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1.  Population dynamics of methicillin-susceptible and -resistant Staphylococcus aureus in remote communities 
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was first reported in remote regions of Western Australia (WA) in 1992 and is now the predominant MRSA isolated in the State. To gain insights into the emergence of CA-MRSA, 2146 people living in 11 remote WA communities were screened for colonization with S. aureus.
Antibiogram analysis, contour-clamped homogeneous electric field electrophoresis, multilocus sequence typing, Panton–Valentine leucocidin determinant detection and accessory genetic regulator typing were performed to characterize the isolates. MRSA was further characterized by staphylococcal cassette chromosome mec typing.
The S. aureus population consisted of 13 clonal complexes and two Singleton lineages together with 56 sporadic isolates. Five lineages contained MRSA; however, these were not the predominant methicillin-susceptible S. aureus (MSSA) lineages. There was greater diversity amongst the MSSA while the MRSA appeared to have emerged clonally following acquisition of the staphylococcal cassette chromosome mec. Three MRSA lineages were considered to have been endemic in the communities and have subsequently become predominant lineages of CA-MRSA in the wider WA community. People colonized with MSSA tended to harbour clones of a different genetic lineage at each anatomical site while people colonized with MRSA tended to harbour clones of the same lineage at each site. Overall, the isolates were resistant to few antimicrobials.
Although the evidence suggests that in WA CA-MRSA strains arose in remote communities and have now disseminated into the wider community, there is no evidence that they arose from the predominant MSSA clones in these communities.
PMCID: PMC2740637  PMID: 19713400
S. aureus; community methicillin-resistant Staphylococcus aureus; population structure; colonization
2.  Hospitalisation for gastroenteritis in Western Australia 
Archives of Disease in Childhood  2004;89(8):768-772.
Aims: To document gastroenteritis hospitalisations of the 1995–96 cohort of infants born in Western Australia to mid-2002, and to assess factors associated with their hospitalisations and readmissions.
Methods: Retrospective analysis of the State's hospitalisation data, Midwives' Notification of Births data, the Australian Bureau of Statistics mortality data and clinical and demographic information.
Results: Aboriginal infants were hospitalised for gastroenteritis eight times more frequently than their non-Aboriginal peers, and were readmitted more frequently and sooner for diarrhoeal illnesses than the other group. They also stayed in hospital for twice as long and many Aboriginal patients were hospitalised on numerous occasions. Hospitalisation rates were higher in remote areas and were significantly associated with co-morbidities such as undernutrition, anaemia, co-existing infections, and intestinal carbohydrate intolerance.
Conclusions: Gastroenteritis is very prevalent in Australian Aboriginal infants and children and is a major cause of their hospitalisation in Western Australia. It is often associated with undernutrition, anaemia, intestinal parasitic infestations, other infections, intestinal carbohydrate intolerance, and, in some instances, with low birth weight. This is often due to unhygienic living conditions and behaviours and presents major challenges to public health, health promotion, and clinical personnel, particularly paediatric services. Childhood diarrhoeal diseases occur commonly in other indigenous groups but have not received the attention that they deserve.
PMCID: PMC1720021  PMID: 15269080
3.  Community Strain of Methicillin-Resistant Staphylococcus aureus Involved in a Hospital Outbreak 
Journal of Clinical Microbiology  1999;37(9):2858-2862.
Western Australia (WA) has been able to prevent methicillin-resistant Staphylococcus aureus (MRSA) strains from outside of the state from becoming established in its hospitals. Recently, a single-strain outbreak of MRSA occurred in a WA metropolitan teaching hospital following admission of an infected patient from a remote community. The strain responsible for the outbreak was unrelated to any imported strains and spread rapidly in the hospital. Screening of two remote communities in the region from which the index case came revealed that 42% of the people in one community and 24% in the other carried MRSA. Isolates were typed by resistance pattern, plasmid analysis, contour-clamped homogeneous electric field electrophoresis, bacteriophage pattern, and coagulase gene restriction fragment length polymorphism. It was found that of the people carrying MRSA, 39% in the former community and 17% in the latter community were carrying an MRSA strain which was indistinguishable from the strain that caused the hospital outbreak.
PMCID: PMC85396  PMID: 10449465
4.  Virulence factors of enteric Escherichia coli in young Aboriginal children in north-west Australia. 
Epidemiology and Infection  1992;109(2):283-289.
Enterotoxigenic Escherichia coli (ETEC) were the most frequently identified enteric pathogens associated with diarrhoea in 0-5 year old Aboriginal children in tropical north-west Australia with an incidence similar to those from other tropical regions. Heat-stable toxin-producing (ST+) strains were associated with diarrhoea throughout the year but heat-labile toxin-producing (LT+) strains were more important in the monsoonal summer season. ST+ strains were commonest in children with diarrhoea between 6 and 18 months of age while LT+ strains were associated with diarrhoea in children aged 18-24 months. Vero-toxigenic E. coli (VTEC) which produced VT1, but not VT2, and enteroadherent (EAF+) E. coli were significant causes of diarrhoea, mainly in children below 18 months but without a seasonal pattern.
PMCID: PMC2271915  PMID: 1397116
5.  Epidemiology and microbiology of diarrhoea in young Aboriginal children in the Kimberley region of Western Australia. 
Epidemiology and Infection  1992;108(1):67-76.
Infectious diarrhoea is common in young Australian Aborigines and is one of the main causes for their unsatisfactory health standards with consequent widespread failure to thrive and undernutrition. Most published reports relate to patients in hospital or to hospital admission statistics and give little indication of the extent or severity of diarrhoeal disease in children in Aboriginal communities. The present investigation involved more than 100 Aboriginal children up to 5 years of age living in remote communities in the tropical north of Western Australia who were studied prospectively over a 12-month period.
PMCID: PMC2272186  PMID: 1547842
6.  Pyloric stenosis in Western Australia, 1971-84. 
Archives of Disease in Childhood  1987;62(5):512-513.
Analyses of hospital records and census data for 1971-84 showed no significant increase in incidence of infantile hypertrophic pyloric stenosis in Western Australia. No link was found between breast feeding and incidence of disease. Low birth weight, short gestation pregnancies, and paternal family history of the disease were significant features.
PMCID: PMC1778384  PMID: 3606189
7.  Invasiveness of Aeromonas spp. in relation to biotype, virulence factors, and clinical features. 
Of 69 fecal isolates of Aeromonas spp., 18 had the ability to invade HEp-2 cells. Invasiveness correlated with biotype; of the 18 invasive strains, 16 were A. sobria and 2 were A. hydrophila. No invasive strains were found among the A. caviae. Of the 18 invasive strains, 13 were enterotoxigenic. Of the enterotoxigenic and invasive strains, 12 were A. sobria, but enterotoxicity was also more common among noninvasive strains of A. sobria. Fucose-resistant hemagglutination was also more common in A. sobria, but invasive strains were equally divided between fucose-resistant hemagglutination and other patterns. Detailed clinical information was available for 27 of the 69 strains. All 15 strains of A. sobria or A. hydrophila associated with diarrhea were enterotoxigenic; 6 of the 10 strains of A. sobria were also invasive. Blood was present in the stool samples of five of the six patients with invasive A. sobria and in none of the patients with noninvasive strains. Although limited, these observations suggest that dysenteric symptoms may be produced by invasive Aeromonas spp.
PMCID: PMC268319  PMID: 4019741
9.  Isolation of Aeromonas hydrophila from a metropolitan water supply: seasonal correlation with clinical isolates. 
The occurrence of Aeromonas spp. in the metropolitan water supply of Perth, Western Australia, Australia, was monitored at several sampling points during a period of 1 year. Water within the distribution system conformed to international standards for drinking water but contained Aeromonas spp. in numbers comparable to those in raw surface water, although this water was free of Escherichia coli. Coliforms and E. coli were found in raw surface waters, and Aeromonas spp. were found in raw water from surface and underground sources. Chemical treatment, followed by chlorination at service reservoirs, resulted in water free of E. coli and a decrease in the number of Aeromonas spp. Aeromonas spp. were found in the greatest numbers in summer. Multiple regression analysis showed that growth of Aeromonas spp. in chlorinated water was related to water temperature, residual chlorine, and interaction between these variables. The incidence of Aeromonas-associated gastroenteritis, determined from isolates referred to us for enterotoxin testing, paralleled the pattern of isolation of Aeromonas spp. in water within the distribution systems. We suggest that the presence of Aeromonas spp. in drinking water needs public health appraisal and that further work should be undertaken to permit reevaluation of standards for the quality of drinking water.
PMCID: PMC241518  PMID: 6385848
10.  Isolation of Aeromonas spp. from an unchlorinated domestic water supply. 
The recovery of Aeromonas spp. from the unchlorinated water supply for a Western Australian city of 21,000 people was monitored at several sampling points during a period of 1 year. Membrane filtration techniques were used to count colonies of Aeromonas spp., coliforms, and Escherichia coli in water sampled before entry to service reservoirs, during storage in service reservoirs, and in distribution systems. Aeromonas spp. were identified by subculture on blood agar with ampicillin, oxidase tests, and the use of Kaper medium and then were tested for production of enterotoxins and hemolysins. During the same period, two-thirds of all fecal specimens sent for microbiological examination were cultured on ampicillin-blood agar for Aeromonas spp. Recovery of Aeromonas spp. from water supplies at distribution points correlated with fecal isolations and continued during autumn and winter. Coliforms and E. coli were found most commonly in late summer to autumn. This pattern differs from the summer peak of Aeromonas isolations both from water and from patients with Aeromonas spp.-associated gastroenteritis in Perth, Western Australia, a city with a chlorinated domestic water supply. Of the Aeromonas strains from water, 61% were enterotoxigenic, and 64% produced hemolysins.
PMCID: PMC241519  PMID: 6486783
11.  Biotyping and virulence factors in clinical and environmental isolates of Aeromonas species. 
Biochemical characteristics and virulence factors were compared in 147 Aeromonas spp. isolated from patients with diarrhea and in 94 strains isolated from metropolitan water supplies in the same area during the same period. Fermentation of arabinose occurred with 58.5% of the environmental strains and 15% of the clinical isolates; 39.4% of the strains from water and 6.8% of the fecal isolates fermented salicin. The frequency of esculin hydrolysis was the same in both groups. Ninety-one percent of clinical isolates and 70.2% of environmental strains were enterotoxigenic and, except for four clinical isolates, all of these strains also produced hemolysins. Hemagglutination that was inhibited by fucose and mannose but not by galactose was found in 67% of the water isolates and 10.2% of the clinical strains. Although the distribution of several characteristics differs in clinical and environmental strains, many of the strains found in water have properties identical with those of the clinical isolates. We suggest that such strains may be potential enteric pathogens.
PMCID: PMC240085  PMID: 6742829
12.  Hemagglutination patterns of Aeromonas spp. in relation to biotype and source. 
Aeromonas spp. show patterns of hemagglutination with human group O cells in the presence of fucose, galactose, and mannose. These patterns are related to biotype as well as to the source of isolates. There was good correlation between hemagglutination pattern and the presence of diarrhea among strains isolated in Western Australia, which was the only source with adequate data for classification of children with an without diarrhea. Most of the environmental and other nonfecal isolates produced patterns different from those in strains associated with diarrhea. These results suggest that hemagglutinins should be considered with enterotoxins as virulence factors in Aeromonas spp.
PMCID: PMC270974  PMID: 6690466
13.  Correlation of enterotoxicity with biotype in Aeromonas spp. 
Journal of Clinical Microbiology  1983;18(5):1196-1200.
Enterotoxin production correlated with biotype in a study of 686 strains of Aeromonas spp. from Indonesia, Thailand, the United States, and Western Australia. Most strains were isolated from feces but nonfecal human isolates and environmental strains were also included. More than 80% of Voges-Proskauer (VP)-positive strains, classified as A. hydrophila, were enterotoxigenic in the suckling mouse assay as were 90% of VP-positive, arabinose-negative strains. An association between positive VP, arabinose fermentation, and failure to produce enterotoxins was found only with environmental strains. VP-negative strains which did not oxidize gluconate or produce gas from glucose were classified as A. punctata subsp. caviae. Only 2 of the 286 strains produced enterotoxins, and both were from Indonesian fecal samples. There were few remaining VP-negative strains, classified as A. punctata subsp. punctata and, of these, about half were enterotoxigenic. Regardless of source and species, 97% of Aeromonas spp. were correctly classified in relation to enterotoxin production with a hemolysin assay. A combination of biochemical testing and hemolysin assay should be suitable for diagnostic laboratories to identify enterotoxigenic Aeromonas spp. which, in children, are associated with diarrhea, unlike non-enterotoxigenic strains.
PMCID: PMC272866  PMID: 6643669
14.  Studies on enterotoxigenic Escherichia coli isolated from persons without diarrhoea in Western Australia. 
The Journal of Hygiene  1983;90(1):99-106.
The epidemiology of enterotoxigenic Escherichia coli (ETEC) was studied in children without diarrhoea in two remote Aboriginal communities in tropical north-western Australia. Serial surveys of the same individuals during different seasons showed that isolations were much more frequent in the wet monsoonal summer than in the dry winter. All E. coli were isolated from symptomless children aged 5 years or less; in addition, clearance of ETEC carriage without treatment was observed in all individuals within 3 months of isolation. Of the 58 ETEC strains isolated, 40 had either an H32 or an O126 antigen. Five O antigens which have never been associated with ETEC (O2, O41, O71, O77 and O157) were found. A recently proposed system to detect ETEC, using groups of polyvalent antisera, would have detected only 3 out of these 58 ETEC strains.
PMCID: PMC2134196  PMID: 6337212
15.  Biochemical characteristics of enterotoxigenic Aeromonas spp. 
Biotypes of Aeromonas spp. correlated well with enterotoxin production in a study of 174 strains. Using biochemical characteristics determined by conventional methods and multitest systems, we correctly classified 93% of the strains with regard to enterotoxin production. Most of the enterotoxigenic strains were Voges-Proskauer (VP) positive and did not hydrolyze arabinose, but VP-positive strains which hydrolyzed arabinose were mainly non-enterotoxigenic. Aeromonas punctata subsp. caviae, which is VP negative and does not oxidize gluconate or produce gas from glucose, was non-enterotoxigenic. Although the number of other VP-negative strains was small, most were enterotoxigenic. Discrimination was improved so that 97% of the strains were correctly classified if the hemolysin assay was used either for all strains or for only the VP-positive, arabinose-positive and VP-negative, non-A. punctata subsp. caviae strains. Because the proposed classification system does not require facilities for carrying out in vivo assays such as suckling mouse or ileal loop methods, the identification of enterotoxigenic Aeromonas strains should be possible in diagnostic laboratories and will facilitate epidemiological studies of the role of these organisms in acute diarrhea.
PMCID: PMC272021  PMID: 6764776
16.  Effects of salicylate on intestinal absorption: in vitro and in vivo studies with enterotoxigenic micro-organisms. 
Gut  1980;21(8):683-688.
This study was done to determine whether salicylate could affect alterations in intestinal absorption induced by preparations of enterotoxigenic micro-organisms. It was found in rats that salicylate increased intestinal monosaccharide uptake in vitro and reversed the inhibitory effects induced by cell-free preparations of Staphylococcus sp., Candida sp. and Klebsiella sp. In vivo, salicylates increased net water absorption in rat jejunum exposed to cell-free preparations of various micro-organisms. Increase in net fluid flux occurred after subcutaneous injection only with bacteria which stimulate adenylate cyclase activity. These observations suggest that the absorptive and anti-secretory effects of aspirin are cyclic nucleotide dependent. The potential clinical role of salicylates as anti-secretory agents in diarrhoeal diseases, particularly in children, requires further investigation.
PMCID: PMC1419111  PMID: 7429332
17.  Defective Candida killing in childhood malnutrition. 
Archives of Disease in Childhood  1979;54(6):445-447.
This study shows that malnourished children have impaired candidacidal activity of leucocytes, a finding which runs parallel to the higher rates of isolation of Candida sp. from throat secretions. In well nournished subjects the mean candidacidal ability was 44.5% in the moderately undernourished group it was 17.6%, and in the severely malnourished group it was 13.7%. This impaired candidacidal capacity may be important in the establishment of large numbers of Candida sp. which are commonly found in the upper intestine and in the pathogenesis of diarrhoea in children with malnutrition.
PMCID: PMC1545458  PMID: 475427
18.  Diet and serum cholesterol. An Australian family study. 
Archives of Disease in Childhood  1977;52(10):790-793.
Dietary intake patterns were studied in families in Busselton, Western Australia, known to have mothers and children with high, median, or low serum cholesterol values. There were no significant differences in the percentage contributions to total daily calories by protein, fat, or carbohydrate in mothers, children, or their families from these three groups. The results support the view that diet, per se, does not account for differences in observed serum cholesterol levels within a culturally homogeneous community.
PMCID: PMC1544787  PMID: 931426
19.  The stomach in malnutrition. 
Archives of Disease in Childhood  1977;52(4):325-327.
Basal gastric acid output was reduced in 9 out of 14 infants and young children with malnutrition compared with 21 age-matched controls. In all the patients the response of the gastric mucosa to stimulation by pentagastrin was impaired, and gastritis of variable severity was present in 8 out of the 9 patients in who biopsies were performed. Impaired gastric acid secretion probably contributes towards bacterial overgrowth and diarrhoeal diseases in malnourished children.
PMCID: PMC1544650  PMID: 871218
20.  ROSE system for treatment of cholera dehydration. 
British Medical Journal  1977;1(6064):839-840.
PMCID: PMC1606181  PMID: 851755
21.  Use of a simple duodenal capsule to study upper intestinal microflora. 
The upper intestinal microflora was studied in 10 malnourished Indonesian children using the paediatric Enterotest Capsules. Trophozoites of Giardia lamblia were found in 2 specimens, profuse fungal mycelia in 3, and ascaris worms and eggs in 1. In 9 patients an abnormally profuse small intestinal bacterial flora was found. Provided precautions are taken to exclude artefactual contamination of the line on its withdrawal, this is a safe and simple method for studying the upper gut flora which could be applied to field conditions since it does not require radiological facilities.
PMCID: PMC1546208  PMID: 836057
22.  Deoxycholate depresses small-intestinal enzyme activity. 
Gut  1975;16(1):53-56.
Feeding sodium deoxycholate orally to rats for four days caused depression of the activity of the small intestinal enzymes lactase, sucrase, maltase, alkaline phosphatase, and N-acetyl-beta-glucosaminidase. The first four are brush border enzymes, the last a lysosomal enzyme. Alkaline phosphatase activity recovered very rapidly and rebounded to above the normal level within 24 hours. The activity of the three disaccharidases returned to normal within seven days while no recovery was observed within 96 hours of the activity of the lysosomal enzyme, N-acetyl-beta-glucosaminidase, after removing the bile salt from the diet.
PMCID: PMC1410943  PMID: 1140627
23.  Sugar-induced diarrhoea in children. 
Archives of Disease in Childhood  1973;48(5):331-336.
PMCID: PMC1648389  PMID: 4581770
24.  Employment Medical Advisory Service. 
PMCID: PMC1009484  PMID: 4685305

Results 1-25 (30)