Mitja O.,University of Barcelona |
Mitja O.,Lihir Medical Center International |
Lukehart S.A.,University of Washington |
Pokowas G.,Lihir Medical Center International |
And 9 more authors.
The Lancet Global Health | Year: 2014
Background: Skin infections with ulceration are a major health problem in countries of the south Pacific region. Yaws, caused by Treponema pallidum subspecies pertenue and diagnosed by the presence of skin ulcers and a reactive syphilis serology, is one major cause, but this infection can be confused clinically with ulcers due to other causative agents. We investigated T pallidum pertenue and another bacterium known to cause skin infections in the Pacific islands. Haemophilus ducreyi-as causes of skin ulceration in a yaws-endemic region. Additionally, we identified specific signs and symptoms associated with these causative agents of cutaneous ulcers and compared these findings with laboratory-based diagnoses. Methods: We did a prospective cohort study of five yaws-endemic villages (total population 3117 people) during a yaws elimination campaign in Papua New Guinea in April, 2013. We enrolled all consenting patients with chronic moist or exudative skin ulcers. We undertook a detailed dermatological assessment, syphilis serology, and PCR on lesional swabs to detect the presence of T pallidum pertenue and H ducreyi. Patients with PCR-confirmed bacterial infections were included in a comparative analysis of demographics and clinical features. Findings: Full outcome data were available for 90 people with skin ulcers. Of these patients, 17 (19%) had negative results in all molecular tests and were therefore excluded from the comparative analyses. A bacterial cause was identified in 73 (81%) participants-either H ducreyi (n=42), T pallidum pertenue (yaws; n=19), or coinfection with both organisms (dual infection; n=12). The demographic characteristics of the patients infected with yaws and with H ducreyi were similar. Skin lesions in patients with yaws and in those with dual infection were larger than those in patients infected with H ducreyi (p=0·071). The lesions in patients with yaws and dual infection were more circular in shape (79% and 67%) than in those infected with H ducreyi (21%; p<0·0001); more likely to have central granulating tissue (90% and 67% vs 14%; p<0·0001); and more likely to have indurated edges (74% and 83% vs 31%; p=0·0003). The prevalence of reactive combined serology (positive T pallidum haemagglutination test and rapid plasmin reagin titre of ≥1:8) was higher in cases of yaws (63%) and dual infections (92%) than in H ducreyi infections (29%; p<0·0001). Interpretation: In this yaws-endemic community, H ducreyi is an important and previously unrecognised cause of chronic skin ulceration. Reactive syphilis serology caused by latent yaws can occur in ulcers with the presence of H ducreyi alone. The introduction of PCR for ulcer surveillance could improve the accuracy of diagnosis in countries with yaws eradication campaigns. © 2014 Mitjà et al.
O'Brien B.H.,Royal Brisbane and Womens Hospital |
McClymont K.,Sullivan Nicolaides Pathology |
Brown I.,Royal Brisbane and Womens Hospital
American Journal of Surgical Pathology | Year: 2011
Collagenous ileitis (CI), characterized by subepithelial collagen deposition in the terminal ileum, is an uncommon condition. The few cases reported to date have been associated with collagenous colitis (CC) or lymphocytic colitis. Thirteen cases of CI retrieved over a 9-year period were retrospectively studied. There were 7 female and 6 male patients, with an age range of 39 to 72 years (mean, 64 y). Two groups were identified: (1) CI associated with collagenous or lymphocytic disease elsewhere in the gastrointestinal tract and (2) CI as an isolated process. Diarrhea was the presenting symptom in 11 cases. Most patients had no regular medication use. Subepithelial collagen thickness ranged from 15 to 100 μm (mean, 32 μm) and involved 5% to 80% of the subepithelial region of the submitted biopsies. Six cases had >25 intraepithelial lymphocytes (IELs)/100 epithelial cells, and villous blunting was observed in 11 cases. Chronic inflammation of the lamina propria was present in 9 cases, and focal neutrophil infiltration was identified in 3 cases. In biopsies taken from other sites, 7 of 13 colonic biopsies showed CC, 4 of 9 gastric biopsies showed collagenous gastritis, and 2 of 10 duodenal biopsies were abnormal with collagenous sprue (n=1) and partial villous atrophy and increased IELs (n=1) (both celiac disease related). Resolution of the subepithelial collagen deposition was found in the 1 case in which follow-up of terminal ileal biopsies were taken. There was partial or complete resolution of symptoms in 6 of 9 patients for whom follow-up information was available. Copyright © 2011 by Lippincott Williams & Wilkins.
Shield P.W.,Queensland University of Technology |
Crous H.,Sullivan Nicolaides Pathology
Diagnostic Cytopathology | Year: 2014
This study reviewed the clinical presentation, cytologic findings, and the immunophenotype of 69 Merkel cell carcinoma (MCC) cases sampled by fine-needle aspiration (FNA). Demographic and clinical data, the cytology findings, and results of ancillary testing were reviewed. Median patient age was 78 years (372104) with a 1:1.8 female to male ratio. The most common FNA sites sampled included lymph nodes in the neck, the axillary region, the inguinal region and the parotid gland. Most patients had a history of MCC (68%) and/or non-MCC malignancy (70%). The common cytologic pattern was a cellular smear with malignant cells arranged in a dispersed pattern with variable numbers of disorganized groups of cells. Cytoplasm was scant or absent and nuclei showed mild to moderate anisokaryosis, stippled chromatin, inconspicuous nucleoli, and nuclear molding. Numerous apoptotic bodies were often present. Cell block samples (28 cases) were usually positive for cytokeratins in a perinuclear dot pattern, including 88% of cases with CK20 positivity. CD56 was the most sensitive (95%) neuroendocrine marker on cell blocks and was also positive with flow cytometry in nine cases tested. MCC is most commonly seen in FNA specimens from the head and neck of elderly patients, often with a history of previous skin lesions. Occasional cases present in younger patients and some may be mistaken for other round blue cell tumors, such as lymphoma. CD 56 may be a useful marker in cell block preparations and in flow cytometric analysis of MCC. © 2014 Wiley Periodicals, Inc.
Shield P.W.,Sullivan Nicolaides Pathology |
Shield P.W.,Queensland University of Technology |
Papadimos D.J.,Sullivan Nicolaides Pathology |
Walsh M.D.,Sullivan Nicolaides Pathology
Cancer Cytopathology | Year: 2014
BACKGROUND: The usefulness of GATA3 (GATA-binding protein 3 to DNA sequence [A/T]GATA[A/G]) as a marker for metastatic breast carcinoma in serous effusion specimens was investigated. METHODS: Cell block sections from 74 serous effusion specimens (32 ascitic, 2 pericardial, and 40 pleural fluids) were stained with an anti-GATA3 murine monoclonal antibody. The specimens included 62 confirmed metastatic carcinomas from the breast (30 specimens), female genital tract (13 specimens), gastrointestinal tract (7 specimens), lung adenocarcinoma (9 specimens), pancreas (1 specimen), kidney (1 specimen), and bladder (1 specimen). The breast carcinoma cases included 15 ductal carcinomas and 8 lobular carcinomas; the histology subtype was not available for 7 specimens. Twelve cases containing florid reactive mesothelial cells were also stained. The breast carcinoma cases were also stained for mammaglobin and gross cystic disease fluid protein of 15 kilodaltons (GCDFP-15) to compare their sensitivity with GATA3. RESULTS: Positive nuclear staining for GATA3 was found to be present in 90% of metastatic breast carcinoma specimens (27 of 30 specimens). All nonbreast metastatic carcinomas tested were negative with the exception of the single case of metastatic urothelial carcinoma. No staining was observed in any of the benign reactive cases or in benign mesothelial cells present in the malignant cell block preparations. Two cases demonstrated weak positivity of benign lymphoid cells. Staining results were unambiguous because all positive cases demonstrated intense nuclear staining in>50% of tumor cells. Mammaglobin (57% staining; 17 of 30 cases) and GCDFP-15 (33% staining; 10 of 30 cases) were found to be less sensitive markers of breast carcinoma. If used in a panel, mammaglobin and GCFP-15 staining would have identified only 1 additional case compared with those stained with GATA3. CONCLUSIONS: GATA3 may be a useful addition to immunostaining panels for serous effusion specimens when metastatic breast carcinoma is a consideration. © 2014 American Cancer Society.
Dimeski G.,Princess Alexandra Hospital |
Badrick T.,Sullivan Nicolaides Pathology |
John A.S.,ARC Consulting
Clinica Chimica Acta | Year: 2010
Ion Selective Electrodes (ISEs) are used to measure some of the most critical analytes on clinical laboratory and point-of-care analysers. These analytes which include Na+, K+, Cl-, Ca2+, Mg2+ and Li+ are used for rapid patient care decisions. Although the electrodes are very selective, they are not free of interferences. It is important for laboratories to have an understanding of the type and extent of interferences in order to avoid incorrect clinical decisions and treatment. © 2009 Elsevier B.V. All rights reserved.
Stewart C.J.R.,King Edward Memorial Hospital |
Leung Y.C.,University of Western Australia |
Whitehouse A.,Sullivan Nicolaides Pathology
Histopathology | Year: 2012
Aims: To determine the frequency and distribution of Fallopian tube involvement in patients with ovarian metastases of non-gynaecological origin. Methods and results: All Fallopian tube tissue was processed for histological examination in a consecutive series of 31 patients with ovarian metastases of non-gynaecological origin. The most common primary sites were appendix (n=10) colon (n=7), stomach (n=6) and breast (n=4). Twenty cases (65%) showed at least one type of tubal spread. Mural involvement was most common (14 cases) but serosal, intra-vascular, intra-epithelial and intra-lumenal spread were also identified in 12, 9, 8 and 11 cases respectively. Intra-epithelial involvement was restricted to the fimbrial epithelium and mimicked tubal carcinoma in situ (CIS) architecturally. Pagetoid invasion was noted in two of the cases. Conclusions: The Fallopian tubes are commonly involved in patients who have neoplasms metastatic to the ovaries. Metastases may show a CIS-like pattern of intra-epithelial spread and therefore small serous CIS-type lesions may not represent proof of tubal tumour origin in patients who have high-stage pelvic serous carcinomas. The frequency of intra-lumenal tumour cells supports transtubal spread as a likely mechanism for mucosal involvement by metastatic tumours involving the lower genital tract. © 2012 Blackwell Publishing Ltd.
Williams C.,Sullivan Nicolaides Pathology
Australian Journal of Medical Science | Year: 2011
The use of the automated parameter red cell distribution width SD (RDW-SD) to assist in the discrimination of both alpha and beta thalassaemia trait from iron deficiency was evaluated in a large community laboratory in Brisbane, Australia. Differentiation between these common causes of red cell microcytosis is important clinically, as failure to identify a thalassaemia trait may lead to an unpredicted thalassaemia major which can affect the quality of life or, in the case of alpha thalassaemia, lead to death in utero. A total of 313 samples were divided into three groups - alpha thalassaemia (103), beta thalassaemia (102) and iron deficiency (108). The red cell parameters red cell count (RBC), mean corpuscular haemoglobin (MCH), red cell distribution width CV (RDW-CV) and RDW-SD, as well the discriminative formulas Mentzer Index, England and Fraser, Srivastava Index, Ricerca Index, Green and King Index and RDW Index, were evaluated. Receiver operating characteristic curves, sensitivity, specificity, area under the curve, Youden index and positive and negative predictive values were calculated. While all parameters and formulas managed to discriminate a varying proportion of cases of both alpha and beta thalassaemia trait from iron deficiency, the RDW-SD showed most promise as a simple, automated parameter that could be used as a sensitive and specific predictor of both alpha and beta thalassaemia trait because of the high sensitivity (97% alpha thalassaemia and 96% beta thalassaemia) and specificity (95% for both alpha and beta thalassaemia). Further evaluation of the parameter was also performed, incorporating reproducibility, stability studies and correlation to other analyser platforms, proving the basic laboratory performance of the RDW-SD.
Henry R.,Sullivan Nicolaides Pathology |
Glegg D.,Sullivan Nicolaides Pathology
Clinical Chemistry and Laboratory Medicine | Year: 2016
A 62-year-old diabetic man with prostate cancer first presented to our clinical laboratory in 2003 with a normal serum protein electrophoresis and immunofixation. In March 2009 he was diagnosed with an IgG κ myeloma. He underwent treatment and went into remission with the original paraprotein band being undetectable. Over the following 5 years, he developed oligoclonal bands and then eventually relapsed. Serum protein electrophoresis and immunofixation were inconclusive, however, isoelectrofocusing identified the oligoclonal pattern then the return of the original band, indicating relapse. This case illustrates the usefulness of an isoelectric focusing method to correctly determine clonality of small abnormal protein bands. It also highlights the need for appropriate commenting on reported results so that they are not confusing for clinicians. © 2016 by De Gruyter 2016.
Harrison M.,Sullivan Nicolaides Pathology
Australian Prescriber | Year: 2015
C-reactive protein is a better indicator of inflammation than the erythrocyte sedimentation rate. It is more sensitive and responds more quickly to changes in the clinical situation. False negative and false positive results are more common when measuring the erythrocyte sedimentation rate. Renal disease, female sex and older age increase the erythrocyte sedimentation rate. The erythrocyte sedimentation rate has value in detecting low-grade bone infection, and in monitoring some patients with systemic lupus erythematosus. © 2015, Australian Government Publishing Service. All rights reserved.
Bygott J.M.,Sullivan Nicolaides Pathology |
Robson J.M.,Sullivan Nicolaides Pathology
Sexually Transmitted Infections | Year: 2013
Objectives Infection with Trichomonas vaginalis has declined dramatically in urban Australia but remains endemic in some predominantly indigenous rural regions. The objective was to determine T vaginalis positivity rates in clinical specimens by PCR detection, from a large community-based private pathology laboratory servicing rural and urban Australian populations. Methods Retrospective analysis of data from 44 464 specimens referred for T vaginalis PCR testing over 8 years from 2004 to 2011. Results 44 464 consecutive specimens (37 137 female, 7242 male, 85 sex-unspecified) were analysed: T vaginalis was detected in 633 specimens. The overall community T vaginalis positivity rate was 1.4% (95% CI 1.3% to 1.5%). Overall rates were 2.1-fold higher in women than in men (1.5% vs 0.7%). Positivity rates were highest in the 10-14 year age group (p0.0001). Referrals from urban areas of South-East Queensland accounted for 52% of specimens (23 121): the T vaginalis positivity rate in this urban cohort was 0.7% (95% CI 0.6% to 0.8%). Referrals identified to be from indigenous patients accounted for 48% of positive cases (304/633), and came from predominantly rural and regional areas of northern Queensland. Where follow-up testing was available 21% of patients (14/66) remained T vaginalis PCR positive when tested again within 3 months and 25% (26/101) within 6 months of the initial diagnosis. Conclusions This study confirms that T vaginalis is rare in the urban non-indigenous Australian setting. Guidelines need to be developed to allow targeted testing. Follow-up testing 3 months after treatment should be considered.