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4.
Clin Infect Dis ; 60(2): 228-36, 2015 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-25301212

RESUMO

BACKGROUND: Infections with human parechoviruses (HPeVs) are associated with a wide range of clinical presentations in children, ranging from mild or asymptomatic infections to severe sepsis-like presentations or meningoencephalitis. METHODS: We reviewed medical records of infants admitted to 5 hospitals in New South Wales, Australia, during an outbreak of HPeV-3 infection. Data were collected on clinical presentation, laboratory markers, and outcome of infants with HPeV infection confirmed by reverse transcription polymerase chain reaction. RESULTS: We identified 118 infected infants. Most presented with an acute sepsis-like syndrome with high fever, tachycardia, poor perfusion, and severe irritability. Other common features were erythrodermic rash, abdominal distension, edema, and hepatitis. The age range of infants was 4 days to 9.5 months; 75% were <2 months old, including all but 1 of the 30 infants (25%) admitted to intensive care units (ICUs), who as a group, were significantly younger than infants not admitted to ICUs. Only 4% of evaluable cerebrospinal fluid samples had pleocytosis, but HPeV was detected in 95%. Brain magnetic resonance imaging on a small number of children demonstrated white matter changes and diffusion restriction. Sequencing of the VP1 gene confirmed HPeV-3 in all samples tested. All children recovered without ongoing complications at last follow-up. CONCLUSIONS: We report the largest series of HPeV-3 infection in infants, and the first outbreak in Australia. Infants presented with a severe sepsis-like syndrome with a high rate of ICU admissions, but all recovered from the acute infection without complications. Long-term sequelae are unknown.


Assuntos
Surtos de Doenças , Parechovirus/isolamento & purificação , Infecções por Picornaviridae/complicações , Infecções por Picornaviridae/epidemiologia , Sepse/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , New South Wales/epidemiologia , Parechovirus/classificação , Parechovirus/genética , Infecções por Picornaviridae/patologia , Infecções por Picornaviridae/virologia , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sepse/virologia
5.
PLoS One ; 8(2): e57998, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23469126

RESUMO

BACKGROUND: Vitamin B12 deficiency is prevalent in many countries of origin of refugees. Using a threshold of 5% above which a prevalence of low Vitamin B12 is indicative of a population health problem, we hypothesised that Vitamin B12 deficiency exceeds this threshold among newly-arrived refugees resettling in Australia, and is higher among women due to their increased risk of food insecurity. This paper reports Vitamin B12 levels in a large cohort of newly arrived refugees in five Australian states and territories. METHODS: In a cross-sectional descriptive study, we collected Vitamin B12, folate and haematological indices on all refugees (n = 916; response rate 94% of eligible population) who had been in Australia for less than one year, and attended one of the collaborating health services between July 2010 and July 2011. RESULTS: 16.5% of participants had Vitamin B12 deficiency (<150 pmol/L). One-third of participants from Iran and Bhutan, and one-quarter of participants from Afghanistan had Vitamin B12 deficiency. Contrary to our hypothesis, low Vitamin B12 levels were more prevalent in males than females. A higher prevalence of low Vitamin B12 was also reported in older age groups in some countries. The sensitivity of macrocytosis in detecting Vitamin B12 deficiency was only 4.6%. CONCLUSION: Vitamin B12 deficiency is an important population health issue in newly-arrived refugees from many countries. All newly-arrived refugees should be tested for Vitamin B12 deficiency. Ongoing research should investigate causes, treatment, and ways to mitigate food insecurity, and the contribution of such measures to enhancing the health of the refugee communities.


Assuntos
Refugiados/estatística & dados numéricos , Vitamina B 12/sangue , Adolescente , Adulto , Afeganistão/epidemiologia , Anemia/sangue , Anemia/epidemiologia , Austrália , Butão/epidemiologia , Criança , Pré-Escolar , Contagem de Eritrócitos , Feminino , Humanos , Lactente , Recém-Nascido , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/epidemiologia , Adulto Jovem
6.
Australas J Dermatol ; 51(3): 195-7, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20695859

RESUMO

We report a case of cutaneous leishmaniasis in a 3-year-old West African girl with a 3-month history of multiple disfiguring, infiltrated, ulcerating and variably necrotic granulomatous plaques on the limbs and face that occurred after swimming in a river approximately 6 weeks before arriving in Australia. A diagnosis of cutaneous leishmaniasis, a protozoal zoonosis usually transmitted by the Phlebotomus species of sandfly, was considered. The clinico-pathological features were consistent with Leishmania major infection, known to be the major endemic species causing cutaneous leishmaniasis in the country of origin. Because of the presence of lesions on the face, active treatment was instituted. Continuing resolution of all lesions over 6 weeks was noted to occur with cribiform scarring with the use of oral fluconazole 150 mg daily. Oral fluconazole appears to be emerging as a therapy for uncomplicated cutaneous leishmaniasis, with advantages particularly important in paediatrics.


Assuntos
Fluconazol/uso terapêutico , Leishmaniose Cutânea/tratamento farmacológico , Administração Oral , Cefalexina/uso terapêutico , Pré-Escolar , Cicatriz/tratamento farmacológico , Feminino , Fluconazol/administração & dosagem , Humanos , Leishmania major/efeitos dos fármacos , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/patologia
7.
Aust N Z J Public Health ; 33(5): 466-70, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19811485

RESUMO

OBJECTIVES: To document the health needs of refugee children accessing comprehensive refugee health services in New South Wales (NSW), to match needs with available services and establish gaps in services. METHODS: We collated clinical data on all children aged under 14 years attending the three refugee specific clinics seeing children in NSW in 2005. We compared these data to the number of refugee children settling in NSW in 2005. RESULTS: NSW received 1,557 refugee children (<14 years) in 2005. Around one in five (n=331) was seen in a refugee specific clinic. Most were asymptomatic. Of those tested, 25% had anaemia, 27% were serology positive for schistosomiasis, 16% had evidence of current or recent malaria, 25% were tuberculin skin test positive, 69% were hepatitis B non-immune and 20% had low vitamin D levels. Most children needed catch up immunisation. Other problems included chronic health, developmental and behavioural problems. Screening tests varied across sites. Follow up was problematic for most. CONCLUSIONS: A small proportion of refugee children arriving in NSW have access to comprehensive screening and assessment, in spite of significant health needs. There is variation in screening practices, and follow up is poor. There is a high pick up rate for diseases of personal and public health significance. IMPLICATIONS: There is a strong moral and public health imperative to provide appropriately resourced, culturally competent and comprehensive health care to optimise refugee children's wellbeing.


Assuntos
Atenção à Saúde/organização & administração , Emigrantes e Imigrantes/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Refugiados/estatística & dados numéricos , Adolescente , Criança , Proteção da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento , New South Wales
8.
Med J Aust ; 190(12): 670-3, 2009 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-19527200

RESUMO

OBJECTIVE: To characterise epidemiological, clinical and laboratory features of children in New South Wales with chronic hepatitis B (HBV) or C (HCV) infections. DESIGN AND SETTING: Retrospective record review of epidemiological, clinical, laboratory, liver biopsy and treatment data for children (aged < 18 years) referred to tertiary referral paediatric and refugee clinics in NSW with chronic HBV or HCV during 2000-2007; and comparison with NSW Health notification data for the same period. MAIN OUTCOME MEASURES: Numbers and characteristics of referred children with HBV and HCV, and notifications to NSW Health. RESULTS: During 2000-2007, 79 children with chronic HBV and 29 with HCV infection were referred to specialist clinics, while 930 children with HBV and 777 with HCV infection were reported to NSW Health. Most of the referred children with HBV were born overseas, while most with HCV were born in Australia to mothers with a history of intravenous drug use. Of the 79 HBV-infected children, 56 were e-antigen positive. Most HCV-infected children (23/29) had alanine aminotransferase levels < or = 2 times the upper limit of normal, and more than half of those who had genotype determined had type 2 or 3. Fibrosis was evident in liver biopsies performed for both HBV and HCV. CONCLUSIONS: Although advanced liver disease was uncommon in children referred with HBV or HCV infection, a large number of infected children in NSW were not referred for specialist medical care, indicating that opportunities to intervene early in the natural history of these infections, particularly HCV, are being missed.


Assuntos
Hepacivirus , Vírus da Hepatite B , Hepatite B Crônica/epidemiologia , Hepatite C Crônica/epidemiologia , Adolescente , Biópsia , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Seguimentos , Genótipo , Hepacivirus/genética , Hepacivirus/imunologia , Hepacivirus/isolamento & purificação , Antígenos da Hepatite B/análise , Vírus da Hepatite B/genética , Vírus da Hepatite B/imunologia , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/diagnóstico , Antígenos da Hepatite C/análise , Hepatite C Crônica/diagnóstico , Humanos , Lactente , Fígado/patologia , Fígado/virologia , Masculino , Morbidade/tendências , New South Wales/epidemiologia , Reação em Cadeia da Polimerase , Prognóstico , RNA Viral/análise , Estudos Retrospectivos
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