RESUMO
Background A priority area in the 2016 Victorian Hepatitis B Strategy is to increase diagnostic testing. This study describes hepatitis B testing and positivity trends in Victoria between 2011 and 2016 using data from a national laboratory sentinel surveillance system. METHODS: Line-listed diagnostic and monitoring hepatitis B testing data among Victorian individuals were collated from six laboratories participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) of sexually transmissible infections and blood-borne viruses. Diagnostic tests included hepatitis B surface antigen (HBsAg)-only tests and guideline-based hepatitis B tests (defined as a single test event for HBsAg, hepatitis B surface antibody and hepatitis B core antibody). Using available data, the outcomes of testing and/or infection were further classified. Measures reported include the total number of HBsAg and guideline-based tests conducted and the proportion positive, classified as either HBsAg positive or chronic hepatitis B infection. RESULTS: The number of HBsAg tests decreased slightly each year between 2011 and 2016 (from 91043 in 2011 to 79664 in 2016; P < 0.001), whereas the number of guideline-based hepatitis B tests increased (from 8732 in 2011 to 16085 in 2016; P <0.001). The proportion of individuals classified as having chronic infection decreased from 25% in 2011 to 7% in 2016, whereas the proportion classified as susceptible and immune due to vaccination increased (from 29% to 39%, and from 27% to 34%, respectively; P < 0.001). CONCLUSIONS: The study findings indicate an increased uptake of guideline-based hepatitis B testing. The ongoing collection of testing data can help monitor progress towards implementation of the Victorian Hepatitis B Strategy.
Assuntos
Anticorpos Anti-Hepatite B/imunologia , Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Hepatite B Crônica/diagnóstico , Testes Sorológicos/tendências , Estudos de Coortes , Controle de Doenças Transmissíveis , Feminino , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Hepatite B/imunologia , Hepatite B/prevenção & controle , Vacinas contra Hepatite B/uso terapêutico , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/imunologia , Hepatite B Crônica/prevenção & controle , Humanos , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Vigilância de Evento Sentinela , Vitória/epidemiologiaAssuntos
Doença Hepática Induzida por Substâncias e Drogas/virologia , Hepatite Viral Humana/patologia , Herpesvirus Humano 4/patogenicidade , Fígado/lesões , Fígado/virologia , Doença Aguda , Adulto , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/patologia , Feminino , Hepatite Viral Humana/diagnóstico , Humanos , Fígado/patologiaRESUMO
Objectives: Knowledge of contemporary epidemiology of candidaemia is essential. We aimed to identify changes since 2004 in incidence, species epidemiology and antifungal susceptibilities of Candida spp. causing candidaemia in Australia. Methods: These data were collected from nationwide active laboratory-based surveillance for candidaemia over 1 year (within 2014-2015). Isolate identification was by MALDI-TOF MS supplemented by DNA sequencing. Antifungal susceptibility testing was performed using Sensititre YeastOne™. Results: A total of 527 candidaemia episodes (yielding 548 isolates) were evaluable. The mean annual incidence was 2.41/105 population. The median patient age was 63 years (56% of cases occurred in males). Of 498 isolates with confirmed species identity, Candida albicans was the most common (44.4%) followed by Candida glabrata complex (26.7%) and Candida parapsilosis complex (16.5%). Uncommon Candida species comprised 25 (5%) isolates. Overall, C. albicans (>99%) and C. parapsilosis (98.8%) were fluconazole susceptible. However, 16.7% (4 of 24) of Candida tropicalis were fluconazole- and voriconazole-resistant and were non-WT to posaconazole. Of C. glabrata isolates, 6.8% were resistant/non-WT to azoles; only one isolate was classed as resistant to caspofungin (MIC of 0.5 mg/L) by CLSI criteria, but was micafungin and anidulafungin susceptible. There was no azole/echinocandin co-resistance. Conclusions: We report an almost 1.7-fold proportional increase in C. glabrata candidaemia (26.7% versus 16% in 2004) in Australia. Antifungal resistance was generally uncommon, but azole resistance (16.7% of isolates) amongst C. tropicalis may be emerging.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidemia/epidemiologia , Candidemia/microbiologia , Anidulafungina , Austrália/epidemiologia , Azóis/farmacologia , Candida/classificação , Candida/genética , Candida glabrata/efeitos dos fármacos , Candida glabrata/genética , Candida glabrata/isolamento & purificação , Candida tropicalis/efeitos dos fármacos , Candida tropicalis/genética , Candida tropicalis/isolamento & purificação , Caspofungina , Farmacorresistência Fúngica/genética , Equinocandinas/farmacologia , Feminino , Fluconazol/farmacologia , Humanos , Incidência , Lipopeptídeos/farmacologia , Masculino , Micafungina , Testes de Sensibilidade Microbiana/métodos , Análise de Sequência de DNA/métodos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Triazóis/farmacologia , Voriconazol/farmacologiaRESUMO
We describe a case of Neisseria gonorrhoeae isolated from a nipple piercing wound in a homosexual man with pharyngeal gonococcal carriage.
Assuntos
Piercing Corporal , Gonorreia/diagnóstico , Neisseria gonorrhoeae/isolamento & purificação , Faringe/microbiologia , Homossexualidade , Humanos , MasculinoRESUMO
We report the first case of reactive arthritis associated with lymphogranuloma venereum (LGV) proctitis in Australia. Since 2004, LGV proctitis has emerged as an important infection worldwide in men who have sex with men. While reactive arthritis is usually associated with serovars D to K of Chlamydia trachomatis, association with LGV serovars is historically rare. Screening for chlamydial infection should be considered in this group if they present with an acute arthritis otherwise the condition could go undiagnosed. Asymptomatic infections are being increasingly reported in Europe and prolonged treatment is required to ensure a cure.
Assuntos
Artrite Reativa/etiologia , Infecções por Chlamydia/complicações , Chlamydia trachomatis/isolamento & purificação , Linfogranuloma Venéreo/complicações , Proctite/complicações , Administração Oral , Antibacterianos/uso terapêutico , Austrália , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/efeitos dos fármacos , Chlamydia trachomatis/genética , Doxiciclina/uso terapêutico , Infecções por HIV/virologia , Homossexualidade Masculina , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Proctite/tratamento farmacológico , Proctite/microbiologia , Comportamento Sexual , Parceiros SexuaisRESUMO
Microsphaeropsis arundinis is an anamorphic fungal plant inhabitant belonging to the form class Coelomycetes. We describe two cases of M. arundinis soft tissue infections in immunosuppressed patients. This organism has not previously been described as causing disease in humans. It was identified on the basis of its typical ostiolate pycnidial conidiomata, ampulliform conidiogenous cells, and small, smooth-walled, brown, cylindrical conidia.
Assuntos
Ascomicetos/patogenicidade , Micoses/microbiologia , Infecções dos Tecidos Moles/microbiologia , Idoso , Idoso de 80 Anos ou mais , Ascomicetos/genética , Ascomicetos/isolamento & purificação , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Micoses/patologia , Infecções dos Tecidos Moles/patologiaRESUMO
During 6 months of treatment, we measured human immunodeficiency virus (HIV)-1 virus loads, CD4 T cell counts, and immune activation markers, in 111 HIV-1-infected patients with active tuberculosis (TB). The median virus load (baseline, 5.58 log(10) copies/mL) significantly increased at 1 month (5.71 log(10) copies/mL), then returned to near-baseline levels at 3 months (5.40 log(10) copies/mL) and at 6 months (5.36 log(10) copies/mL). In contrast, the median CD4 counts increased at 1 month (186/mm(3)), at 3 months (238/mm(3)), and at 6 months (239/mm(3)). CD4 counts and virus loads did not change during therapy. Expression of CD38 and HLA-DR remained high throughout treatment, whereas plasma levels of interleukin-6 decreased over time.
Assuntos
Antituberculosos/uso terapêutico , Linfócitos T CD4-Positivos/imunologia , Infecções por HIV/complicações , HIV-1/genética , HIV-1/isolamento & purificação , RNA Viral/análise , Tuberculose/tratamento farmacológico , Tuberculose/imunologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Antituberculosos/farmacologia , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/efeitos dos fármacos , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , Humanos , Mycobacterium tuberculosis , África do Sul , Tuberculose/complicações , Tuberculose/virologia , Carga ViralRESUMO
OBJECTIVE: To determine the potential role of steroid therapy combined with early antiviral and supportive care in patients infected with human immunodeficiency virus (HIV) with varicella pneumonia. MATERIALS AND METHODS: A retrospective review was conducted of the incidence, clinical course, and outcome of varicella pneumonia in patients with HIV or acquired immunodeficiency syndrome (AIDS). RESULTS: Seven of 12 patients (58%) who were hospitalized with chickenpox developed clinically severe varicella pneumonia. All patients had advanced immunosuppression and all developed diffuse reticulonodular radiographic abnormalities, although two patients had normal chest radiographs on admission. All patients received antiviral therapy within 12 hours of hospital admission. The overall mortality rate was 43%. Six patients were treated with systemic corticosteroids in addition to antiviral agents, including all four of the survivors. CONCLUSIONS: Hospitalized patients with HIV or AIDS with chickenpox are at high risk for developing varicella pneumonia. There is a potentially high rate of death despite prompt initiation of appropriate antiviral therapy. Intensive care management and adjunctive use of systemic corticosteroids may improve outcome.