Infectious diseases

To the Editor: I read with great interest the recent article by Knox and Marshall.1 Chromoblastomycosis may result in a number of rare systemic complications that may be associated with significant morbidity. For instance, chromoblastomycosis may affect the cornea. This usually follows cataract surgery. Cladophialophora carrionii is the aetiological agent involved in corneal chromoblastomycosis.2 Keratitis occurs, resulting in ocular pain and decreased visual acuity. Topical and ...

Shailendra Kapoor

The 2007–2010 outbreak of Q fever in the Netherlands was the largest ever identified, with 4000 people affected. Although further research is needed on best practice to control transmission and detect and treat infection, lessons have already emerged for Australian medical and public health practitioners.

Heather F Gidding BAppSc, MAppEpid, PhD · Stephen R Graves BSc, MB BS, PhD

To the Editor: We congratulate Kwan and colleagues on their evaluation of an online chlamydia testing program (OLC) in Western Australia. However, their study does not demonstrate OLC to be a “highly effective means of increasing access to testing among young people at risk of STIs [sexually transmitted infections]”.1 Adolescents account for 30% of chlamydia notifications in WA,2 yet only 37 of the 377 people (10%) who were ...

Peter S Azzopardi · Elissa C Kennedy · Alex D Brown

In reply: Azzopardi and colleagues seem to equate “young” with “adolescent”. We defined “young” as less than 30 years of age; 84% of chlamydia notifications in Western Australia occur in this age group,1 and they comprised 71% of online chlamydia testing program (OLC) users.2 This group accesses the internet frequently, with about 90% of Australians under 35 years of age using the internet at least once a ...

Lewis J Marshall · Edwina A Jachimowicz · Lisa Bastian · Donna B Mak

PETER DOHERTY’s ability to span the gap between the most abstract basic science and the everyday world is once again evident in this, his third popular science paperback. Put it on your Christmas gift list. It will intrigue the nerdiest high school student, stimulate the most militant environmentalist and give pleasure to anyone who has worked in the biological sciences or medicine during the past ...

Yvonne E Cossart

Good working relationships with journalists are needed during public health crises but many journalists believe that health departments could do a better job of meeting their information needs, both in content and timeliness.

Melissa A Sweet BA, MA · Kate E Holland PhD · R Warwick Blood PhD

Some facilities in the United States have enforced a mandatory influenza vaccination policy with punitive action for noncompliance, resulting in sustained vaccination rates of above 97%.

Vivian K Y Leung · Susan E Harper · Monica A Slavin

Data collected before and after the H1N1 2009 influenza pandemic indicate significant shifts in public threat perception and anticipated response to a future pandemic. The H1N1 2009 pandemic has altered public perceptions of the probability of a pandemic in the future, but has left the public feeling less vulnerable.

Melanie R Taylor BSc(Hons), PhD, CPsychol · Garry J Stevens BSc(Hons), MClinPsych · Kingsley E Agho MSc, MPH, PhD · Sheree A Kable BMed, PhD · Beverley Raphael MB BS, MD, FRANZCP

H1N1-containing vaccines were not statistically associated with Guillain-Barré syndrome, but this study could not exclude smaller increases in the relative incidence. Active surveillance of adverse events following immunisation is required to maintain public and health care professional confidence in mass vaccine implementation programs.

Nigel W Crawford MB BS, MPH, PhD · Allen Cheng MPH, PhD, FRACP · Nick Andrews MSc · Patrick G Charles MB BS, PhD, FRACP · Hazel J Clothier MAppEpid, MscID, FIBMS · Bruce Day MB BS · Timothy Day MB BS · Peter Gates MB BS · Richard Macdonell MB BS · Les Roberts MB BS · Victoria Rodriguez-Casero MB BS · Tissa Wijeratne MB BS · Lynette Kiers MB BS

To the Editor: In September 2012, the Australian Institute of Health and Welfare (AIHW) released its report on cancer survival and prevalence in Australia from 1982 to 2010, incorporating incidence and mortality estimates for all malignancies reported to Australian cancer registries.1 Cancer is a leading cause of morbidity and mortality in Australia, accounting for about 20% of the total disease burden and 30% of deaths.2 Liver cancer ...

Jennifer H MacLachlan · Benjamin C Cowie

These data show a sustained and substantial decline in severe rotavirus disease and all-cause AGE since the introduction of rotavirus vaccination, most pronounced in the target age group, but with evidence of herd immunity. The impact of rotavirus vaccination in Indigenous children in hyperendemic settings was less remarkable.

Aditi Dey MB BS, MPH, PhD · Han Wang MStats · Robert Menzies BAppSc, MPH, PhD · Kristine Macartney MB BS, MD, FRACP

Objective: To estimate the risk of active tuberculosis (TB) in immigrants to Victoria, Australia, as a function of time since arrival and stratified by age group and region of origin.Design, setting and subjects: Longitudinal study of the incidence of active TB in Victorian immigrants, excluding New Zealanders, who arrived in Australia between 1975 and 2007. Victorian immigration data were used to describe annual arrival ...

Emma S McBryde MB BS, PhD, FRACP · Justin T Denholm BMed, MPHTM, FRACP

Clinical record A 58-year-old man with a history of Crohn’s disease presented to the emergency department of a peripheral hospital in March 2011. He had been ill for the past day, with confusion, fluctuating expressive dysphasia, frontal headache and fever, preceded by 12 hours of lethargy and myalgia. The patient had been diagnosed with Crohn’s disease 2 years earlier after a colonoscopy for profuse bloody stools, which revealed extensive ...

Kaspar J Willson MB BS, BMedSci · Antony Jacob MB BS, MRCP(UK) · Mohit P Shetti MB BS, MD(Med), DNB(Med) · Rajesh Bhatia MB BS, FRACP · Kwang Yee MB BS(Hons), FRACP · William Osler MBChB, FRACP

To the Editor: The focus of HIV clinical care has shifted since the advent of potent antiretroviral therapy (ART). This change is characterised by a reduction in HIV-specific morbidities, an increase in HIV non-specific comorbidities,1,2 and an accompanying lack of clinician confidence in managing these comorbidities.3 The measurement of key performance indicators (KPIs) is useful for monitoring and improving clinical performance, but it is yet ...

Mark D Kelly · Jennifer K Broom · Sharon Young

To the Editor: Australian gonorrhoea infection rates are rising.1 Infection spreads through various sexual practices, and extragenital infections are commonly asymptomatic.2 Nucleic acid amplification tests (NAATs) provide rapid, sensitive testing, regardless of the site involved or presence or absence of symptoms.3,4 There have therefore been calls for a change to NAAT-based screening for high-risk groups, including men who have sex with men (MSM).5 Limitations include ...

Miranda Sherley · Karina J Kennedy · Sarah J Martin

There are no sirens. Nor is the silence disrupted by the rush of feet or frantic blue lights. Instead, our enduring patients arrive at the hospital gates on foot, most having travelled for many hours, if not days, through the unrelenting 40° C heat; the privileged cling to motorcycles already laden with firewood and kitchen utensils in anticipation of a prolonged admission. Through these same gates arrived ...

James D Smith

Chlamydia, caused by the bacteria Chlamydia trachomatis, is a sexually transmitted infection (STI) and the most commonly notified disease in Australia and in Western Australia ...

Kellie S H Kwan BA(Hons), GradCertAppEpi · Edwina A Jachimowicz BNsng, MNsgSt(Midwifery), GradDipNseEd · Lisa Bastian BAppSc(Nursing), MPH · Lewis Marshall MPH, FAFPHM, FACSHM · Donna B Mak MPH, FAFPHM, FACRRM

To the Editor: We read with interest the letter by Playford and colleagues, but important questions remain about the authors’ methods and conclusions.1 First, not only do the data periods for assessing hand hygiene (HH) compliance and for rates of health care-associated Staphylococcus aureus bacteraemia (HCA-SAB) not overlap, but the data period for HCA-SAB rates precedes the HH compliance data period. Second, the study design ...

M Lindsay Grayson · Philip L Russo

In reply: We thank Grayson and Russo for their interest and comments. Clearly our intent was to stimulate much-needed debate about the presentation and interpretation of publicly disclosed infection control data. Given that no study has shown a reduction in the rate of methicillin-susceptible Staphylococcus aureus bacteraemia (SAB) through increased compliance with hand hygiene (HH), we again question why the MyHospitals interpretive comments for these data ...

Elliott G Playford · David McDougall · Mary-Louise McLaws

To the Editor: Influenza is a common respiratory infection that is infrequently associated with severe disease requiring hospitalisation. We have conducted hospital-based surveillance in the Influenza Complications Alert Network (FluCAN) since 20091 and report on our findings in 2010 and 2011. In 2010, 15 hospitals based in capital cities or large regional centres were involved, as previously described.1,2 In 2011, eight hospitals in Victoria, South Australia, Western Australia ...

on behalf of the FluCAN Investigators

Appropriate assessment and management of diabetes-related foot ulcers (DRFUs) is essential to reduce amputation risk. Management requires debridement, wound dressing, pressure off-loading, good glycaemic control and potentially antibiotic therapy and vascular intervention. As a minimum, all DRFUs should be managed by a doctor and a podiatrist and/or wound care nurse. Health professionals unable to provide appropriate care for people with DRFUs should ...

Shan M Bergin BAppSci(Pod), PhD · Joel M Gurr BSc(Pod), MBA · Bernard P Allard MB BS, FRACS(Vasc) · Emma L Holland RN, CDE, MA(Ed) · Mark W Horsley MB BS, FRACS(Ortho) · Maarten C Kamp FRACP, MHA, GAICD · Peter A Lazzarini BAppSci(Pod) · Vanessa L Nube DipAppSci(Pod), MSc(Med) · Ashim K Sinha MB BS, MD, FRACP · Jason T Warnock DipAppSc(Chir), GradCertDiabEd · Jan B Alford RN, MEd(AdEd), CDE · Paul R Wraight MB BS, FRACP, PhD

To the Editor: Murray Valley encephalitis virus (MVEV) is rarely seen in south-eastern Australia, as described in the recent review in the Journal by Knox and colleagues.1 During the MVEV transmission period in early 2011, there was extensive flooding, and high notification rates were reported for other mosquito-transmitted infections, including flavivirus infection among horses. MVEV seroconversion was detected in sentinel chicken flocks. However, despite concerns ...

Joseph S Doyle · Suellen Nicholson · Jennifer A Leydon · Rodney J Moran · Michael G Catton