Sexual transmission of Zika virus: a literature review.

Zika virus is an emerging health threat worldwide. A member of the yellow fever virus family, it is primarily spread by mosquitoes of the Aedes (Stegomyia) genus. Unusually for a mosquito-borne virus, sexual spread has also been reported; with cases of male-to-female, female-to-male and male-to-male sexual transmission all now published in the scientific literature, in both symptomatic and asymptomatic infection. Female-to-female sexual transmission has not yet been reported, but is biologically plausible. The extent of the effect of sexual transmission on the spread of Zika virus around the world is not well-characterised, but has particular relevance to travellers to and from non-endemic regions, and assisted reproduction services.

Multiple simultaneous infections in a patient with well-controlled HIV: when Occam's razor fails.

Multiple concurrent infectious processes have previously been reported in the context of advanced HIV with significant immunosuppression. Here we report a case of multiple infections in a 56-year-old man with well-controlled HIV diagnosed 5 years earlier. Soon after returning to Australia following 12 years living in Thailand, he became unwell with fevers, night sweats, arthralgia and myalgia. There were no localising symptoms and examination was unremarkable. Investigations revealed positive syphilis (Treponema pallidum) serology with an RPR of 16, a positive urine culture (Klebsiella pneumoniae), a pulmonary nodule, a liver abscess and colitis (Entamoeba histolytica). Recovery was only complete when all the individual infections were treated.

Rectal chlamydia infection in women at high risk of chlamydia attending Canberra Sexual Health Centre.

Chlamydia is the most commonly notified sexually transmitted infection in Australia. Australian guidelines recommend urogenital screening in asymptomatic men and women, and rectal screening in men who have sex with men or women reporting anal sex/symptoms. International studies describe a rectal chlamydia prevalence in women of 5% to 21%. We found that in women at high risk of chlamydia, 57% (32/56) tested positive for rectal chlamydia. Of these, 97% (31/32) had concurrent urogenital chlamydia. Women with urogenital chlamydia were significantly more likely to have a positive rectal result (χ(2), p = 0.000). Neither anal symptoms nor reported anal sex were associated with a positive rectal chlamydia test. The recommended treatment of rectal chlamydia differs substantially from that of urogenital chlamydia, raising the possibility that Australian women are being regularly undertreated due to a lack of rectal testing. Untreated rectal chlamydia may increase the risk of persistent infection, reproductive tract reinfection, complications and transmission. Further work is needed to determine the optimal management of chlamydia in women.

Why doctors should care about animal cruelty.

BACKGROUND: Animal cruelty is a significant problem for society, and there are good reasons why doctors should be particularly concerned by it. Increasing evidence for links between animal cruelty and child or spousal abuse is an area of growing concern internationally and of real importance to health professionals. OBJECTIVE: This article aims to raise awareness of the relevance of animal cruelty to medical practice. The links between animal cruelty and human health are discussed broadly and some wider ethical issues raised. DISCUSSION: Animal cruelty impacts on human health in disparate ways: intentional and unintentional acts of cruelty may reflect underlying mental health problems that need to be addressed. Cruelty within the family setting is an important sentinel for domestic violence and should prompt an assessment for possible child abuse. Furthermore, animal cruelty raises important questions about the nature of empathy, and the type of society that we wish to live in.

The traditional categories of fluoroacetate poisoning signs and symptoms belie substantial underlying similarities.

Sodium monofluoroacetate (Compound 1080) has been widely used around the world as a vertebrate pest control agent. Following ingestion of 1080 there is a latent period, during which the compound is metabolised into a toxic form, before the onset of symptoms. The timing of this period varies significantly between species as does the median lethal dose. Traditionally different species have also been classified into groups depending on the primary organ system involved in 1080 toxicosis (cardiac, nervous, or mixed signs/symptoms). However, general acceptance of this method of classification has obscured the fact that several signs of fluoroacetate poisoning are common to most vertebrate species. This paper reviews five decades of literature on the signs/symptoms of fluoroacetate poisoning in vertebrates and concludes that there is little justification for the division of animals poisoned by fluoroacetate into symptomatic groups.

Evolution of multi-resistance plasmids in Australian clinical isolates of Escherichia coli.

Plasmids allow the movement of genetic material, including antimicrobial resistance genes, between bacterial species and genera. They frequently mediate resistance to multiple antimicrobials and can result in the acquisition by a pathogen of resistance to all or most clinically relevant antimicrobials. Unfortunately, there are still large gaps in our understanding of how new multi-resistance plasmids evolve. Five Australian clinical institutions collaborated in this study of multi-resistance plasmids in clinical isolates of Escherichia coli. We characterized 72 resistance plasmids in terms of the antimicrobial resistance profile they conferred, their size and their incompatibility group. Restriction fragment length polymorphisms were used to determine the genetic relationships between the plasmids. Relationships between the host cells were determined using multi-locus enzyme electrophoresis. A lack of correlation between the evolutionary history of the host cells and their plasmids suggests that the horizontal transfer of resistance plasmids between strains of E. coli is common. The resistance plasmids were very diverse, with a wide range of resistance profiles and a lack of discrete evolutionary lineages. Multi-resistance plasmids did not evolve via the co-integrative capture of smaller resistance plasmids; rather, the roles of recombination and the horizontal movement of mobile genetic elements appeared to be most important.

Species differences in plasmid carriage in the Enterobacteriaceae.

Modern concerns about the spread of antibiotic resistance raise questions about the effect of bacterial species on plasmid evolution and maintenance. We studied 223 Enterobacteriaceae isolated from wild mammals and determined the number of plasmids per isolate, the size of those plasmids, and the distribution of plasmid incompatibility groups N, P, W, FII, and A/C. All of these variables were non-randomly distributed with respect to bacterial species, suggesting that host-cell factors constrain the plasmids that a strain will carry. The implication for the evolution of multiple-resistance plasmids in a clinical setting is that although inter-generic plasmid transfer may introduce a novel resistance plasmid into a bacterial genus, it is likely to be modified to suit the requirements of the new host cell. This then further suggests that resistance plasmids will evolve independent lineages within bacterial species although the genes incorporated in them may have come from the same original source.