The genus Acinetobacter, well known as a nosocomial pathogen, can also cause severe community-onset pneumonia. Previous small case series have suggested fulminant disease and a pooled hospital mortality of > 60%. We conducted a prospective observational study of all episodes of bacteremic, community-onset, and radiologically confirmed pneumonia due to Acinetobacter species at a tertiary referral hospital in tropical Australia from 1997 to 2012 following the introduction of routine empirical treatment protocols covering Acinetobacter. Demographic, clinical, microbiologic, and outcome data were collected. There were 41 episodes of bacteremic community-onset Acinetobacter pneumonia, of which 36 had no indicators suggesting health-care-associated infection. Of these, 38 (93%) were Indigenous Australians, one-half were men, the average age was 44.1 years, and 36 episodes (88%) occurred during the rainy season. All patients had at least one risk factor, with hazardous alcohol intake in 82%. Of the 37 isolates available for molecular speciation, 35 were Acinetobacter baumannii and two were Acinetobacter nosocomialis. All isolates were susceptible in vitro to gentamicin, meropenem, and ciprofloxacin, but only one was fully susceptible to ceftriaxone. ICU admission was required in 80%. All 41 patients received appropriate antibiotics within the first 24 h of admission, and 28- and 90-day mortality were both low at 11%. Community-acquired Acinetobacter pneumonia is a severe disease, with the majority of patients requiring ICU admission. Most patients have risk factors, particularly hazardous alcohol use. Despite this severity, correct initial empirical antibiotic therapy in all patients was associated with low mortality.

A retrospective study of 191 cases of septic arthritis was undertaken at Royal Darwin Hospital in the tropical north of Australia. Incidence was 9.2 per 100,000 overall and 29.1 per 100,000 in Aboriginal Australians (RR 6.6; 95% CI 5.0-8.9). Males were affected more than females (RR 1.6; 95% CI 1.2-2.1). There was no previous joint disease or medical illness in 54%. The commonest joints involved were the knee (54%) and hip (13%). Significant age associations were infected hips in those under 15 years and infected knees in those over 45 years. Seventy two percent of infections were haematogenous. Causative organisms included Staphylococcus aureus (37%), Streptococcus pyogenes (16%) and Neisseria gonorrhoeae (12%). Unusual infections included three melioidosis cases. Polyarthritis occurred in 17%, with N. gonorrhoeae (11/23) more likely to present as polyarthritis than other organisms (22/168) (OR 6.0; 95% CI 2.1-16.7). Univariate and multivariate analysis showed the hip to be at greater risk for S. aureus than other joints. Open arthrotomy was a more successful treatment procedure than arthroscopic washout or needle aspiration.

From November 1990 to June 1991 33 acute cases of melioidosis occurred in the Northern Territory, Australia; 25 cases were reported in the capital city, Darwin. We carried out an epidemiological investigation to exclude a common source outbreak, describe the risk factors for disease, and develop and institute appropriate control measures. We compared population based attack rates among various risk groups using logistic regression, and the demographic, medical and behavioral risk factors for melioidosis by a matched case-control study. Environmental Health Officers collected soil, surface water and cooling tower water specimens for Pseudomonas pseudomallei culture. The crude attack rate of melioidosis during the outbreak was 52 per 100,000. Age, gender, race, diabetes and alcohol abuse were independent risk factors for disease. The relative risk of disease in diabetic patients was 12.9 (95% CI 5.1-32.7; p < 0.001) and 6.7 in alcoholic patients (95% CI 2.9-15.2; p < 0.001). We found no significant difference between cases and controls in matched pair analysis for any of several exposure factors studied. We isolated Pseudomonas pseudomallei from 4% of soil samples and 9% of surface water samples. Our study confirms the importance of host factors in the development of melioidosis, and attempts to quantify the risk of disease during the Darwin epidemic. Pseudomonas pseudomallei is widespread in the soil of urban Darwin.

Objectives: Crusted scabies (CS, Norwegian scabies) is a severe form of scabies, characterized by hyper-infestation of Sarcoptes scabiei mites. CS is commonly associated with immunosuppression but is also reported in overtly immunocompetent individuals. We reviewed immunosuppressive risk factors and comorbidities associated with CS. Methods: The National Library of Medicine (PubMed) database was reviewed for patient case reports of CS from January 1998 to July 2023. Two authors screened records for eligibility, extracted data, and one critically appraised the quality of the studies. Systematic review registration: PROSPERO CRD42023466126. Results: A total of 436 records were identified, of which 204 were included for systematic review. From these, 683 CS patients were included. CS impacted both genders equally. Adults (21-59 years) were more commonly affected (45.5%) compared to children (0-20 years, 21%). Corticosteroid use was the most prevalent immunosuppressive risk factor identified (27.7% of all cases). About 10.2% of reports were associated with HIV/AIDS, and 8.5% with HTLV-1 infection. 10.5% of patients were overtly immunocompetent with no known risk factors. Overall, 41 (6.0%) died, many subsequent to secondary bacteremia. Conclusion: This study represents the first systematic review undertaken on immunosuppressive risk factors associated with CS. This provides insights into trends of immunosuppression and mechanisms of CS development.

Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. E-mental health tools offer an opportunity for accessible, effective, and acceptable treatment. The AIMhi Stay Strong app and the ibobbly suicide prevention app are treatment tools designed to combat the disproportionately high levels of mental illness and stress experienced within the Aboriginal and Torres Strait Islander community. This study aimed to explore Aboriginal and Torres Strait Islander community members' experiences of using two culturally responsive e-mental health apps and identify factors that influence the acceptability of these approaches. Using qualitative methods aligned with a phenomenological approach, we explored the acceptability of two culturally responsive e-mental health apps through a series of three 3-hour focus groups with nine Aboriginal and Torres Strait Islander community members. Thematic analysis was conducted and coresearcher and member checking were used to verify findings. Findings suggest strong support for the concept of e-mental health apps and optimism for their potential. Factors that influenced acceptability related to three key themes: personal factors (eg, motivation, severity and awareness of illness, technological competence, and literacy and language differences), environmental factors (eg, community awareness, stigma, and availability of support), and app characteristics (eg, ease of use, content, graphics, access, and security and information sharing). Specific adaptations, such as local production, culturally relevant content and graphics, a purposeful journey, clear navigation, meaningful language, options to assist people with language differences, offline use, and password protection may aid uptake. When designed to meet the needs of Aboriginal and Torres Strait Islander Australians, e-mental health tools add an important element to public health approaches for improving the well-being of Aboriginal and Torres Strait Islander people.

We describe a haemodialysis patient who presented with an exacerbation of previously undiagnosed chronic focal myositis during a hospital admission for missed dialysis and chronic foot osteomyelitis. The association of focal myositis with haemodialysis has been reported once previously, but we report the third case in our experience and argue that it is probably more common than previously appreciated. We consider a focused differential diagnosis for a diabetic dialysis patient with leg pain and discuss important features of this rare condition.

Individual values sometimes lead patients to make lifestyle choices that have negative effects on their health. Doctors tend to feel responsible for delivering best-practice health outcomes to such patients, but also feel inclined to respect their patients' values. The adoption of a harm reduction model may provide a strategy for delivering the best care that is compatible with each patient's chosen lifestyle.

No abstract available

Melioidosis, caused by the intracellular pathogen Burkholderia pseudomallei, is endemic in northern Australia and Southeast Asia. Risk factors for this infection have also been associated with functional neutrophil defects. Because of this, granulocyte colony-stimulating factor (G-CSF) was adopted for use in patients with septic shock due to melioidosis in December 1998. We compared the mortality rates from before and after the introduction of G-CSF therapy at the Royal Darwin Hospital (Darwin, Australia) during the period of 1989-2002. The mortality rate decreased from 95% to 10% after the introduction of G-CSF. Risk factors, the duration of illness before presentation, and the severity of illness were similar in both groups. A smaller decrease in mortality among patients in the intensive care unit who did not have melioidosis was observed, suggesting that other changes in management did not account for the magnitude of the benefit seen. We conclude that G-CSF may have contributed to the reduction in the mortality rate among patients with septic shock due to melioidosis.

Survival after a stroke is lower for Indigenous than other stroke patients in Australia. It is not known whether recurrence is more common for Indigenous patients, or whether their higher prevalence of comorbidity affects their lower survival. This study aimed to investigate the stroke recurrence and role of comorbidities in adverse stroke outcomes (recurrence and death) for Indigenous compared with other Australians. A retrospective cohort study of first hospitalization for stroke (n = 2105) recorded in Northern Territory hospital inpatient data between 1996 and 2011 was conducted. For the multivariable analyses of adverse outcomes, logistic regression was used for case fatality and competing risk analysis for recurrent stroke and long-term death. Comorbidities (identified from inpatient diagnosis data) were analyzed using the Charlson Comorbidity Index (modified for stroke outcomes). Prevalence of comorbidities, case fatality, incidence of re-hospitalization for recurrent stroke, and long-term death rate were higher for Indigenous than non-Indigenous stroke patients. Adjustment for comorbidity in multivariable analyses considerably reduced Indigenous patients' excess risk for case fatality (odds ratio: 1·25, 0·88-1·78) and long-term death (standard hazard ratio: 1·27, 1·01-1·61) (but not recurrence), implying that their excess risk of death was in part due to higher comorbidity prevalence. Indigenous stroke patients have higher prevalence of comorbidities than non-Indigenous stroke patients, which explained part of the disparity in both case fatality and long-term survival but did not explain the disparity in stroke recurrence at all.

Hospitals are frequently faced with high levels of emergency department presentations and demand for inpatient care. An important contributing factor is the subset of patients with complex chronic diseases who have frequent and preventable exacerbations of their chronic diseases. Evidence suggests that some of these hospital readmissions can be prevented with appropriate transitional care. Whilst there is a growing body of evidence for transitional care processes in urban, non-indigenous settings, there is a paucity of information regarding rural and remote settings and, specifically, the indigenous context. This randomised control trial compares a tailored, multidimensional transitional care package to usual care. The objective is to evaluate the efficacy of the transitional care package for Indigenous and non-Indigenous Australian patients with chronic diseases at risk of recurrent readmission with the aim of reducing readmission rates and improving transition to primary care in a remote setting. Patients will be recruited from medical and surgical admissions to Alice Springs Hospital and will be followed for 12 months. The primary outcome measure will be number of admissions to hospital with secondary outcomes including number of emergency department presentations, number of ICU admissions, days alive and out of hospital, time to primary care review post discharge and cost-effectiveness. Successful transition from hospital to home is important for patients with complex chronic diseases. Evidence suggests that a coordinated transitional care plan can result in a reduction in length of hospital stay and readmission rates for adults with complex medical needs. This will be the first study to evaluate a tailored multidimensional transitional care intervention to prevent readmission in Indigenous and non-Indigenous Australian residents of remote Australia who are frequently admitted to hospital. If demonstrated to be effective it will have implications for the care and management of Indigenous Australians throughout regional and remote Australia and in other remote, culturally and linguistically diverse populations and settings. Australian New Zealand Clinical Trials Registry, ACTRN12615000808549 - Retrospectively registered on 4/8/15.

We describe the recent temporal patterns of respiratory syncytial virus (RSV) and influenza virus detections in the Northern Territory (NT) of Australia, between 2020 and 2023.This retrospective analysis of patients presenting with respiratory diseases utilised a multiplex viral nucleic acid detection assay for RSV, influenza and SARS Cov2 (COVID-19) to determine the relative frequency of non-COVID-19 respiratory viral detections by age and month during the study period.During this period of the NT COVID-19 epidemic, disruption of the usual annual wet season RSV outbreak patterns occurred, and the yearly influenza peak was absent for two annual cycles. Our data also reveals that 25% of RSV infections were occurring in patients greater than 40 years of age, compared to 32% of influenza infections presenting in the same period, documenting a greater burden of adult disease than previously documented in the NT.Loss of non-COVID-19 viral seasonality and a substantial unrecognised RSV adult burden were noted. We will continue to monitor seasonality, and the RSV burden and this will help to target the populations benefiting from recently released RSV vaccine.

This prospective study was designed to describe problems that arise when Aboriginal people undergo anaesthesia, in order to develop guidelines for anaesthetists who are not accustomed to treating Aboriginal people. Data were collected on 1122 consecutive different individuals undergoing anaesthesia at Royal Darwin Hospital, 24.5% of whom described themselves as Aboriginal. Aboriginal patients were in a poorer physiological state than were non-Aboriginal patients. The prevalence of diabetes mellitus, renal disease and rheumatic heart disease reported in Aboriginal patients was very high. Communication difficulties were more commonly reported in Aboriginal patients; the most common difficulty was apparent shyness or fear, rather than actual language difficulty. The results suggest that the treatment of Aboriginal people involves diagnosis and management of diverse preoperative medical problems, and that better management may be achieved by learning simple cultural strategies and by adding Aboriginal interpreters and health workers to the anaesthetic team.

Acute postinfectious glomerulonephritis is common in indigenous communities in the Northern Territory, Australia. It is a major risk factor for the high prevalence of chronic kidney disease. We aimed to analyse the clinical presentation, pathological spectra, treatment and outcomes of biopsy-proven acute postinfectious glomerulonephritis in the Northern Territory. We performed a retrospective cohort analysis of all adult patients (≥18 years) who were diagnosed with acute postinfectious glomerulonephritis on native renal biopsies from 01/01/2004 to 31/05/2014. The outcome measure was end-stage renal disease requiring long-term dialysis. Forty-three of 340 patients who had renal biopsies had acute postinfectious glomerulonephritis. Most were Aboriginals (88.4%). They had co-morbidities; diabetes mellitus (60.5%), hypertension (60.5%) and smoking (56.4%). Forty-nine per cent had multiple pathologies on biopsy. Predominant histological pattern was diffuse proliferative glomerulonephritis (72%). Main sites of infections were skin (47.6%) and upper respiratory tract infection (26.2%) with streptococcus and staphylococcus as predominant organisms. Fifty per cent of patients developed end-stage renal disease. On multivariable logistic regression analysis, those on dialysis had higher baseline creatinine (P = 0.003), higher albumin/creatinine ratio at presentation (P = 0.023), higher serum creatinine at presentation (P = 0.02) and lower estimated glomerular filtration rate at presentation (P = 0.012). Overall, most patients had pre-existing pathology with superimposed acute postinfectious glomerulonephritis that led to poor outcomes in our cohort.

BACKGROUND: Thrombolytic treatment with streptokinase in acute myocardial infarction has proven to be safe and effective in Caucasian populations with relatively low levels of anti-streptokinase IgG and streptokinase resistance. Higher levels of antibodies, as seen in previous recipients of streptokinase therapy, cause more adverse reactions and may result in lower efficacy. AIMS: To examine the levels of anti-streptokinase IgG and streptokinase resistance in a population subjected to endemic streptococcal infections. METHODS AND RESULTS: Thirty Aboriginal adults from a remote community in Northern Australia with endemic streptococcal infections and 15 non-Aboriginal adults from an urban community without endemic infections participated in this study. Aboriginal adults exhibited levels of anti-streptokinase IgG and streptokinase resistance that, respectively, were almost 20 and 15 times greater than the values of non-Aboriginal adults. At least 23% of Aboriginal adults had sufficiently high levels of streptokinase resistance to neutralise a standard 1.5 million unit dose of streptokinase. CONCLUSIONS: Aboriginal adults from a remote community had dramatically elevated levels of anti-streptokinase IgG and in vitro streptokinase resistance. Prospective studies are needed to assess the clinical relevance of streptokinase resistance in populations from areas with endemic streptococcal infection.

The prevalence of bronchiectasis is significantly higher among adult Aboriginal Australians (the Indigenous peoples of Australia) compared to non-Aboriginal Australians. Currently, there is no well-established tool to assess bronchiectasis severity specific to Indigenous peoples. Nor has the applicability and validity of the two well-established bronchiectasis severity assessment tools - The "Bronchiectasis Severity Index" (BSI) and "FACED" scale been vigorously tested in an Indigenous population. This retrospective study evaluated the validity of the BSI and FACED amongst an adult Aboriginal Australian cohort with bronchiectasis in the Top End Northern Territory (NT) of Australia.Patients with CT confirmed bronchiectasis identified between 2011 and 2020, residing in the Top End of the NT were eligible to be enrolled. The primary endpoint of 4-year mortality was assessed via hospital records, and sensitivity and specificity of the BSI and FACED assessed against this using area under the curve (AUC) receiver operating characteristics analysis. For patients with missing data, a relative BSI / FACED score was used which divided the score recorded for that patient by the total potential score based on their available clinical data.A total of 456 adult Aboriginal Australian patients >18 years of age were included (55.5% female, median age 49 years). According to the BSI score 43.4% of patients were assessed to have mild, 30.5% moderate and 26.1% severe bronchiectasis (median score 4 (IQR 2, 8)). According to the FACED 80.9% were assessed to have mild, 17.8% moderate and 1.3% severe (median score of 1 (IQR 0, 2)). Four-year mortality was 11.2% (median age of death 55.6 years). Sensitivity and specificity of the BSI combining moderate and severe were 86.3 and 47.2% respectively, and for severe alone 51% and 77%. Sensitivity and specificity of the FACED combining moderate and severe were 21.6% and 81.2%, respectively, and for severe alone 2% and 98.8%. The AUC for the continuous total BSI was 0.703, and the FACED 0.515. Utilising a relative score, based only on data available for patients with missing data (ie lung function or BMI) resulted in slightly improved AUCs for both the BSI (0.717) and FACED (0.571).Both BSI and FACED bronchiectasis assessment tools may not be ideal in an Indigenous/Aboriginal people's context. However, it may be reasonable to utilise the relative BSI score in this population until Indigenous people's specific bronchiectasis severity assessment tools are developed.Adult Indigenous people globally have a higher prevalence of chronic respiratory disorders, and bronchiectasis is no exception. To assess the bronchiectasis severity and to predict future mortality, there are well-established assessment tools. However, the existing bronchiectasis assessment tools are developed predominately from data gathered from non-Indigenous population cohorts. To date, it is unclear if these existing bronchiectasis assessment tools are appropriate or applicable for Indigenous people. Therefore, this study assessed how existing bronchiectasis tools, namely the “Bronchiectasis Severity Index” (BSI) and “FACED” [Forced expiratory volume in 1 s, Age, Chronic colonization, Extension, and Dyspnea] fit for an adult Indigenous/ Aboriginal Australian cohort diagnosed to have bronchiectasis. The results of the study showed that both BSI and FACED assessment tools may not be ideal in the Australian Indigenous/Aboriginal population, due to population demographics and other social determinants, including geographical isolation. Hence, further research is warranted in developing Indigenous/Aboriginal specific bronchiectasis assessment tools.

Activated self-reactive B cells play an important part in systemic lupus erythematosus (SLE). A proliferation-inducing ligand (APRIL) and B cell-activating factor (BAFF) are B-cell specific stimulators, but activate B cells through different receptors. We investigated the reciprocal association between serum APRIL (s-APRIL), serum BAFF (s-BAFF) and immunological and clinical findings in SLE patients. A cross-sectional case-control study was performed in 100 SLE patients (87% female, age 49 years, disease duration 12 years). APRIL and BAFF levels were measured by sandwich ELISA, compared with healthy controls and correlated with autoantibody, cytokine (IL-6 and IL-17) and clinical findings through nonparametric and multivariate regression analyses. Both median s-APRIL (478 vs. 0 pg/ml, p = 0.01) and s-BAFF (1720 vs. 0.9 pg/ml, p < 0.001) were higher in SLE patients than controls. Increased s-BAFF was observed in 86% of patients, while s-APRIL was increased only in 17% (p < 0.01). S-APRIL correlated with s-BAFF in controls (p = 0.04), but not in SLE (p = 0.8). Increased s-APRIL was strongly and independently associated with IL-17 activation (p < 0.001), while increased s-BAFF levels were associated with anti-nucleosome antibody presence (p = 0.001). Disease activity and organ damage were associated with s-BAFF but not s-APRIL. While both s-BAFF and s-APRIL levels are elevated in SLE patients, they reflect different immunologic and clinical pathways. The strong association between s-APRIL and IL-17 activation supports a role for Th17 helper cells in B cell activation in SLE.

The National Notifiable Diseases Surveillance System (NNDSS) received notification of 9,291 cases of disease transmitted by mosquitoes during the 2010-11 season (1 July 2010 to 30 June 2011). The alphaviruses Barmah Forest virus and Ross River virus accounted for 7,515 (81%) of these. There were 133 notifications of dengue virus infection acquired in Australia and 1,133 cases that were acquired overseas, while for 10 cases, the place of acquisition was unknown. The number of overseas acquired cases of dengue continues to rise each year, and these are most frequently acquired in Indonesia. Sentinel chicken, mosquito surveillance, viral detection in mosquitoes and climate modelling are used to provide early warning of arboviral disease activity in Australia. In early 2011, sentinel chickens in south eastern Australia widely seroconverted to flaviviruses. In 2010-11, there were 16 confirmed human cases of Murray Valley encephalitis acquired in Australia. There was one human case of Kunjin virus infection. There were 7 notifications of locally-acquired malaria in Australia and 407 notifications of overseas-acquired malaria during the 2010-11 season.

This report describes the epidemiology of mosquito-borne diseases of public health importance in Australia during the 2013-14 season (1 July 2013 to 30 June 2014) and includes data from human notifications, sentinel chicken, vector and virus surveillance programs. The National Notifiable Diseases Surveillance System received notifications for 8,898 cases of disease transmitted by mosquitoes during the 2013-14 season. The Australasian alphaviruses Barmah Forest virus and Ross River virus accounted for 6,372 (72%) total notifications. However, over-diagnosis and possible false positive diagnostic test results for these 2 infections mean that the true burden of infection is likely overestimated, and as a consequence, the case definitions have been amended. There were 94 notifications of imported chikungunya virus infection and 13 cases of imported Zika virus infection. There were 212 notifications of dengue virus infection acquired in Australia and 1,795 cases acquired overseas, with an additional 14 cases for which the place of acquisition was unknown. Imported cases of dengue were most frequently acquired in Indonesia (51%). No cases of locally-acquired malaria were notified during the 2013-14 season, though there were 373 notifications of overseas-acquired malaria. In 2013-14, arbovirus and mosquito surveillance programs were conducted in most jurisdictions. Surveillance for exotic mosquitoes at international ports of entry continues to be a vital part of preventing the spread of vectors of mosquito-borne diseases such as dengue to new areas of Australia, with 13 detections of exotic mosquitoes at the ports of entry in 2013-14.

Urinary incontinence (UI) is likely to be high in Aboriginal women in rural Australia due to risk factors including high body mass index, parity and diabetes. However, UI appears to be under-reported with limited information on whether women access appropriate care. To assess whether women who access specialist gynaecological services in rural and remote Top End Northern Territory (NT) through the specialist outreach program (SONT) are receiving care for UI aligned with best practice. Review of all 1426 SONT referrals in 2012, with audit of management for those women referred for UI or prolapse. Of 1426 SONT referrals, there were 43/1426 (3%) women referred for UI, with 34/43 (79%) attending. Of those referred, 31/43 (72%) were Aboriginal. Of twenty-six women diagnosed with probable stress UI, less than a fifth, 5/26 (19%), were referred to physiotherapy, with 2/5 (40%) attending appointments. Referral occurred for 14/23 (61%) of those suitable for urodynamics but only 6/14 (43%) attended. Just under half of women 7/16 (14%) with stress UI were referred for surgery, with 6/7 (86%) attending. In rural and remote Top End NT, specialist health service management of female UI could be improved by increased provision of current best-practice and an integrated multi-disciplinary team approach with allied health. Under-reporting and under-referral for female UI could be addressed by increasing awareness among community and primary healthcare providers of the problem of female UI and the conservative, medical and surgical treatments available.