When the wind blows

.. the cradle will rock. So the rhyme goes, reminding us that the elements are indiscriminate in their destructive actions. At the time of writing Tropical Cyclone Iggy lingers off our shore, still a little undecided on if and where to make landfall.

TC Iggy

The Australian Bureau of Meteorology website provides a useful introduction to cyclone climatology. The northwest WA coast is the most cyclone-affected coastline in Australia. The annual averages are:

• 5 tropical cyclones form off the northwest coast
• 2 cyclones come ashore
• 1 of these will be severe, most often in March or April

Making tracks

Cyclone tracks vary considerably, some making U-turns or even loops. However, BOM notes that there is a preferred route starting in a south westerly direction, then turning more southerly and eventually south easterly when they travel as far south as the Pilbara.

The link with melioidosis

The path cyclones follow has been a matter of interest to the Micrognome for some time because of the link between melioidosis and severe weather in northern Australia. His team noticed there was a correlation between the direction cyclones took in a given year and the number of cases of severe disease.

Cyclone dynamics

Cyclone physics is complex and reflected in the variability of their destructive effect, wind speed, rainfall and duration. In general, BOM notes four main stages in the life-cycle of a tropical cyclone: formative, immature, mature and decay. We noted that the years when more cases occurred were years in which cyclones made landfall over the Northern Territory then followed a south westerly track. Years with cyclones approaching exclusively from the West and making landfall over the Kimberley or Pilbara coast were not bad years for severe melioidosis.

The fluid dynamics of interaction between a cyclone and the land it passes over  are most definitely complex. An added level of complexity is the rainfall that occurs in the cyclone’s decay stage. This looks like it may explain some of the excess cases observed in the NT.

At least we can predict cyclones like TC Iggy are unlikely to cause extra cases of melioidosis, while the likes of TC Carlos (see moving image) are a different kettle of fish.

Melioidosis info sources

• melioidosis clinical guideline
• the treatment of melioidosis
• melioidosis, a disease of surprises

Clinical Parasitology

This list captures a typical top ten common enteric parasites of medical importance, though the order of importance will vary around Australia. Information on Entamoeba histolytica is given, as this species is a common reason for a test request even if a positive result is relatively uncommon. The pathogenic role of several of the other parasite species is debatable, and detection may be more useful as an indication of poor hygiene, recent international travel or immune compromise. Further details at the CDC.

Myiasis

Dermatobia larva, ca. 1cm long

Infestation of skin by fly larvae, which feed on living or dead tissue

There are three main variants of this condition: cutaneous, body cavity and accidental myiasis

1   Cutaneous myiasis

• bloodsucking, in which larvae attach to the skin and either bite or suck blood: Auchmeromyia, Tabanidae, Therevidae
• furuncular, in which larvae penetrate skin to make boil-like lesions: Cordylobia, Dermatobia, Wohlfartia
• creeping, in which larvae tunnel in the epidermis without completing their life cycle: Hypodermatinae, Gasterophilinae
• wound/traumatic, in which larvae develop in wounds: Calliphoridae, Fanniidae, Muscidae, Phoridae, Sarcophagidae

2   Body cavity myiasis

• nasopharyngeal, lung, auricular & ophthalmomyiasis in which eggs or larvae deposited in cavities: Calliphoridae, Oestridae, Phoridae, Sarcophagidae

3   Accidental myiasis

• intestinal, in which larvae ingested or enter via rectum: Anisopodidae, Calliphoridae, Drosophilidae, Fanniidae, Muscidae & others
• urogenital in which adults attracted to infected tissue or clothing: Anisopodidae, Calliporidae, Fanniidae, Muscidae and others

Larva of Dermatobia hominis, the cause of furuncular cutaneous myiasis in man, cattle, dogs, other mammals and some birds in Central and South America.

D. hominis is occasionally seen in international travellers from outside the region. Dermatobia belongs to the Cuterebrinae sub-family of the Oestridae family of Diptera. Their larvae have bodies with strong, evenly distributed spines and posterior spiracles with a lot of small, serpentine slits.

A small nodule with a central breathing pore develops around the larva at the site of penetration. These swelling usually last for a few weeks, before the mature larva emerges and drops to the ground to pupate.

Reference:

Hall MJR, Smith KGV. Diptera causing myiasis in man. Ch 12. ed Lane RP, Crosskey RW. Medical Insects & Arachnids. Chapman & Hall, London, 1993. ISBN 0 412 40000 6.

Micrognome, October, 2011

Crocodile bites

The 4.55m saltwater crocodile caught by Northern Territory rangers this week was a monster. The thought of the damage he could do is sobering. You wonder how dull life in the Territory can be if people have to resort to planking on crocs to brighten things up. Previously, we took a look at the infective consequences of shark bites. Now we examine what damage a croc can do. Here’s a microbiological perspective on crocodile bites.

How a crocodile bites: Crocodiles and related species (alligators, caimans etc) have bite strength in proportion to the length of their jaws. Long snouted species are suited to swift lateral attacks, while shorter snouted crocodialians are more suited to a grasp, shake and roll attack.  Strong, swift lateral attacks on the extremities cause decapitation or limb amputation. Other extremities can also be attacked – men beware. Clearly decapitation is swiftly fatal. Traumatic amputation may not be if the victim can somehow get immediate life-saving medical attention.

Image credit: Boredstop

If the victim of a crocodile attack suffers a lesser injury, there is a substantial risk of wound infection. The bacteria cultured from crocodile bite wounds include Aeromonas hydrophila, Burkholderia pseudomallei, Clostridium species, Enterococcus species, Proteus species, Pseudomonas aeruginosa. Interestingly, in one study of crocodile intestinal bacteria no Salmonellas were found. The fungi commonly necountered in that series was Cladosporium sp.

Crocodile teeth are peg shaped and may harbour a flourishing resident bacterial flora. Unfortunately the data on the composition of that flora are limited. Other sources of bacteria contaminating crocodile bite wounds are likely to include the water in which the injury occurs and the bacteria present on the skin surface of the victim. A wide variety of potential infective agents can therefore be expected.

Recommended management of wounds inflicted by crocodile bites is:

1. immediate wound stabilising surgery
2. irrigation, removal of foreign bodies (including teeth) & devitalised tissue
3. antibiotic therapy: suggestions vary but include doxycycline and moxifloxacin (dose & duration not specified in current editions of antibiotic guidelines)

warning sign, NT

Prevention: best summarised as avoiding crocodile encounter by any legitimate means.

The largest single mass crocodile attack is thought to be the result of a hasty retreat by Japanese troops through crocodile infested swamps in the Battle of Ramree Island during the Second World War.

Where ?  No systematic surveillance of crocodile attacks is available in the form of easily accessible mapped data, however the Australian risk zone is restricted to the northern coastal area .

image source: Australian Zoo

Further information:

• Medscape article on animal bites in emergency medicine
• Alligator biology
• Review of microbiology of animal bites

MicroGnome, 11-JUN-11.

5 key points on fever in international travellers (clinical problem)

• a travel history should be obtained from anyone with a febrile illness
• malaria should be excluded in anyone with a fever who has been in a malaria-endemic area recently
• then consider dengue & other arbovirus infections if there has been mosquito exposure
• do not forget the neglected bacterial tropical infections: enteric fever, leptospirosis, scrub typhus & melioidosis
• do not forget to ask about potential risk for sexually-transmitted infections & HIV/AIDS

Leishmaniasis:  5 point summary of highlights, further details in leishmaniasis module of Tropical Medicine teaching series

• parasitic infection transmitted by the bite of a sandfly
• distinct skin, mucocutaneous & visceral forms of infection are known
• leishmaniasis is present in one or more of its forms in the Indian Subcontinent, the Middle East & Mediterranean rim, Central and South America
• some cutaneous lesions can be treated conservatively
• laboratory confirmation of diagnosis requires specialist pathology services

Dengue: 5 point summary of highlights, further details in arbovirus module of Tropical Medicine teaching series

• viral infection of humans spread via Culicine mosquitoes
• in rare cases may prove fatal
• clinical features may not distinguish dengue from other infections
• dengue can be acquired in tropical Australia
• no antiviral treatment is effective against dengue

Malaria: 5 point summary of highlights, further details in malaria module of Tropical Medicine teaching series

1. commonest fatal parasitic infection worldwide
2. prevented by avoiding bites from malaria-bearing Anopheles mosquitoes
3. all international travellers to malaria-endemic zone with fever on their return have malaria until proven otherwise
4. malaria cannot be completely ruled out by a single, one-off blood test
5. first line treatment recommended for uncomplicated malaria is based on an ACT-containing regimen unless good reason for choosing otherwise

Recent news on the rabies risk of your favorite holiday destination, courtesy the ABC: video clip.

• Where more than 40 people a day come in for a check up following a dog bit or lick.
• and more than half those tested for the disease have evidence of rabies.

Things that bite can do you harm in various ways:

• RABIES: FACTM rabies lecture notes
• SHARK BITE: bacterial risks from shark bites
• SNAKE BITE: neglected tropical disease

MicroGnome, 29-DEC-10.

It’s been a bit quiet lately for students of micrognomics. You didn’t realise how much you missed the micrognome, did you? Here’s a  clue what the micrognome has been up to lately. See if you can work it out from the title. Suffice it to say that he’s been out and about bug hunting.

Forthcoming posts include:

• FACTM part 1 exam news
• Wilderness & Expedition Medicine conference report
• Influenza update
• Another chapter in the Language of Infection
• Microbial genomes news
• More field applications of molecular microbiology

This should keep the Micrognome busy until the end of the year.

Marine Envenoming – an Australian overview
by Chris Nickson, September 2010

Marine Envenoming

Introduction

• The marine world is a rich source of venomous and poisonous creatures – what’s on land pales in comparison…
• The global impact of marine envenoming on human health and activities is largely unknown.
• This overview is not comprehensive, we will focus on 4 types of envenoming:

1. jellyfish-like creatures that sting (Cubozoans and Hydrozoans – true jellyfish are the Scyphozoans)
2. Organisms that primarily cause paralysis (e.g. the Blue-ringed octopus)
3. Painful fish envenoming (e.g. the Stonefish).
4. Sea snakes

• The best prevention strategy is to stay away from water – unfortunately people often seem to find this difficult. Remember Struan Sutherland’s advice to Douglas Adams about how to survive envenoming by a deadly creature: “don’t get bitten!”.
• One last general piece of advice before we get stuck in, never kiss a jellyfish.

Box Jellyfish (Chironex fleckeri)

• Chironex fleckeri is a cubozoan with a deserved reputation of being the most lethal venomous animal in the world. There have been about 70 deaths in Australia alone and related species (other chirodropids, or multi-tentacled box jellyfish) probably account for much greater mortality figures worldwide. Each organism has 60 tentacles, each up to 2 or meters in length, and each packed with up to 1500 cigar-shaped nematocysts per mm2!!!
• Stings result in immediate severe pain, the characteristic cross-hatched markings are pathognomonic. Systemic envenoming occurs with extensive stings – cardiovascular collapse can occur within minutes, presumably due to toxin-mediated disruption of sodium and calcium channel flux. Other problems in survivors include delayed type hypersensitivity and the potential for permanent scarring.
• In Northern Australia, stings usually occur when wading in water <1m deep. Deaths typically occur in remote locations, usually children. Stinger suits and stinger nets are useful preventative measures where available.
• Copious application of vinegar and the removal of adherent tentacles, together with basic life support are the mainstays of first aid. Most stings require only simple analgesia and ice packs.
• The effectiveness of CSL Box Jellyfish antivenom is unproven, its use in humans is based on anecdotal experience and case series. Doses given, preferably IV rather than IM, are: 6 ampoules (or whatever is available) for cardiac arrest, 3 ampoules for the haemodynamically unstable patient (repeat if required), and 1 ampoule for pain refractory to opioids.

Life in the Fast Lane links:

• Box jellyfish
• Toxicology Conundrum 010 – Box jellyfish

Irukandji Syndrome (Carukia barnesi and others)

• Irukandji syndrome is a hypercatecholaminergic syndrome resulting from jellyfish envenoming. Classically the syndrome involves a mild initial sting with delayed onset of systemic symptoms after about 20 minutes. Symptoms include nausea and vomiting, as well as severe and often cyclical pain (affecting many parts of the body, including the abdomen, back, chest and limbs) and even priapism. Cardiovascular manifestations include severe hypertension and its complications, cardiomyopathy (with raised troponins) and acute pulmonary edema.
• A causative organism was identified with the discovery of the tiny carybdeid (4-tentacled box jellyfish) Carukia barnesi by the intrepid Jack Barnes in 1963. Barnes demonstrating the causative role of this thumbnail-sized organism by stinging himself, his 9 year-old son and a local surf life-saver… All three were subsequently admitted to Cairns Base Hospital!
• Irukandji-like syndromes may be found in many parts of the world other than Northern Australia. The syndrome may have different seasonal, environmental and clinical patterns in different regions, probably reflecting different causative species and human activites.
• Following first aid treatment with vinegar, the mainstays of management are supportive care including analgesia (usually opioids such as IV fentanyl) and antiemetics (e.g. IV promethazine). IV glyceryl trinitrate may be a useful option for uncontrolled hypertension and acute pulmonary edema.
• IV magnesium is commonly used for refractory pain and hypertension, but evidence of effectiveness is limited to anecdotal experience and small case series lacking methodological rigour.

Life in the Fast Lane links:

• Irukandji Syndrome
• Jack Barnes and the Irukandji Enigma
• Irukandji in the Northern Territory
• Toxicology Conundrum 008 – Irukandji Syndrome
• Toxicology Conundrum 009 – Irukandji Syndrome 2

Blue bottles (Physalia spp.)

• Physalia spp. (Portuguese Man O’ War, Blue-bottles) probably account for more marine envenomings than any other organism.
• Physalia spp. are hydrozoans (related to stinging corals) and each ‘individual’ is actually a colony of separate organisms living cooperatively.
• Stings involve rapid onset burning associated with linear or eliptical markings; pain lasts a few hours and envenoming is typically self-limiting and rarely serious.
• Wash sting sites with sea water, not vinegar (unlike cubozoan stings).
• Hot water (45C) for 15 minutes is proven to effectively decrease pain.

Life in the Fast Lane links:

• BlueBottle (Physalia spp.) stings

Blue-ringed octopus (Hapalochlaena spp.)

• The organism that inspired one on the worst movie titles of all time – Octopussy – is found throughout Australia and in many other other parts of the world. Envenoming is rare, and generally results from these cute little creatures being picked up out of their coastal rock pools. There have been 3 reported fatalities.
• Severe envenoming may become manifest within minutes, resulting in a rapidly progressive symmetrical paralysis. The patient will remain conscious until the end stages of fatal respiratory failure…
• The venom’s major component is maculotoxin, which is identical to tetrodotoxin. This is produced by bacteria and used as a poison or venom by many different species. Examples of tetrodotoxic organisms include fish (e.g. puffer fish), mollusks (e.g. sea slugs), worms (e.g. ribbon worms), amphibians (e.g. salamanders) and crustaceans (e.g. xanthid crabs). The conotxin of cone shell snails (Conus spp.) is chemically different, but has similar clinical effects to a blue-ringed octopus envenoming,
• Appropriate first aid involves application of Pressure Immobilisation Bandages and basic life support.
• The mainstay of treatment is respiratory support (e.g. intubation and ventilation) until paralysis resolves, typically within 24 hours.

Life in the Fast Lane links:

• Toxicology Conundrum 011 – Blue-Ringed Octopus (BRO) envenoming

Stonefish (Synanceia spp.)

• Many fish have venomous spines (e.g. Lionfish, Stingrays and Catfish), but the Stonefish, a master of camouflage, has the greatest notoriety. It is found throughout Northern Australia and 13 venomous dorsal spines, each with 2 venom glands. The venom contains a mixture of hemolysins, hyaluronidases, cytolytic toxins, and the vasoactive stonustoxin.
• Stonefish envenoming causes severe local pain, swelling and a puncture wound. Non-specific symptoms such as syncope are usually a result of severe pain; true cardiovascular toxicity is exceedingly rare.
• Most painful fish envemonings can be treated with submersion in hot (45C) water (this probably has a neuromodulatory effect, rather than causing toxin denaturation). Pharmacological analgesia and local or regional anesthesia are also options – beware of the potential for iatrogenic burns if local anesthesia is used in conjunction with hot water!
• Wound care may require removal of foreign bodies, debridement and antibiotics to cover marine organisms.
• CSL Stonefish antivenom may be used for severe pain – administer 1 ampoule for every 2 spine punctures. It is also though to be effective for some other fish envenomings, such as those caused by the Scorpionidae, like the Bullrout and Lionfish.

Life in the Fast Lane links:

• Toxicology Conundrum 012 – Stingray envenoming
• Toxicology Conundrum 013 – Lionfish envenoming

Sea snakes (Hydrophiidae)

• Sea snakes are found throughout the world. In Australia they all belong to the Hydrophiidae family, are found in most regions (except some regions of the southern coast and western Tasmania). Terrestrial snakes can also swim and bite people in the water…
• Sea snake envenoming is rare, they are inquisitive but generally not aggressive. Bites occur when attempts are made to handle them (e.g. freeing from fishing nets).
• Envenoming results in progressive descending paralysis and rhabdomyolysis over a period of hours.
• Pressure Immobilisation bandaging is the mainstay of first aid.
• Management involves supportive care and treatment with 1 ampoule of CSL Sea Snake antivenom.

Life in the Fast Lane links:

• Toxicology Conundrum 026 – Snakebite Envenoming Challenge

Finally, putting envemoning aside, there are also myriad ways of being poisoned by marine life… Check out Toxicology Conundrum 036 – Seafood Poisoning to find out more.

Anyone fancy a swim?

STOP PRESS

When: March, 2011. Exact date to be announced in New Year.

• Paper 1 at 09:45-12:15pm
• Paper 2 at 13:45-16:15hrs
• including 15” instruction & reading time, 2hr writing time and 15” administration window

Where:

In Townsville and Perth, plus any other major Australian centre, in accordance with demand and availability of exam supervisors/venue.

Who:

• A   FACTM (Clinical) Medical graduates qualified and registered to practice in Australia or New Zealand. Overseas qualified medical practitioners currently licensed to practice in either Australia or New Zealand (e.g. as trainees or on conditional registration) will be eligible to enter for the FACTM examination. At least two years of medical practice and some experience in tropical or travel medicine are advisable. Those with less clinical experience will be expected to make a case for early entry in order to avoid disappointment.
• B   FACTM (Paraclinical). The Paraclinical Fellowship exam is designed for other health care professionals qualified and licensed to practice in Australia or New Zealand with an interest in tropical or travel health e.g. paramedics, remote area nurses, travel health clinic staff, medical laboratory scientists, epidemiologists, veterinary medical and scientific officers, pharmacists and other professions allied to medicine

How:

1. Register your expression of interest with the College Secretariat and apply for the Affiliate category of membership (the application form can be found on the ACTM website) before 30th September, 2010. If you have recently completed a Diploma in Tropical Medicine recognised by the College, you may apply for recognition in lieu and exemption from the part 1 exam (Clinical).
2. Indicate your preferred exam centre, your 2 referees and the names of any senior ACTM members who are willing to act as local exam supervisors.
3. The College will contact you with detailed exam instructions including an invoice for exam fees ($500)
4. Complete your exam revision
5. Attend examination centre and complete papers 1 and 2
6. Results will be communicated to candidates via the College Secretariat after completion of marking, audit by the external examiner and review by the College Examination Board.
7. Candidates must achieve an overall mark of 50% in both papers to be granted a pass and MUST achieve an aggregate score of at least 60% in their preferred topic. For FACTM (Clinical) candidates, the preferred topic is automatically Clinical Tropical Medicine.
8. No grades other than PASS or FAIL will be given, however the highest scoring successful candidates in each of the Clinical and Paraclinical streams will be recognised with a College award.

What:

• Paper 1 will comprise different multiple choice question formats, including 30 x 5 subquestion T/F from a bank of 45 arranged by topic area (i.e. 150 x T/F) with negative marking, and 20 x 5 objective structured questions from a bank of 25 without negative marking. Total marks will be expressed as a final mark out of 50 plus a subtotal for the preferred topic.
• Paper 2 will comprise 10 data interpretation questions arranged by topic of which 8 must be attempted, and 10 short notes questions of which 8 must be attempted. Short notes questions will be designed to be answered succinctly in table, dot point, annotated list, graph or sketch diagram form. Total marks will be expressed as a final mark out of 50 plus a subtotal for the preferred topic.

Recommended revision plan:

• A    Clinical: use the Oxford Handbook of Tropical Medicine as a baseline, supplemented by the respective chapters in 22^nd edition of Manson’s Tropical Diseases, and the core text books for your chosen three other topics. Aim for a DTM&H standard of knowledge and use the sample questions with worked answers on the College website to assess your knowledge. Supplementary revision material can also be found on the MicroGnome website. When using other study materials, seek an Australasian perspective on the subject matter.
• B      Paraclinical: use the core textbooks in the recommended list to master each of the four topics. Priority should be given to health issues of direct relevance to the Australasian region, as applied by health practitioners in Australia and New Zealand. Ensure a good grasp of the common, the serious and life threatening. The part 1 exam will emphasise breadth of knowledge with practical use in our region. Sample questions with worked answers can be found on the College website. These examples are not exhaustive, nor are revision materials.

If in doubt about the scope of knowledge required, use the recommended textbook for that topic as a guide.

TJJI for the IEB, 13-AUG-10

To the Ends of the Earth is the theme of a day conference on wilderness and expedition medicine we’re running with the Rural Clinical School in Bunbury this coming October. Further details on the enclosed poster, which you may want to download, print off and circulate to anyone interested in medicine, paramedical work or first aid in wild places.

The Romans called the very edge of the known world ‘ultima thule’; a place that probably equates to the Outer Hebrides.

The MicroGnome has been to this particular candidate for the World’s End and found a wild but very beautiful landscape of islands set among fingers of the Eastern Atlantic.

Barra is at the far end of the chain of inhabited outer islands and can be reached by ferry from Oban on the mainland or from  Lochmaddy to the north.

The quicker alternative is to take a British Airways flight and land on the beach – time subject to tides. Here’s what’s in store if you want to get to the end of the earth in a hurry.

Calling all Leishmaniacs:  it’s time to move on from tropical infections of the gastrointestinal tract to one of the most interesting of parasitic infections; Leishmaniasis. Next Tuesday’s Tropical Medicine Breakfast will cover the subject in two units: clinical tropical medicine, and clinical parasitology/entomology. The emphasis will be on Leishmaniasis as seen in Australia.

Download (DOC, 173.5KB)

For those working towards the ACTM Fellowship exam there are some useful on-line learning resources:

• eMedicine
• WHO
• Centers for Disease Control & Prevention
• Medical Journal of Australia

It’s near the end of a winter week on call and I’m getting ready to jet off to plan another bug-hunting adventure. No boxes, lab gear or cold reagents to worry about this time. Just ideas and a B5 notebook. Some things need sketching out in pencil on a clean sheet of paper before they can fly. So the MicroGnome will be absent from his desk for a couple of days; disconnected briefly from a reliable Blogging engine. But do not fear; the next Topical Medicine Breakfast has already been prepared, supplementary material for the last TMB is under starter’s orders, and there will be an on-line version of this week’s talk on field applications of molecular microbiology up on this site very shortly.

In the meantime, you need to take a look at this futuristic introduction to social medicine from our supporters at Life in the Fast Lane. Here you will encounter such exotic species as the solar-powered RMO (yes, the light’s just gone on and, no, the sun does not necessarily shine out of his mouth or any other orifice). Clearly the jungle is full of wonderful beasts. After the MicroGnome’s initial, jaw-dropping awe had subsided, he began to consider the possible consequences for zoonotic infection when mere mortals stray into the social medicine jungle. LITFL’s guide hints at navigation aids for the beginner. Could there be a field guide for the novice backhacker?

Clinical case of upper abdominal pain in overseas resident

A 54 year old businessman presents with right upper quadrant pain after spending the last six months living in Java.

An ultrasound scan revealed gallstones. A laparoscopic cholecystectomy was then performed. At this point a lesion was observed on the surface of the liver, but not biopsied.

Four months later, on another return visit to Australia, the patient re-presented with fever, a cough and pain radiating to his shoulder tip. He was admitted to a district hospital and a chest X-ray performed. Changes consistent with right lower lobe consolidation were observed and intravenous antibiotics (i.v. Ticarcillin/Clavulanic acid) commenced. The patient did not improve and was transferred to a larger hospital.

After 7 days of intravenous antibiotics he coughed up a large quantity of viscous, brown phlegm with a paste-like consistency. These CT scan views were obtained at this point:

CT thorax after coughing up 'anchovy paste'

CT upper abdomen showing hepatic lesion

The patient’s serum was sent to the Microbiology laboratory with the following result:

Entamoeba histolytica titre > 1:4096

This was seen under the microscope in the paste-like sample of phlegm:

Microscope view of patient's sputum, showing microbe with internalised red cells

Q1   What do the CT scans show?

Show answer

Q2   What object was seen under the microscope?

Show answer

Q3   What pathological process explains these observations?

Show answer

Q4   What treatment would you recommend?

Show answer

• Additional clinical questions
• Amoebiasis in Australia
• Travel related infections, case series from SCGH

What’s so special about the number 100?

Could it be something to do with the sense of achievement when you score 100%, reach your hundredth birthday or score that century in a game the MicroGnome never could fathom? The common theme apart from the raw number, or its mathematic significance as the first three-figure number, is a sense of achievement.

So with this in mind, the MicroGnome notes with a warm glow that this site has just passed its 100th posting the very same week as Tropical Medicine celebrates its centenary. What better way to mark the milestone that to assemble all the posts we’ve made connected with the Centenary event in one place:

• Centenary meeting, Townsville, QLD
• Lost for words
• Anton Breinl
• Tropical Medicine Masterclass
• Snake bite as a neglected tropical disease
• Another nasty arbovirus infection
• Q fever outbreak in Holland
• Molecular aspects of microbiology field investigations

Download (PDF, 653.76KB)

The Micrognome is only rarely lost for words, but the Centenary of Tropical Medicine meeting was obviously an exception.

The first symptoms were, ironically, a loss of marksmanship. So the MicroGnome’s spirits sank as he flew about as far as you can go in Australia to get there for the Tropical Medicine Masterclass. Just in time, not only for the start of the class (public apology to all participants for not having time to properly meet and greet the stellar cast) but also in the nick of time to belt out the first talk before his voice disappeared down the plug hole. Its temporary replacement was an odd squeak in place of every two out of three words.

By the next day the MicroGnome was utterly incapable of audible utterance. His principle means of imparting Gnomic wisdom had faded to a pale whisper, resembling the Godfather on dark chocolate. So he was forced to shut up and listen – best thing he’s done in a long time. He was treated to a parade of expertise from leading authorities on snake bite, travel associated infections, arboviruses, Q fever and emerging nutritional diseases.

What’s the connection between Ena Sharples; the hairnet helmeted doyenne of Coronation St and tropical medicine? Coronation St afficionados would be hard pressed to place the sullen rows of back-to-back brick terraces with the humid tropics.

The explanation will be unveiled during next Tuesday’s tropical medicine breakfast in the Emergency Department seminar room at Sir Charles Gairdner Hospital.

You may glean a shrew idea if you take a look at the lecture notes before Tuesday.

Download (PDF, 830.79KB)

The second Charlie’s postgraduate Tropical Medicine sessions takes place next Tuesday (27th April)  at 06:50 in the ED seminar room. Notes can be found on this site here.

This is part of the FACTM pt 1 series, and concludes our malaria unit.

Revision of the earlier two modules is also available on this site.

A light breakfast will be provided.