Topics
Infectious diseases
Legionnaires’ disease cluster investigation in Sydney
To the Editor:We report an extensive investigation into a cluster of five confirmed cases of Legionnaires’ disease in Sydney’s Inner West in May 2016. The patients were aged 62–89 years, four were men, all were ex-smokers, and four had significant comorbidities, such as immunosuppression. Hospitalisations lasted a median of 6 days and one patient died. All patients tested positive for Legionella pneumophila serogroup 1 urinary antigens; however, L. pneumophila was isolated by culture in only one patient. Patients were interviewed to obtain the histories of where they had been in the 2–10 days before the onset of symptoms (the incubation period), and then, to identify the focus for our environmental investigation, we mapped the locations against water source locations.1 Local councils assisted in the collection of water samples: 86 samples were obtained from cooling towers and 15 from other sites, such as fountains. At the time of sampling, requests were made for immediate cleaning of all visibly unclean air conditioning cooling towers or those with cloudy water. Only one sample tested positive for Legionella: a fountain with a low positive result of Legionella anisa. If Legionella isolates are genetically indistinguishable, the genomic sequencing of clinical and environmental samples is a useful tool that can link cases to each other and to an environmental source. In this investigation, L. pneumophila was cultured in only one case and in no environmental samples; therefore, we could not link cases to each other or to an environmental source by genotyping, leaving the possibility that cases were unrelated and sporadic. Despite this investigation, no environmental source for these infections was identified. It is uncommon in an investigation of this size to not detect L. pneumophila in any cooling towers — a routine New South Wales survey found L. pneumophila in 2% of cooling towers in a non-outbreak situation.2 Possible explanations for not detecting Legionella include low sensitivity of sampling at one point in time, incidental and possibly unrelated cleaning of the source cooling tower before sampling, or underestimating the distance that contaminated aerosols may travel, meaning that the source cooling tower was not sampled.3 No further cases with similar exposures were reported in the period immediately after the environmental investigation. This suggests that the extensive public health interventions taken at the time to remedy the problems identified may have been effective, or that incidental cleaning of cooling towers before our sampling may have eliminated the potential source.
Marianne Dowsett · Emma Quinn · Leena Gupta
HPV vaccine coverage is increasing in Australia
Identifying and removing barriers to completing the vaccination course in schools is proving successful
Julia ML Brotherton · Karen L Winch · Lisette Bicknell · Genevieve Chappell · Marion Saville
Streptococcus pyogenes pericarditis in a healthy adult: a common organism in an uncommon site
N/A
Lauren C Giudicatti · Gar-Hing Lee · Claire Italiano · Nik Stoyanov
Mycobacterium chimaera and cardiac surgery
Contaminated heater-cooler units pose a rare but serious risk, and careful management is required
Andrew J Stewardson · Rhonda L Stuart · Allen C Cheng · Paul DR Johnson
The excess burden of severe sepsis in Indigenous Australian children: can anything be done?
Reducing the transmission of Staphylococcus aureus and early treatment are key factors
Pamela Palasanthiran · Asha C Bowen
The burden of invasive infections in critically ill Indigenous children in Australia
Population-based mortality is more than twice as high for Indigenous as for non-Indigenous Australian children
Justyna A Ostrowski · Graeme MacLaren · Janet Alexander · Penny Stewart · Sheena Gune · Joshua R Francis · Subodh Ganu · Marino Festa · Simon J Erickson · Lahn Straney · Luregn J Schlapbach
The Roman fever: observations on the understanding of malaria in the ancient Roman world
Ancient Roman hypotheses about the transmission of malaria were ahead of their time
Milton J Micallef
Antimicrobial use in Australian hospitals: how much and how appropriate?
Antimicrobial agents play a central role in modern health care, especially in the hospital setting
John D Turnidge · Karin Thursky · Caroline S Chen · Vicki R McNeil · Irene J Wilkinson
Sexual transmission of HIV and the law: an Australian medical consensus statement
Given current scientific evidence, public health management rather than prosecution should be considered where appropriate
Mark Boyd · David Cooper · Elizabeth A Crock · Levinia Crooks · Michelle L Giles · Andrew Grulich · Sharon R Lewin · David Nolan · Trent Yarwood
Does Lyme disease exist in Australia?
There is no convincing evidence that classic Lyme disease occurs in Australia
Peter J Collignon · Gary D Lum · Jennifer MB Robson
Impact of the Australian National Cervical Screening Program in women of different ages
The program has had substantially reduced the overall incidence of cervical cancer in women aged 25 and over
Megan Smith · Karen Canfell
No Jab, No Pay — no planning for migrant children
Migration should be considered by immunisation policy
Georgia A Paxton · Lauren Tyrrell · Sophie B Oldfield · Karen Kiang · Margie H Danchin
The prevalence and clinical associations of HTLV-1 infection in a remote Indigenous community
HTLV-1 infection may be more prevalent among Indigenous Australians than is currently appreciated
Lloyd J Einsiedel · Hai Pham · Richard J Woodman · Clinton Pepperill · Kerry A Taylor
Primary amoebic meningoencephalitis in North Queensland: the paediatric experience
A potentially fatal disease associated with warm, non-chlorinated water in rural areas
Claire L Nicholls · Fiona Parsonson · Lawrence EK Gray · Adele Heyer · Steven Donohue · Greg Wiseman · Robert Norton
Characterising health care-associated bloodstream infections in public hospitals in Queensland, 2008–2012
n/a
Leon J Worth · Ann L Bull · Michael J Richards
Characterising health care-associated bloodstream infections in public hospitals in Queensland, 2008–2012
In reply
Naomi Runnegar · Damin Si · John Marquess
The inequitable burden of group A streptococcal diseases in Indigenous Australians
We need to fill evidence gaps and make clinical advances to reduce these diseases of disadvantage
Philippa J May · Asha C Bowen · Jonathan R Carapetis
Ebola outbreak in West Africa: considerations for strengthening Australia’s international health emergency response
n/a
Martyn D Kirk · Stephanie Davis · Kerri Viney
Low HIV testing rates among people with a sexually transmissible infection diagnosis in remote Aboriginal communities
Adhering to screening recommendations is essential to avoiding increased HIV infection rates in remote communities
James S Ward · Amalie Dyda · Skye McGregor · Alice Rumbold · Linda Garton · Basil Donovan · John M Kaldor · Rebecca J Guy
Stroke in a young man with untreated HIV infection and neurosyphilis
HIV infection is an important risk factor for stroke and testing should be performed in all young stroke patients
Abhay R Venkat · Jason Wenderoth · Louise Evans · Cecilia Cappelen-Smith
Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection
An up-to-date summary of the causes, impacts and treatment of a highly prevalent infection worldwide
Hazel Mitchell BSc(Hons), DipEd, PhD · Peter Katelaris MD, FRACP, FRCP
Margaret Anne Burgess
A remarkable paediatrician who pioneered research into vaccines and vaccine-preventable diseases in Australia
Peter B McIntyre FAFPHM, FRACP, PhD · Jill M Forrest MD BS
A patient with sarcoidosis and a cryptococcal infection of the skull
n/a
Paul A Rootjes MD · Wouter Rozemeijer MD · Jacob C Dutilh MD
Zika preparedness in Australia
Our comprehensive national response encompasses prevention and surveillance, as well as monitoring and controlling Aedes aegypti in Australia
Chris Baggoley FACEM, BM BS, BVSc · Katrina Knope BSc, MPH · Anna Colwell MB BS(Hon), FRACGP, MPH · Jenny Firman MB BS, FRACGP
The ASID test
The Australasian Society for Infectious Diseases view on infectious diseases challenges in 2016 and beyond
Cheryl A Jones MB BS(Hon), PhD, FRACP · Joshua S Davis MB BS, DTM · David FM Looke FRACP, FRCPA, MMedSci(ClinEpid)
