These recent papers will be useful to review/ discuss (especially the first two):
Guest posting: Dr Nilar Lwin, Microbiology Registrar, Pathology North.
Measles overview including laboratory diagnosis: Measles virus Lwin 2018
Reports of recent measles outbreaks in PNG which are worth a close read:
- Vanimo, 2017: https://reliefweb.int/sites/reliefweb.int/files/resources/MDRPG006dfr.pdf
- Madang, 2014: https://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/473/721
Measles rash, day 3 Koplik spots
It’s useful to know your schedules and appreciate something of the rationale for the dosing recommendations. Also be aware of key vaccines that are yet to be introduced – e.g. rotavirus, HPV. Please work through the SAQ below. Correct 2016 version of Immunisation schedule obtained from PNG Paediatric site, 2018.
In the news:
- Recent menC meningococcal disease outbreak, Fiji
- Polio outbreak in PNG – WHO update (July 2018). Enga case detected now!
Some short questions to consider:
- Contrast the PNG and NHS schedules above. What important gaps are there?
- Why has IPV replaced OPV in the NHS schedule?
- What is happening with wild type polio control across the world? Which subtype has been eradicated? Where are the remaining areas of activity for wild type polio?
- How does OPV revert to virulence?
- What are the risks of dengue vaccine? What is its efficacy in different groups?
- How does one estimate vaccine efficacy?
- Australian Immunisation Handbook 10th Edition : great reference on specific immunisation topics
Guest posting: Dr Ian Marr, Microbiology Registrar, Pathology North.
Melioidosis is a cause of severe pneumonia, bacteraemia, urosepsis, prostatic abscess, CNS infection, pyogenic myositis and liver and spleen abscesses. It is found in PNG especially around the Balimo region – see Warner, Currie et al 2018 : Melioidosis in Papua New Guinea and Oceania- an important short read.
Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative rod, straight or slightly curved, with bipolar staining, or safety pin appearance. It is highly motile when viewed under phase contrast microscopy. Continue reading
Consider specific diagnostic approaches to each agent, including where relevant, serological testing, antigen detection and nucleic acid amplification methods. Also know what is locally in use in your laboratory.
Immunisation – need to know about the vaccines that are available – relevant for HPV, HBV, Influenza, Dengue, JEV, Polio, HAV, HEV, MMR, Rotavirus.
Particular attention required for those agents underlined. This is not an exhaustive listing but includes all viruses of current clinical relevance.
Dr Ian Marr has produced a useful summary for our local ID & Micro tutes recently which is shared – Rabies_2018 Marr .
It includes reference to Australian bat lyssavirus which clearly may have an incidence outside of Australia (in bats and/or humans)! Serosurveillance of bat populations in the Philippines has suggested that lyssavirus infection of bats might be more widespread than previously thought.
For the purposes of post-grad UPNG pathology revision, I would suggest you consider these additional questions-
- What is the local epidemiology of rabies in SE Asia? Especially focus on prevalence of cases within Indonesia.
- Read up the rabies vaccine advice provided by the Australian NHMRC Immunisation handbook.
- Steinman et al. Innovative tools and approaches to end the transmission of Mycobacterium leprae. Lancet ID 2017 See full text pdf already sent via email or request from JF
- Northern Territory, Australia Leprosy Guidelines – updated edition 4, May 2018- an acknowledged source of guidance. These sections especially:
- HPV organism overview summary from Dr Rob Pickles, June 2018 20180615092024.
- Naturally Acquired Immunity Against Human Papillomavirus (HPV): Why It Matters in the HPV Vaccine Era. Editorial, JID 2014.
- Possible interactions between Chlamydial infection/ other STDs and HPV carcinogenesis : Cervical Cancer Induction Enhancement Potential of Chlamydia Trachomatis: A Systematic Review 2018
- Issue of HIV and HPV coinfection – higher risks of malignancy persist despite ARV treatment: 2018 systematic review
- PNG Status Report HPV and related diseases , July 2017 (images below)
- Occupational hazards for proceduralists that deal with HPV (warts, cervical lesions) and do not take sufficient approach to personal protection : HPV-16 positive tonsillar cancer in two laser surgeons: case reports.
- Previous IDMIC posting: testing strategy, impact of immunisation, women’s knowledge (PNG)
- The global roadmap for advancing development of vaccines against sexually transmitted infections: Update and next steps. Gottlieb et al 2014 – as discussed at tutorial. Free text available.
- Kirby Institute WANTAIM trial in progress, 2017 – antenatal screening and treatment for STDs using POC testing as mentioned by Dr Vallely
- Cepheid Xpert-HPV website
From Cepheid Xpert brochure:
Here are the four presentations given to National Academy of Medical Sciences, Bir Hospital Pathology and Medicine Residents over the week commencing 7/5/18 by Emeritus Professor Robert Martin, President of the Diagnostic Microbiology Development Program.
- Laboratory Strengthening and the Diagnostic Microbiology Development Program Martin 2018
- Introduction to Quality Management Systems (Nepal) Martin 2018
- Experiences in Strengthening Health Laboratories in Resource Limited Countries Martin 2018
- NewDiagnosticTechnologies(Nepal) Martin 2018
Elements of laboratory QMS (WHO)
- Laboratory Quality Stepwise Implementation (LQSI) Tool (WHO 2017)
- Demonstration video of the LQSI (WHO – 7 minutes)
- Previous IDMIC posting: Laboratory QMS and laboratory capacity building (2015)
- How MALDI-TOF is changing microbiology – ASM video, ICAAC 2013 (22 minutes)
- Biofire technology demonstration (4.5 minutes)
Here are the three presentations given to National Academy of Medical Sciences, Bir Hospital Medical Residents over the week commencing 7/5/18. Thank you for attending and I hope they were useful. Please feel free to contact me via email if you have questions! As mentioned, I do encourage you to enrol in the international online AMS MOOC course. Best wishes, John
- Antimicrobial resistance and its laboratory detection May 2018 Ferguson
- Community-acquired pneumonia adult 2018 Ferguson
- Antimicrobial Stewardship May 2018 Ferguson
- Antibiotic Susceptibility Testing (AST) summary 2015 Ferguson
- Technical AST postings on idmic.net: unpacking MIC, ECOFFs and Clinical Breakpoints
- Antimicrobial Stewardship online course enrolment
- Nepal Antimicrobial Resistance Situation Summary (GARP) 2015
- Australian AMS Clinical Care Standard