Investigation of zoonotic infections among Auckland Zoo staff: 1991-2010.

Investigation was undertaken to assess the occurrence of zoonotic infection among staff at Auckland Zoological Park, New Zealand, in 1991, 2002 and 2010. Serial cross-sectional health surveys in 1991, 2002 and 2010 comprising a health questionnaire, and serological, immunological and microbiological analysis for a range of potential zoonotic infections were performed. Laboratory results for zoo animals were also reviewed for 2004-2010 to assess the occurrence of potential zoonotic infections. Veterinary clinic, animal handler, grounds, maintenance and administrative staff participated in the surveys, with 49, 42 and 46 participants in the 1991, 2002 and 2010 surveys, respectively (29% of total zoo staff in 2010). A small number of staff reported work-related infections, including erysipelas (1), giardiasis (1) and campylobacteriosis (1). The seroprevalence of antibodies to hepatitis A virus and Toxoplasma gondii closely reflected those in the Auckland community. No carriage of hepatitis B virus (HBV) was detected, and most of those with anti-HBV antibodies had been vaccinated. Few staff had serological evidence of past leptospiral infection. Three veterinary clinic staff had raised Chlamydophila psittaci antibodies, all < 1 : 160 indicating past exposure. Two staff (in 1991) had asymptomatic carriage of Giardia lamblia and one person (in 2010) had a dermatophyte infection. After 1991, positive tests indicating exposure to Mycobacterium tuberculosis were < 10%, comparable to the general New Zealand population. Zoo animals had infections with potential zoonotic agents, including G. lamblia, Salmonella spp., Campylobacter spp. and T. gondii, although the occurrence was low. Zoonotic agents pose an occupational risk to zoo workers. While there was evidence of some zoonotic transmission at Auckland Zoo, this was uncommon and risks appear to be adequately managed under current policies and procedures. Nevertheless, ongoing assessment of risk factors is needed as environmental, human and animal disease and management factors change. Policies and procedures should be reviewed periodically in conjunction with disease monitoring results for both animals and staff to minimise zoonotic transmission.

Extracorporeal shock wave lithotripsy combined with litholytic therapy in the treatment of patients with symptomatic gallstones--the Melbourne experience.

OBJECTIVE: To investigate the role of extracorporeal shock wave lithotripsy using the Dornier MPL9000 lithotripter and adjuvant litholytic therapy in the treatment of symptomatic gallbladder stones. PATIENTS AND METHODS: Between August 1989 and March 1991, 399 patients had their one to three gallbladder stones fragmented by the Dornier MPL9000 lithotripter. Chenodeoxycholic acid alone was used as adjuvant litholytic therapy in the majority. A minority received a combination of chenodeoxycholic acid and ursodeoxycholic acid or ursodeoxycholic acid alone. Patients who died, had cholecystectomies or failed to complete the treatment program were excluded from analysis, leaving a cohort of 287 patients with a follow-up of at least 12 months. This cohort comprised 173 patients with single small stones (20 mm or less in diameter), 32 patients with single large stones (21 mm to 30 mm in diameter) and 82 patients with two to three stones. OUTCOME MEASURES: Patients were followed up by repeated ultrasound examination to monitor the disappearance of fragments from the gallbladder. Stone-free rates, recurrences and complications of treatment were determined. RESULTS: The stone-free rate 12 months after treatment was 37.6% for patients with a single small stone, 3.1% for patients with a single large stone and 18.3% for patients with two to three stones. Of 70 patients with a single small stone who had become stone free at some time during the 12 months after treatment, five (7.1%) experienced recurrence, as did one of the 16 patients (6.9%) with two to three stones. Some 179 patients (44.9%) experienced biliary colic after lithotripsy. Most attacks were mild. Eleven patients (2.8%) developed cholecystitis and nine (2.3%) became jaundiced. Five patients (1.3%) suffered from pancreatitis, of whom one died from severe necrotising pancreatitis. Treatment mortality was 0.25%. Cholecystectomy was needed in 44 patients (11.9%). CONCLUSIONS: Only about 15%-20% of all patients with symptomatic gallbladder stones are suitable for lithotripsy. In this study, only about 28% were stone free after 12 months. As the gallbladder is not removed, stones may re-form. Laparoscopic cholecystectomy and open cholecystectomy by comparison will produce a "stone-free state" in 100% of patients, no matter how many stones are present in the gallbladder, their size, or whether the gallbladder is non-functioning. Consequently, lithotripsy and litholytic therapy are now reserved for those few patients who are unable to tolerate general anaesthesia and cholecystectomy and those who refuse surgery. Even in centres showing the most favourable results, lithotripsy and litholytic therapy will have at best a minor role to play in the overall management of symptomatic gallbladder stones.