Author: John Goswell
Company: J C Goswell P/L

Micro and Macro Pathogens of the Top End
Bart Currie

These are my notes from the talk given by Bart Currie….  John Goswell

Melioidosis
•	Burkholderia pseudomallei
•	In soil ansd surface water
•	Infects humans and animals (nb sheep, camels and alpacas very susceptible)
•	Avoid contact with muddy water (feet) if immunosuppressed
•	No immunity
•	Skin infection
•	Resistant to penicillins, cephalosporins
•	Being considered as a biological weapon so US studying it.
•	Treated with imipenin, or similar
•	IV antibiotics for two weeks
•	Then three months of cotrimoxazole
•	Can effect any organ

Scrub Typhus
•	In Litchfield Park, 14 cases so far
•	Only fatal case from Green Ant Creek
•	First case in 1992 in NT, followed opening of park
•	Killed more in PNG WW2 than malaria
•	Renal, pulmonary
•	Eschar typically black
•	Rainforest regions, constant humidity, 
•	A ricketsia
•	Lives in mites (Leptotrombidium deliense), which feed from endemic rodents
•	Mites goes to warm area eg groin/armpits
•	High fevers, headaches
•	Doxycycline the drug of choice

Leptospirosis
•	Liver, renal, respiratory problems

Nocardia

Vibrio vulniferous
•	Bullous cellulitis can look like necrotising vasculitis
•	Treat with IV doxycycline
•	Usually in those with liver disease, including haemachromatosis
•	Like salt and brackish water
•	Metallophyllic
•	Cases near McArthur River Mine

NT Community –acquired MRSA
•	Sensitive to cotrimoxazole, 
•	If antibiotic needed then use 2 double strength bd
•	some strains are more virulent and cause necrotising pneumonia

Cutaneous larva migrans
•	Ancylostoma braziliense normally in cats and dogs
•	Last about 6 months unless treated with ivamectin or albendazole
•	Old treatment to use cryo

Tropical Ulcers
•	Most tropical ulcers are multi-organism
•	Usually treated with Augmentin or Keflex/Flagyl

Ross River Virus
•	Most indigenous have been infected as children
•	Mostly in tourists

Barmah Forest Virus
•	More rash less arthritis

Dengue
•	Was the commonest cause of admission to the old Darwin Hospital in Doctors Gully
•	Since mid 1800s Aedes aegypti and other mosquitoes had invaded with cane-cutters and ?mine workworkers
•	Using reticulated water and covering fresh water has stopped local occurrences. Still in Qld.
•	Massive program to prevent A. aegypti in NT

Japanese Encephalitis
•	In Torres St Is recently
•	New mosquitoes (Tiger Mosquito)
•	albapictus, aggressive, survives in colder climates
•	A day biter.

Murray Valley Encephalitis
Of those who get the disease:
•	1/3 die
•	1/3 have neurological deficit, 
•	1/3 fully recover
499/500 bitten are Ok

Box Jellyfish
•	Chironex fleckerii
•	Most rapid envenomation within nature
•	Can die within 5 minutes
•	June/July/August/October generally OK
•	Can use venom suit
•	Vinegar does not reverse toxin. Stops firing of undischarged stinging cells
•	Delayed reaction to sting responds to prednisone

Snake bite
Bite site signs
-	describe
-	fang marks may not be visible

Regional lymphadenitis a very specific sign
No
-	headache, nausea, vomiting, abdo pain

Specific
-	coagulpathy (esp browns which have little neuro effects despite neurotoxins present). Make have rapid collapse, and head injury causing increased intracranial haemorrhage.
-	Neurotoxicity (eg Death adder. invariably ptosis first (*, later can’t open eyes), bulbar (critical time for airway protection), intercostal, diaphragmatic
-	myotoxicity (Mulga snake = “King Brown” needs black snake antivenom, local necrosis)
-	other

Dipstick test early and repeat

*fatigue test by asaking patient to look up…. Eyelids droop after 20s

Taipans 
•	Do all of the above

Crocodile bites