Territory Stories

The Northern Territory Disease Control Bulletin

Details:

Title

The Northern Territory Disease Control Bulletin

Creator

Territory Health Services, Centre for Disease Control

Collection

Northern Territory disease control bulletin; E-Journals; PublicationNT; Northern Territory disease control bulletin

Date

2002-03

Location

Casuarina

Notes

Date:2002-03; This publication contains may contain links to external sites. These external sites may no longer be active.; Made available via the Publications (Legal Deposit) Act 2004 (NT).

Language

English

Subject

Communicable diseases; Reporting; Northern Territory; Statistics; Periodicals

Publisher name

Northern Territory Government

Place of publication

Casuarina

Series

Northern Territory disease control bulletin

Volume

v. 9 no. 1

File type

application/pdf

ISSN

1440-883X

Use

Attribution International 4.0 (CC BY 4.0)

Copyright owner

Northern Territory Government

License

https://creativecommons.org/licenses/by/4.0

Parent handle

https://hdl.handle.net/10070/233806

Citation address

https://hdl.handle.net/10070/655675

Page content

The Northern Territory Disease Control Bulletin Vol 9, No.1, March 2002 10 First notified case of Q fever in the NT Peter Markey,CDC Darwin and Dale Fisher, Royal Darwin Hospital Presentation The NTs first notified case of Q fevera was reported in early March 2002. A 49 year old van driver from Palmerston was admitted to hospital in early February with a clinical picture of acute hepatitis. He had been increasingly unwell for 2 weeks, noting right upper quadrant pain and fever, and later developed headaches and arthralgia. A week prior to admission he noticed jaundice and by admission had developed a patchy maculo-papular rash over his trunk and limbs which faded after 3 days. On presentation he had a bilirubin of over 297 umol/L, his ALP was 312 U/L, GGT 199 U/L and ALT 273 U/L. Further investigation was undertaken in hospital. All viral hepatitis tests were negative and high fevers up to 39C were noted. His condition continued to deteriorate with bilirubin peaking at 390 mmol/l. He developed mild pre-renal renal impairment (creatinine 170 umol/L). He had no cough nor signs of pneumonitis. Over the course of the next 3 weeks in hospital he gradually improved without specific treatment. His temperature settled, appetite returned and liver function began to normalise. A liver biopsy revealed granulomatous hepatitis without histological evidence of acid-fast bacilli. Convalescent serum for Q fever serology revealed Phase 1 IgG IFA of 1:640 and Phase 2 IgG IFA 1:20480. Phase 2 IgM IFA was positive. Retrospective testing on admission serum confirmed the rise in IgG Phase 2 titre. He was discharged after 3 weeks in hospital, clinically improving although having incurred a 20kg loss of weight. He was given doxycycline for 3 weeks. History This man had not been out of the NT for 18 months. He grew up in rural towns in South Australia and in Adelaide but had never lived on a farm. He had spent 20 years in the Airforce prior to moving to Darwin 3 years ago. Overseas postings had taken him to Malaysia in 1988 and New Zealand in 1993. He drives a van for a delivery company and delivers packed or frozen meat to restaurants, including eateries at the two wildlife parks near Darwin. In the 4 weeks prior to the onset of his illness he had no direct contact with animals apart from his and his friends domestic pets (mainly dogs). He drives past a stock-yard of cattle and other livestock every morning on his way to work (and drives an un-airconditioned car with the windows down) but has no other contact with cattle or livestock and has never been involved with hunting. Q fever Q fever is a zoonosis caused by the rickettsia Coxiella burnetti. The main reservoir is in farm animals, in particular sheep, cattle and goats but many animals have been known to transmit the disease including dogs, cats and camels. There are also wild reservoirs such as bandicoots and kangaroos. The most infectious part of the animal is the placenta with a report of over one billion organisms identified per gram.1 C. burnetti is very infectious; according to one source an illness has been acquired from the inhalation of as little as one organism.1 Those most at risk are abattoir workers, veterinarians, animal researchers and sheep and dairy farmers. There have been various reports of Q fever being spread to urban dwellers who live downwind from farmlands.1-3 Although there have been anecdotal reports of cases from the 80s there has never been a notified case in the NT despite the existence of an active livestock industry and several abattoirs. All other Australian jurisdictions have cases every year with the majority centred around south-eastern Queensland and northeastern NSW. There was an average of 600 cases per year reported nationally over the period 1991-2001. Figure 1 illustrates the national distribution of cases 1991-94 and Figure 2 the number of cases per annum from 1991. With the NT being considered free of Q fever, there is little or no testing by the department of Primary Industry. Over the past few years between 200,000 and 500,000 head of cattle have come through Darwin every year for export. Up to 80,000 of the cattle come from Queensland and last year there were live camels exported. a At least since electronic records were kept from 1991.


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