Now showing 1 - 10 of 79
  • Publication
    Journal Article
    Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study.
    (2018-04-16)
    Davis K
    ;
    Remenyi B
    ;
    ;
    Dos Santos J
    ;
    Bayley N
    ;
    Paratz E
    ;
    Reeves B
    ;
    Appelbe A
    ;
    Cochrane A
    ;
    Johnson TD
    ;
    Korte LM
    ;
    Do Rosario IM
    ;
    Da Silva Almeida IT
    ;
    ;
    Carapetis JR
    ;
    To determine the prevalence of rheumatic heart disease (RHD) in school-aged children and young people in Timor-Leste. Prospective cross-sectional survey. Echocardiography was performed by Australian cardiologists to determine the presence of RHD. Demographic data were also collected. Patients in whom RHD was detected were entered into a register to allow monitoring of adherence to secondary prophylaxis; the first dose of benzathine penicillin G (BPG) was administered on the day of screening. Schools in urban (Dili) and rural (Ermera) Timor-Leste. School students aged 5-20 years. Definite and borderline RHD, as defined by World Heart Federation echocardiographic criteria. 1365 participants were screened; their median age was 11 years (IQR, 9-14 years), and 53% were girls. The estimated prevalence of definite RHD was 18.3 cases per 1000 population (95% CI, 12.3-27.0 per 1000), and of definite or borderline RHD 35.2 per 1000 (95% CI, 26.5-46.4 per 1000). Definite (adjusted odds ratio [aOR], 3.5; 95% CI, 1.3-9.4) and definite or borderline RHD (aOR, 2.7; 95% CI, 1.4-5.2) were more prevalent among girls than boys. Eleven children (0.8%) had congenital heart disease. Of the 25 children in whom definite RHD was identified, 21 (84%) received education and a first dose of BPG on the day of screening; all 25 have since received education about primary care for RHD and have commenced penicillin prophylaxis. The rates of RHD in Timor-Leste are among the highest in the world, and prevalence is higher among girls than boys. Community engagement is essential for ensuring follow-up and the effective delivery of secondary prophylaxis.
  • Publication
    Journal Article
    First case of NDM-1-producing Acinetobacter baumannii isolated in Timor-Leste.
    (2022-09-26)
    Sarmento N
    ;
    Oakley T
    ;
    Belo JC
    ;
    da Conceição VL
    ;
    Maia CDC
    ;
    Santos CG
    ;
    Amaral E
    ;
    Toto L
    ;
    da Silva ES
    ;
    Marr I
    ;
    ;
      5399
  • Publication
    Journal Article
    An observational study of febrile seizures: the importance of viral infection and immunization.
    (2016) ;
    Richmond P
    ;
    Robins C
    ;
    Lindsay K
    ;
    Levy A
    ;
    Effler PV
    ;
    Borland M
    ;
    Blyth CC
    Febrile seizures are common in young children. Annual peaks in incidence mirror increased respiratory virus activity during winter. Limited virological data are available using modern diagnostic techniques for children with febrile seizures. We aimed to determine the frequency of detection of specific viral pathogens in children with febrile seizures, to describe risk factors including recent vaccination and clinical features associated with specific etiologies. An observational study was performed. Children aged 6 months to 5 years presenting to the Emergency Department of a tertiary children's hospital in Western Australia with febrile seizures were enrolled between March 2012 and October 2013. Demographic, clinical data and vaccination history were collected, and virological testing was performed on per-nasal and per-rectal samples. One hundred fifty one patients (72 female; median age 1.7y; range 6 m-4y9m) were enrolled. Virological testing was completed for 143/151 (95%). At least one virus was detected in 102/143 patients (71%). The most commonly identified were rhinoviruses (31/143, 22%), adenovirus (30/151, 21%), enteroviruses, (28/143, 20%), influenza (19/143, 13%) and HHV6 (17/143, 12%). More than one virus was found in 48/143 (34%). No significant clinical differences were observed when children with a pathogen identified were compared with those with no pathogen detected. Febrile seizures occurred within 14 days of vaccine administration in 16/151 (11%). At least one virus was detected in over two thirds of cases tested (commonly picornaviruses, adenovirus and influenza). Viral co-infections were frequently identified. Febrile seizures occurred infrequently following immunization.
      1366
  • Publication
    Case Reports
    Skin and soft tissue infection caused by Basidiobolus spp. in Australia.
    (2020-02-25) ;
    Taylor B
    ;
    Lim A
    ;
    ; ;
    Fungi from the order Entomophthorales are rare but well recognized cause of tropical fungal infection, typically causing subcutaneous truncal or limb lesions in immunocompetent hosts. They may also mimic malignancy by causing intrabdominal mass, sometimes resulting in obstructive gastrointestinal or renal presentations. A 4-year-old female presented with a progressively growing abdominal wall lesion over several months, developing into acute inflammation of the abdominal wall with systemic symptoms. She underwent surgical debridement and fungal culture of subcutaneous tissue was positive for Basidiobolus spp with characteristic histopathological findings. Treatment with voriconazole followed by itraconazole over a total duration of 6 weeks led to complete resolution. Basidiobolus spp is an unusual cause of infection with characteristic mycological and histopathological findings. Infection can present in a number of ways ranging from a slow-growing mass in the subcutaneous soft tissue to an invasive mass in the gastrointestinal tract. Identification of its unique beak-like zygospore and Splendore-Hoeppli phenomenon on histopathological specimens can be pathognomonic and could provide the key to early diagnosis. Review of the literature found that timely diagnosis and commencement of antifungal therapy can be curative with or without surgical treatment. Considering the rarity of this tropical infection, this case provides the opportunity for revision of the typical presentations and diagnostic findings of Basidiobolus spp. With early recognition and suitable treatment, outcomes are generally favorable.
      616
  • Publication
    Journal Article
    The burden of invasive infections in critically ill Indigenous children in Australia.
    (2017-02-06)
    Ostrowski JA
    ;
    MacLaren G
    ;
    Alexander J
    ;
    Stewart P
    ;
    Gune Sheena
    ;
    ;
    Ganu S
    ;
    Festa M
    ;
    Erickson SJ
    ;
    Straney L
    ;
    Schlapbach LJ
    To describe the incidence and mortality of invasive infections in Indigenous children admitted to paediatric and general intensive care units (ICUs) in Australia. Retrospective multi-centre cohort study of Australian and New Zealand Paediatric Intensive Care Registry data. All children under 16 years of age admitted to an ICU in Australia, 1 January 2002 - 31 December 2013. Indigenous children were defined as those identified as Aboriginal and/or Torres Strait Islander in a mandatory admissions dataset. Population-based ICU mortality and admission rates. Invasive infections accounted for 23.0% of non-elective ICU admissions of Indigenous children (726 of 3150), resulting in an admission rate of 47.6 per 100 000 children per year. Staphylococcus aureus was the leading pathogen identified in children with sepsis/septic shock (incidence, 4.42 per 100 000 Indigenous children per year; 0.57 per 100 000 non-Indigenous children per year; incidence rate ratio 7.7; 95% CI, 5.8-10.1; P < 0.001). While crude and risk-adjusted ICU mortality related to invasive infections was not significantly different for Indigenous and non-Indigenous children (odds ratio, 0.75; 95% CI, 0.53-1.07; P = 0.12), the estimated population-based age-standardised mortality rate for invasive infections was significantly higher for Indigenous children (2.67 per 100 000 per year v 1.04 per 100 000 per year; crude incidence rate ratio, 2.65; 95% CI, 1.88-3.64; P < 0.001). The ICU admission rate for severe infections was several times higher for Indigenous than for non-Indigenous children, particularly for S. aureus infections. While ICU case fatality rates were similar, the population-based mortality was more than twice as high for Indigenous children. Our study highlights an important area of inequality in health care for Indigenous children in a high income country that needs urgent attention.
      1373
  • Publication
    Case Reports
    Complicated Mycobacterium ulcerans infection in a child in the Northern Territory.
    (2023-02-01)
    Mahony M
    ;
    ;
    Cox V
    ;
    Sufyan W
    ;
    Wallis P
    ;
    Nizzero D
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    ;
      4213
  • Publication
    Journal Article
    Influenza hospitalizations in Australian children 2010-2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness.
    (2021-11-16)
    Norman DA
    ;
    Cheng AC
    ;
    Macartney KK
    ;
    Moore HC
    ;
    Danchin M
    ;
    Seale H
    ;
    McRae J
    ;
    Clark JE
    ;
    Marshall HS
    ;
    Buttery J
    ;
    ;
    Crawford NW
    ;
    Blyth CC
    BACKGROUND: Children with comorbidities are at greater risk of severe influenza outcomes compared with healthy children. In Australia, influenza vaccination was funded for those with comorbidities from 2010 and all children aged <5 years from 2018. Influenza vaccine coverage remains inadequate in children with and without comorbidities. METHODS: Children ≤16 years admitted with acute respiratory illness and tested for influenza at sentinel hospitals were evaluated (2010-2019). Multivariable regression was used to identify predictors of severe outcomes. Vaccine effectiveness was estimated using the modified incidence density test-negative design. RESULTS: Overall, 6057 influenza-confirmed hospitalized cases and 3974 test-negative controls were included. Influenza A was the predominant type (68.7%). Comorbidities were present in 40.8% of cases. Children with comorbidities were at increased odds of ICU admission, respiratory support, longer hospitalizations, and mortality. Specific comorbidities including neurological and cardiac conditions increasingly predisposed children to severe outcomes. Influenza vaccine coverage in influenza negative children with and without comorbidities was low (33.5% and 17.9%, respectively). Coverage improved following introduction of universal influenza vaccine programs for children <5 years. Similar vaccine effectiveness was demonstrated in children with (55% [95% confidence interval (CI): 45; 63%]) and without comorbidities (57% [(95%CI: 44; 67%]). CONCLUSIONS: Comorbidities were present in 40.8% of influenza-confirmed admissions and were associated with more severe outcomes. Children with comorbidities were more likely experience severe influenza with ICU admission, mechanical ventilation, and in-hospital morality. Despite demonstrated vaccine effectiveness in those with and without comorbidities, vaccine coverage was suboptimal. Interventions to increase vaccination are expected to reduce severe influenza outcomes.
      2374
  • Publication
    Journal Article
    The COVID-19 laboratory response in Timor-Leste; a story of collaboration.
    (2023-04-11)
    Sarmento N
    ;
    Soares da Silva E
    ;
    Barreto I
    ;
    Ximenes JC
    ;
    Angelina JM
    ;
    Correia DM
    ;
    Babo SM
    ;
    Tilman AJP
    ;
    Salles de Sousa A
    ;
    Hornay E
    ;
    Ico LC
    ;
    Machado FN
    ;
    Niha MV
    ;
    Ballard S
    ;
    Lin C
    ;
    Howden B
    ;
    ;
    Wapling J
    ;
    Alves L
    ;
    Oakley T
    ;
    Marr I
    ;
    ;
    Arkell P
    ;
    Smith-Vaughan H
    ;
    Fancourt NSS
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    ;
    Timor-Leste is a small nation of 1.3 million people which shares a land border with Indonesia and is 550 km from Darwin, Australia. It is one of the poorest nations in Asia. The National Health Laboratory (NHL) and its network of smaller laboratories in Timor-Leste had limited capacity to perform molecular diagnostic testing before the coronavirus disease 2019 (COVID-19) pandemic began. With the support of international development partners, the NHL rapidly expanded its molecular testing service. From March 2020 to February 2022, over 200,000 molecular tests were performed; COVID-19 testing sites were established in hospital and community health center laboratories and all 13 municipalities, and the number of scientists and technicians at the molecular diagnostic laboratory at the NHL increased from five to 28 between 2019 and 2022. Molecular diagnostic testing for COVID-19 was successfully established at the NHL and in the municipalities. The molecular diagnostic laboratory at NHL is now equipped to respond to not only large-scale COVID-19 testing but also laboratory detection of other infectious diseases, preparing Timor-Leste for future outbreaks or pandemics.
      3365
  • Publication
    Journal Article
    What's that spot?
    (2018-08) ;
    Ford T
    ;
      1035
  • Publication
    Journal Article
    Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste.
    (2022-09-16)
    Oakley T
    ;
    Le B
    ;
    da Conceicao V
    ;
    Marr I
    ;
    Maia C
    ;
    Soares M
    ;
    Belo JC
    ;
    Sarmento N
    ;
    da Silva E
    ;
    Amaral S
    ;
    Vaz Nery S
    ;
    ; ;
    Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in LMIC. The aim of this study was to determine colonic carriage of ESBL-producing fluoroquinolone- and aminoglycoside-resistant Enterobacterales in healthy children in three municipalities of Timor-Leste. In November 2020, 621 stool samples were collected from school-aged children and underwent screening for the presence of Enterobacterales species and antimicrobial resistance (AMR). Ciprofloxacin-resistant Gram-negative organisms were cultured from 16.5% (95% CI 6.2-26.9), and gentamicin resistance was identified in 6.8% (95% CI 2.8-10.7). Compared to the prevalence of ciprofloxacin resistance in Dili (36.1%), there was significantly lower prevalence in the rural municipalities of Ermera (12.9%; AOR 0.38, 95% CI 0.24-0.60, p < 0.001) and Manufahi (4.5%; AOR 0.07, 95% CI 0.01-0.51, p = 0.009). The overall cluster-adjusted prevalence of ESBL-producing bacteria was 8.3%, with no significant differences between municipalities. This study demonstrates high rates of carriage of AMR among school-aged children in Timor-Leste, with higher rates observed in Dili compared to rural municipalities. Empiric antibiotic guidelines should include recommendations for treating community-acquired infections that account for the possibility of antimicrobial resistance.
      4554