Sticky tape as a diagnostic device

On Friday at the hospital I was asked to see a patient who had a referral to the practice for a sticky tape test. The specimen collection team weren’t familiar with the test.

Rather than go into details on the interaction I had on Friday I thought I’d let you know about how a humble piece of sticky (or scotch) tape can help make a diagnosis.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enterobius vermicularis is better known as a pinworm. It causes Enterobiasis or pinworm infestation.

Pinworm usually affects children but can cause illness in adults especially institutionalised adults.

The disease manifests as itchiness around the anus and causes sleeplessness and restlessness.

The worm is transmitted via the faecal-oral route. Pinworm eggs get deposited on the skin around the anus and these get transferred to others, especially those who like to rim but more commonly as a result of poor toilet hygiene. It’s easy to understand why this is a disease common in childhood and why families become infested easily.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Worms emerge at the anal verge a few hours after falling asleep. To make a diagnosis it’s best to get the worms and eggs as soon as the patient wakes up before any bathing or bowel movement. On waking, a short strip of sticky tape is applied to the skin close to the patient’s anus and applied to a glass slide. The slide can be sent into a pathology laboratory where it will be stained and examined using a light microscope.

Pinworm infestation gets treated with over-the-counter worming medications.

 

 

Raw milk and why I’m not sure it’s worth the risk

A couple of weeks ago I wrote a piece on Yummy Lummy about a meal Bron and I shared at Jamie’s Italian Canberra. In the middle of the post I ranted a little about the use of raw milk in some cheese, viz., bocconcini. As a clinical microbiologist with an interest in food, food safety and public health I’ve always appreciated the balance between taste and desires of food advocates and the need for safety. In that regard, Australia excels when it comes to using risk management principles to minimise harm to Australians. On balance and with some exceptions, raw milk is not permitted for commercial use in Australia. You can find the regulations at FSANZ.

A couple of days ago ProMED-mail posted a piece on unpasteurised milk in the USA. The ProMED-mail piece provides food for thought and some great references to excellent articles. To be fair, these articles relate to the USA and as I’ve stated, in Australia our regulatory process is very good.

For my money, I’d prefer pasteurised milk to be used at the small cost of some loss of flavour. For the raw milk devotees, I’m sorry but while your enthusiasm is great, in the greater public good, I think Australia should continue to tightly regulate diary products.

Dangers of Raw Milk: Minnesota Study Documents 1 in 6 Become Ill
Nonpasteurized Dairy Products, Disease Outbreaks, and State Laws—United States, 1993–2006
Raw or heated cow milk consumption: Review of risks and benefits

What do you think when you see CBR?

When anyone says CBR or whenever I read CBR two things come to mind.

Chemical Biological Radiological and the code for Canberra airport.

I’ve been involved in Chemical Biological Radiological related work since about 2000. It’s one the main things I work on in my current role. I’ve had an interest in biological warfare and terrorism, that is, countermeasures and response planning even before 2000. As a young microbiologist before studying medicine I was fascinated by the use of microorganisms as weapons.

So when I read or hear CBR my mind turns to

Clinically I think of

Now that I’ve lived in Canberra since 2007, I’ve come to know the Canberra airport very well and its code is CBR.

So what do you think I think of when I see this

2013-12-06 08.34.59 AEDT It's even being used as wallpaper on ACT Government PC monitors.

2013-12-06 08.34.59 AEDT It’s even being used as wallpaper on ACT Government PC monitors.

I don’t think Confident Bold Ready. When I see the bright yellow background and the stylised letters it sends my mind back to the 1970s and 1980s to this

So rather than make me think of Canberra as confident bold ready, the logo makes me look to the past. Apparently the ACT Government has budgeted $2.6 million for this work. I’m expecting Molly Meldrum to materialise and start spruiking Canberra.

For me, CBR is always going to mean Chemical Biological Radiological or Canberra airport.

Words that peeve me

I’ve just posted this page at another site. I’ll add to it from time to time.

https://drgarylum.squarespace.com/words-that-peeve-me/

Where does #manflu fit in this? The difference between a head cold and influenza

One of my pet peeves is when the media contracts a scientific or established official name into something very shorthand. In my mind it’s disrespectful to the people who investigated the microorganism and the disease. To be fair, it’s not something I’m going to sacrifice myself over, after all it’s just a peeve and nothing more. What is more annoying is when we see this creep into official writing, but again, it’s more peeve and annoyance and I have no real influence on anyone but myself.

So in this post I’ll accept manflu as a word but rather than use the common shorthand of flu I will always prefer influenza.

The Internet (Oh how I love the Internet) is replete with descriptions and short videos on manflu, all you need to do is go to YouTube and search manflu for some very funny video clips.

My concern today is the difference between the common cold and influenza. You hear it so often in the workplace. Someone takes a call from an ill colleague who has called in to say they have the influenza. The vast majority of people who call in sick have a common cold. When you’re infected with an Influenza virus you will know it.

The Royal Australian College of General Practitioners has in its emergency management planning a really nice table describing the difference. It references the Center for Disease Control and Prevention in the US.

Symptoms of influenza and the common cold

Symptom Influenza Common cold
Fever Often high, lasting 3 to 4 days Rare
Headache Frequent Rare
Aches and pains Common; can be severe Slight
Cough Common; can become severe Sometimes; mild to moderate
Sneezing Sometimes Common
Runny nose Sometimes Common
Sore throat Sometimes Common
Shivering Common Rare
Physical capacity Frequently bedridden Normal
Energy levels May show moderate to extreme signs of weakness A littler lower than usual
Complications Pneumonia, kidney failure and heart failure. Can be life-threatening Sinus or ear infection

Does manflu exist? Of course not. It’s just the common cold. That hasn’t stopped me tweeting about it though when I’m suffering :-)

CPAP and allergic rhinitis (aka hay fever)

I’ve been using continuous positive airway pressure (CPAP) for nearly twelve months for hypopnœas (more than 30 episodes of non-breathing for <10 seconds in duration each sleep cycle). While I don’t have sleep anpnœa (periods of non-breathing >10 seconds), my sleep physician recommended CPAP. All in all it’s been a good move. I sleep better and I don’t snore. I still don’t feel all that refreshed in the mornings but I do feel like I’m getting more sleep.

This is my first spring using CPAP. Spring in Canberra is something to behold. It’s beautiful every morning. The air is crisp, cold and fresh. The air is also full of pollen, pollen like you wouldn’t believe. It’s bad enough it’s cold and dry, but the beautiful cherry blossoms and other flowers bring with them so much pollen anyone who is afflicted with hay fever will know about it quickly.

For as long as I can remember I’ve had hay fever. On arriving in Canberra I changed from a Fluticasone to various non-sedating oral antihistamines with varying effect. Over the last year or so I’ve needed more powerful antihistamines. The ones that make me feel groggy all morning.

It’s been a revelation though sleeping with CPAP. The CPAP forces air in and I have no problems sleeping unlike the poor sleep I’ve experienced every spring. When I wake up though the symptoms return quickly and occasionally when I’m asleep I sneeze. I think having a humidifier attached to my CPAP machine helps a lot too.

My bedside CPAP set up. Yes, they're baby wipes to clean the mask every morning.

My bedside CPAP set up. Yes, they’re baby wipes to clean the mask every morning.

I’ve previously blogged about my CPAP experience

http://yummylummy.com/2012/11/11/cpap-shogun-japanese-restaurant-a-burger-with-a-difference/

http://yummylummy.com/2012/11/18/cpap-update-and-my-week-in-instagram/

One of my favourite microorganisms, viz., Burkholderia pseudomallei (the cause of Melioidosis)

As a young pathology trainee I remember reading about this mysterious bacterium and the disease it caused. I wasn’t far into my training when one morning I found a rapidly motile bacillus in a wet preparation from the blood culture bottle from a young man in our spinal unit with bacteræmia. The patient was from Cairns. He’d ridden his motorcycle off a cliff and landed in some mud. He had a fractured spine and a bad burn on his leg from the motorcycle’s exhaust pipe. The Gram’s stain from the blood culture bottle revealed a thin Gram-negative bacillus with a bipolar staining pattern. At the time I assumed it would be a Pseudomonas aeruginosa, a common enough finding in spinal patients with indwelling (urinary) catheters. The following morning the colonial morphology on horse blood agar and MacConkey were not typical for Ps. aeruginosa. The bacterium was oxidase positive but there was no green pigmentation. I set up an API 20E and API 20NE. The following day the colonial morphology was very odd, the colonies had become wrinkled and dry. It hit me then that this was likely to be either Burkholderia pseudomalleiBurkholderia cepacia or Pseudomonas stutzeri. The patient’s history suggested he was bacteræmic and had Melioidosis with the portal of entry being the leg burn that was exposed to mud in which B. pseudomallei could be found. B. pseudomallei is commonly found in Northern Australia including far north Queensland.

As my training in Brisbane was coming to an end at the Princess Alexandra Hospital, we experienced a summer of really heavy rainfall. I remember two patients with Melioidosis who had never travelled further north than Brisbane. I was told by a very senior microbiologist that when the Brisbane was first settled an awful lot of horses where buried. Whenever there was really heavy rain, for example, associated with a tropical low or tropical cyclone occasional cases of Melioidosis would emerge. I really have no way of verifying that story, but I know that in subequatorial and tropical climes monsoonal rains which raise the water table brought cases of Melioidosis usually within 10 to 14 days. This was a constant event at the beginning of the ‘wet’ when I was living and working in Darwin.

When I moved to Darwin in February 1996 I grew to love this bacterium and the disease it caused.

For some very basic facts about the bacterium, the disease, how we diagnose it and treat it I’ve created a little presentation. You can view it as a PDF.

During my time in Darwin I learnt so much from the preeminent clinician and scientist in Melioidosis, viz., Prof. Bart Currie. If you enter “Currie and Melioidosis” into a search engine you’ll see he’s authored hundreds of articles in high impact peer reviewed medical and scientific journals. I managed to get involved a couple of times in contributing to the American Society for Microbiology’s Manual of Clinical Microbiology’s Burkholderia chapters.

  1. Gilligan, P. H., G. Lum, P. Vandamme, and S. Whittier.  Burkholderia, Stenotrophomonas, Ralstonia, Brevundimonas, Comamonas, Pandoraea and Acidovorax.  Manual of Clinical Microbiology.  Eighth edition.  ASM Press, Washington D.C.  2003.
  2. LiPuma J., P. Vandamme, and G. Lum. Burkholderia, Stenotrophomonas, Ralstonia, Cupriavidus, Brevundimonas, Comamonas, Delftia, Pandoraea, and Acidovorax Manual of Clinical Microbiology.  Ninth edition.  ASM Press, Washington D.C.  2007.

When I changed jobs and moved to Canberra and the Australian Government’s Department of Health and Ageing my engagement with the B. pseudomallei community was confined to some specialist groups. My biggest thrill though was to be able to talk about B. pseudomallei before senators at Senate Estimates in 2011.

Senate Estimates Hansard Community Affairs 31 May 2011 Check out from page 152 of the document for my responses to the Senators’ questions.

One day I’ll write about my favourite bacterium, viz., Chromobacterium violaceum.

Today I’m thinking obstetrics

On this day my youngest brother was born. On this day my Mum could no longer have any more children. Mum had three sons. I’m the eldest. We were all troublesome. I was a transverse lie and the obstetrician couldn’t turn me. I had the umbilical cord wrapped around my neck. Mum needed a Caesarean section and I was 2 weeks premature. The middle brother was a grade four placenta prævia. Mum was instructed to rest for three months. She had a Caesarian section and the middle brother was a month premature. My youngest brother whose birth we celebrate today was born in an emergency Caesarian section after Mum’s uterus ruptured. Mum recalls the blood and the pain. He was ten weeks premature. Forty something years ago, that was fairly premature. Mum objects when others say she didn’t have a proper pregnancy because she didn’t experience a normal vaginal delivery. People who suggest that to Mum should watch out. Mum suffered a lot to have three healthy sons.

When I was in high school Dad often assisted obstetricians who delivered babies to Dad’s patients when things got complicated. I remember Dad taking me to a delivery. I’d made it clear I was intending to read medicine at university. Dad checked with his patients and the obstetrician and everyone was sweet. I really enjoyed being in an operating theatre as a high school student watching the miracle of birth. I recall the obstetrician spraying me with amniotic fluid.

As a medical student I recall the confinement of a Spanish lady who didn’t speak English. The midwife made panting noises and gestures and the lady pushed rather than pant. Disasters occur in slow motion. I watched her perineum tear and I remember seeing the end of her rectum. It appeared to happen so slowly yet I know it happened in a second or two. The baby was fine. The Mum needed some repair work. I hope she ended up okay as she grew older.

The last deliveries I was involved with professionally were when I was a junior house officer doing my country relieving stint in Wondai. The head midwife was the Mum of a famous Australian cricket player. She told great stories of her son and amazing stories of the local politicians. “Old Rack” was fun catching babies with. That was her term for delivering babies, “Catching baby time”.

Obstetrics is really important as a clinical microbiologist. So many serious infections can occur. Some can lead to ongoing congenital problems. Others are deadly at the time of confinement. Understanding obstetric microbiology is really important and so many lives have been saved and so many humans owe a normal human existence to the pioneers of obstetric clinical microbiology.

Happy birthday Grasshopper, I hope you have a great day.

The National Critical Care and Trauma Response Centre

NCCTRC

One of the things I’m proudest of is my association with the National Critical Care and Trauma Response Centre in Darwin.

I was there last week for meetings.

Check out their website http://www.nationaltraumacentre.nt.gov.au/

Check out my initiation and involvement with the NCCTRC http://yummylummy.com/2012/10/12/the-2002-bali-bombings-my-experience-and-my-memories/