles are lymphatic filariasis vectors. SUMMARY: With adequate sustained treatment coverage, mass drug administration should meet the criteria for elimination of lymphatic filariasis. However, it may be difficult to sustain sufficiently high mass drug administration coverage to achieve lymphatic filariasis elimination in some areas, particularly, where Aedes species are the vectors. Since vector control was effective in controlling and even eliminating lymphatic filariasis transmission, integration of vector control with mass drug administration will ensure the sustainability of transmission suppression and thereby better ensure the success of national filariasis elimination programs. Although trials of some vector control interventions are needed, proven vector control strategies are ready for immediate integration with mass drug administration for many important vectors. Vector control is the only presently available additional lymphatic filariasis control measure with the potential for immediate implementation.

Journal Article↗
PubMed2004

Strongyloides serology--useful for diagnosis and management of strongyloidiasis in rural Indigenous populations, but important gaps in knowledge remain.

General practitioners who care for Aboriginal patients in rural and remote communities from tropical Australia must be aware of strongyloidiasis. The prevalence of this parasitic infection is high and occasional cases can have a fatal outcome. Other groups in Australia at high risk of strongyloidiasis are immigrants from endemic countries, particularly from Southeast Asia, and military personnel who have served overseas in endemic areas. Elimination programs for enteric parasites in rural Australian Indigenous communities are so important that a nationally coordinated approach has been advocated. Wisely used, cost-effective diagnostic tests are a critical component of an elimination program. Strongyloidiasis must be confirmed by laboratory diagnosis and the strongyloides ELISA, although not ideal, is a useful test that can be used to diagnose strongyloidiasis and to monitor cure. In this article the value of the current strongyloides ELISA is discussed and a cost-benefit analysis is conducted using direct costs only. In a typical rural Aboriginal community in tropical Australia with prevalence of strongyloidiasis at 20% each true positive case detected by the strongyloides ELISA is estimated to cost approximately AU590 dollars to diagnose and manage until cure, proven by negative serology.

Journal Article↗
PubMed2004

Adaptive immunity in melioidosis: a possible role for T cells in determining outcome of infection with Burkholderia pseudomallei.

Melioidosis is a potentially fatal disease caused by the bacterium Burkholderia pseudomallei. Individuals with subclinical melioidosis have no apparent clinical signs or symptoms, and are identified only by positive serology. The present study is the first to investigate cell-mediated immune (CMI) responses following in vitro stimulation with B. pseudomallei antigens in peripheral blood mononuclear cells (PBMC), collected under field conditions in Papua New Guinea (PNG) from individuals with exposure to B. pseudomallei (n = 13). While five had a clinical history of melioidosis (C(+)), the remaining individuals (n = 8) were seropositive, yet healthy with no clinical history of melioidosis (S(+)/C(-)). Proliferation and IFN-gamma production were significantly greater in lymphocyte cultures from S(+)/C(-) individuals compared to C(+) individuals (P < 0.001 and P < 0.05, respectively). These findings demonstrate that compared to C(+) patients, individuals with subclinical melioidosis have a stronger CMI response to B. pseudomallei antigens in vitro. Such a response may be essential for protection against disease progression.

Adolescent↗
PubMed2004

Head lice prevalence in primary schools in Victoria, Australia.

OBJECTIVES: To determine the prevalence of and assess risk factors associated with head lice infections (pediculosis) in children from government primary schools in Victoria, Australia. METHODS: Between May and October 2001, children were selected by clustered random sampling of schools and classes, then examined for head lice using hair conditioner and a fine-toothed head lice comb. There were 1838 children screened from 16 primary schools. Risk factors evaluated included metropolitan or rural residence, school class, gender and hair length. RESULTS: Thirteen percent of children (239/1838) had an active infection (95% CI, 10.9-15.1) and 3.3% (61/1838) had an inactive infection (95% CI, 2.0-4.6). Prevalence of active pediculosis varied between schools from 0 to 28%. Our screening identified no more than one case per class in the majority of classes screened (58.5%). Females were 2.2 times more likely to have active infection than males (95% CI [1.7,2.9]) and there was no significant difference for the other risk factors investigated. CONCLUSIONS: Our study demonstrated the prevalence of head lice varied across Victoria and showed that risk factors commonly attributed to head lice infections did not hold true. Our findings support the premise that traditional ad hoc mass school-based screening may not be the best use of resources when controlling head lice. We suggest a more pragmatic community-based approach.

Adolescent↗
PubMed2004

Effect of season and temperature on mortality in amphibians due to chytridiomycosis.

OBJECTIVE: To investigate the distribution and incidence of chytridiomycosis in eastern Australian frogs and to examine the effects of temperature on this disease. DESIGN: A pathological survey and a transmission experiment were conducted. PROCEDURE: Diagnostic pathology examinations were performed on free-living and captive, ill and dead amphibians collected opportunistically from eastern Australia between October 1993 and December 2000. We conducted a transmission experiment in the laboratory to investigate the effects of temperature: eight great barred frogs (Mixophyes fasciolatus) exposed to zoospores of Batrachochytrium dendrobatidis and six unexposed frogs were housed individually in each of three rooms held at 17 degrees C, 23 degrees C and 27 degrees C. RESULTS: Chytridiomycosis was the cause of death or morbidity for 133 (55.2%) of 241 free-living amphibians and for 66 (58.4%) of 113 captive amphibians. This disease occurred in 34 amphibian species, was widespread around the eastern seaboard of Australia and affected amphibians in a variety of habitats at high and low altitudes on or between the Great Dividing Range and the coast. The incidence of chytridiomycosis was higher in winter, with 53% of wild frogs from Queensland and New South Wales dying in July and August. Other diseases were much less common and were detected mostly in spring and summer. In experimental infections, lower temperatures enhanced the pathogenicity of B. dendrobatidis in M. fasciolatus. All 16 frogs exposed to B. dendrobatidis at 17 degrees C and 23 degrees C died, whereas 4 of 8 frogs exposed at 27 degrees C survived. However, the time until death for the frogs that died at 27 degrees C was shorter than at the lower temperatures. Infections in survivors were eliminated by 98 days. CONCLUSION: Chytridiomycosis is a major cause of mortality in free-living and captive amphibians in Australia and mortality rate increases at lower temperatures.

Amphibians↗
PubMed2004

Toxic effects of mebendazole at high dose on the haematology of red-legged pademelons (Thylogale stigmatica).

OBJECTIVE: To investigate the effects of mebendazole at high dose on the haematology of macropods. Experimental. PROCEDURE: Five red-legged pademelons (Thylogale stigmatica) were dosed orally with mebendazole at 50 mg/kg/d for 5 to 6 days. Two control pademelons were dosed with water. Regular blood samples were taken for haematology over 20 days. RESULTS: All four treated pademelons sampled at 5 days developed severe leucopenia and neutropenia, moderate lymphopenia, thrombocytopenia, eosinopenia and monocytopenia, as well as bone marrow aplasia within 5 to 11 days after the first mebendazole dose. Four pademelons died unexpectedly or became ill and were euthanased 5 to 11 days after the first dose while the other animal recovered after 5 days of illness. Necropsy revealed systemic infection with opportunistic enteric bacteria, non-suppurative inflammation in tissues, haemorrhage and ulceration of the gastrointestinal tract. CONCLUSIONS: Red-legged pademelons rapidly develop bone-marrow aplasia and subsequent septicaemia after administration of high doses of mebendazole. Mebendazole at high doses should not be used for macropods.

Agranulocytosis↗
PubMed2003

The use of hospital-based nurses for the surveillance of potential disease outbreaks.

OBJECTIVE: To study a novel surveillance system introduced in Mpumalanga Province, a rural area in the north-east of South Africa, in an attempt to address deficiencies in the system of notification for infectious conditions that have the potential for causing outbreaks. METHODS: Hospital-based infection control nurses in all of Mpumalanga's 32 public and private hospitals were trained to recognize, report, and respond to nine clinical syndromes that require immediate action. Sustainability of the system was assured through a schedule of regular training and networking, and by providing feedback to the nurses. The system was evaluated by formal review of hospital records, evidence of the effective containment of a cholera outbreak, and assessment of the speed and appropriateness of responses to other syndromes. FINDINGS: Rapid detection, reporting and response to six imported cholera cases resulted in effective containment, with only 19 proven secondary cholera cases, during the two-year review period. No secondary cases followed detection and prompt response to 14 patients with meningococcal disease. By the end of the first year of implementation, all facilities were providing weekly zero-reports on the nine syndromes before the designated time. Formal hospital record review for cases of acute flaccid paralysis endorsed the value of the system. CONCLUSION: The primary goal of an outbreak surveillance system is to ensure timely recognition of syndromes requiring an immediate response. Infection control nurses in Mpumalanga hospitals have excelled in timely weekly zero-reporting, participation at monthly training and feedback sessions, detection of priority clinical syndromes, and prompt appropriate response. This review provides support for the role of hospital-based nurses as valuable sentinel surveillance agents providing timely data for action.

Cholera↗
PubMed2003

Strongyloidiasis: an issue in Aboriginal communities.

Strongyloidiasis, a disease caused by the parasitic gut nematode (roundworm), Strongyloides stercoralis, has the highest prevalence in the world in rural and remote Aboriginal communities of northern Australia. With prevalences greater than 25%, these communities have rates of strongyloidiasis higher those in the worst affected developing countries where surveys have been recently conducted. Available data indisputably support that strongyloidiasis is more prevalent in rural and remote Aboriginal communities than in the mainstream Australian community. However control of strongyloidiasis has not been given a high priority by government health departments, with the result that Aboriginal people in remote and rural communities in Northern Australia are still suffering from a preventable and treatable disease. This article suggests that the only way to address the strongyloidiasis problem in Indigenous communities is to have strongyloidiasis recognised and addressed at the national level. One component of this must be making health departments responsible for establishing appropriate systems of effective treatment for and monitoring of patients with strongyloidiasis.

Journal Article↗
PubMed2002

Rabies post-exposure management in South Africa: a telephonic survey used as a rapid tool for operational research.

Rabies is an important disease in rural South Africa, and vaccine and immunoglobulin are provided, at the State's expense, to humans following suspected exposure to rabies virus by bite, scratch or mucosal splash. Health facilities where post-exposure treatment is available are listed, with contact telephone numbers, in national rabies guidelines. To verify the accuracy of this recently updated information, members of the national Rabies Advisory Group were tasked to complete a rapid survey. A simple standardized telephone interview technique was used. This revealed startling deficiencies in the availability of vaccine and immunoglobulin at the indicated sites and led to decisive corrective action. This 'quick and dirty' survey technique provided valuable information for improving an important public health programme, and should be considered when auditing other health programmes, particularly where a means for validating responses is readily available.

Animals↗
PubMed2002

Leprosy in Mpumalanga Province, South Africa--eliminated or hidden?

In South Africa, leprosy has been a notifiable condition since 1921. Although the WHO elimination target of less than one case per 10,000 population has been achieved at country level, the distribution of leprosy in the country is distinctly heterogeneous, with a prominent 'leprosy belt' of greater prevalence stretching across Mpumalanga Province into northern Kwa-Zulu Natal. The highest prevalence in this 'belt' has historically been in Ermelo District. Recent trends of few newly detected leprosy patients in this district raised concerns that health system changes may have resulted in failure to detect leprosy cases. Thus a large-scale community awareness campaign was conducted followed by an intensively advertised screening programme of 3-month duration at schools and central gathering points in villages and farms from 1 June to 31 August 2000. One thousand one hundred and seventy-seven people presented for clinical screening at designated points, while 790 scholars were screened at schools and an additional 1433 people were screened at their homes by the field team. Forty-four people with skin or nervous system lesions compatible with leprosy were referred for specialized assessment and biopsy where indicated. Four new leprosy patients were diagnosed, including an elderly lady with pronounced disability. Two of these patients had prior contact with the health service due to dermatological manifestations of leprosy without diagnosis being made. All patients provided a history of close prolonged contact with known leprosy patients. Ongoing intense tracing and follow-up of close contacts of proven leprosy cases may be a more efficient method of detecting leprosy cases in areas with relatively stable populations that have accomplished 'leprosy elimination', than resource intensive community surveys.

Adult↗
PubMed2001

Salmonelliasis in wildlife from Queensland.

During a 20 yr period (1978 to 1998), 233 isolates of Salmonella spp. were cultured from 179 wildlife animals (representing 25 species), 32 crocodile (Crocodylus porosus) eggs and six crocodile nesting sites, and represented 59 different serotypes. Salmonella serotype Virchow, the major serotype infecting humans in north Queensland, (Australia) was common in macropodids, but was not found in reptiles and was isolated only once from cane toads (Bufo marinus). Investigations of human cases of salmonellosis should include simultaneous studies on wild and domestic animals in contact with the case.

Alligators and Crocodiles↗
PubMed2001

A case of pubic lice resistant to pyrethrins.

BACKGROUND: Effective therapeutic protocols for the treatment of pubic lice include application of approved insecticidal products to all body and scalp hair, retreatment at seven days, and use of mechanical removal of lice and eggs. OBJECTIVE: We report here infection with pubic lice in a 43 year old male in Australia which failed to be eradicated by adequate therapy with a pyrethrin and piperonyl butoxide product. DISCUSSION: Pubic lice collected from the case survived after exposure to the same product in vitro. The infestation was cured by use of 5% permethrin. This appears to be the first report of Pthirus pubis resistant to insecticides, in this case pyrethrins and their synergist, piperonyl butoxide.

Adult↗
PubMed1999

Head lice in pupils of a primary school in Australia and implications for control.

BACKGROUND: Anecdotal reports suggest that head lice infestations are a common problem in school-aged children in Australia; however, only a few data are available. The present study aimed to determine the prevalence of infestation with head lice in children in an urban Australian school. METHODS: All 735 pupils from grades preschool to five of a government run primary school were invited to participate in the cross-sectional survey. Overall, 212 boys (46.5%) and 244 girls from 29 classes were examined. The main outcome measures were: (1) the detection of lice or eggs by visual examination of the child's head, and classification into 'not infested' and 'infested;' infested cases were further classified into 'active infestation' (lice or viable eggs found) or 'inactive infestation' (only unhatched eggs found); (2) for each child, a parent or guardian was asked to complete a standardized questionnaire. RESULTS: Of the 456 children examined, 33.7% (95% confidence interval = 95%-CI = [26.9%, 40.4%]) had evidence of infestation with head lice, 21.0% (95%-CI = [15.2%, 26.8%]) with active infestation. The prevalence of infestation (active plus inactive) varied greatly between classes, ranging from zero to 72.2% (p < 0.001). Head lice were more prevalent in girls than boys (p < 0.001). Analysis of questionnaires showed that 47.7% (95%-CI = [43.0%, 52.4%]) of the children had been infested with head lice in the previous 6 months. For children with active pediculosis capitis on examination, 14.0% (95%-CI = [7.9%, 22.4%]) of parents or guardians had not noticed the infestation. CONCLUSIONS: In an urban primary school in Australia, head lice infestation was present at a hyperendemic level. Clustering by class indicated the classroom as a main source of infestation. Control strategies implemented in schools and including the education of teachers and parents need to be evaluated.

Animals↗