Search

Background: Abdominal obesity and presence of the metabolic syndrome (MetS) significantly increase the risk of developing diseases such as Type 2 diabetes mellitus (T2DM) with escalating emergence of MetS and T2DM constituting a significant public health crisis worldwide. Lower prevalence of inflammatory and metabolic diseases such as T2DM in countries with higher incidences of helminth infections suggested a potential role for these parasites in the prevention and management of certain diseases. Recent studies confirmed the potential protective nature of helminth infection against MetS and T2DM via immunomodulation or, potentially, alteration of the intestinal microbiota. This Phase 1b safety and tolerability trial aims to assess the effect of inoculation with helminths on physical and metabolic parameters, immune responses, and the microbiome in otherwise healthy women and men., Methods: Participants eligible for inclusion are adults aged 18-50 with central obesity and a minimum of one additional feature of MetS recruited from the local community with a recruitment target of 54. In a randomised, double-blind, placebo-controlled design, three groups will receive either 20 or 40 stage three larvae of the human hookworm Necator americanus or a placebo. Eligible participants will provide blood and faecal samples at their baseline and 6-monthly assessment visits for a total of 24 months with an optional extension to 36 months. During each scheduled visit, participants will also undergo a full physical examination and complete diet (PREDIMED), physical activity, and patient health (PHQ-9) questionnaires. Outcome measurements include tolerability and safety of infection with Necator americanus, changes in metabolic and immunological parameters, and changes in the composition of the faecal microbiome., Discussion: Rising cost of healthcare associated with obesity-induced metabolic diseases urgently calls for new approaches in disease prevention. Findings from this trial will provide valuable information regarding the potential mechanisms by which hookworms, potentially via alterations in the microbiota, may positively influence metabolic health., Trial Registration: The protocol was registered on ANZCTR.org.au on 05 June 2017 with identifier ACTRN12617000818336. Alternatively, a Google search using the above trial registration number will yield a direct link to the trial protocol within the ANZCTR website.

Objective: To evaluate whether colonoscopy protects against subsequent colorectal cancer (CRC)., Design: Case and population survey., Setting: Townsville region in northern Queensland, between mid 1985 and January 1998., Subjects: All 8430 patients who underwent 11,148 colonoscopies performed by the author at the Mater Private Hospital (a community-based open-access colonoscopy service) between July 1985 and December 1996; those who were subsequently diagnosed with CRC, to January 1998; and all 476 residents diagnosed with colorectal cancer between 1994 and 1997., Main Outcome Measures: Age-standardised CRC incidence for 1994-1997 for patients who had had a previous colonoscopy and for the remaining community; Dukes' grade of CRCs., Results: For people aged 50 years and over, the incidence of CRC was significantly lower among those who had had a previous colonoscopy than in the remaining community (1.14 versus 2.31 per 1000 patient-years; P = 0.0046). For people aged 35-49 years, the incidence was 0.35 versus 0.31 per 1000 patient-years (P = 0.86). Thirty-one CRCs developed in 29 people who had had previous colonoscopy; only five of these CRCs were graded Dukes C, with none graded Dukes D. In contrast, almost half the CRCs in the rest of the community were graded Dukes C or D (P < 0.001). All but one of those diagnosed with CRC on repeat colonoscopy had risk factors (personal or family history), and 23 of the CRCs were subclinical, with 20 being diagnosed during surveillance colonoscopy., Conclusions: Patients aged over 50 years who had previously undergone a colonoscopy and ensuing treatment were less likely to be diagnosed with CRC than otherwise expected. Surveillance colonoscopy led to diagnosis of CRCs with lower Dukes grades.

Objective: To describe the clinical presentation, diagnosis and management of strongyloidiasis in northern Queensland, and to identify predisposing factors for this infection., Design: A five-year retrospective study of medical records of all cases diagnosed in a regional hospital microbiology laboratory, with follow-up by interview where possible., Setting: The Townsville General Hospital., Patients: A total of 14 cases of strongyloidiasis were identified, with patients ranging in age from 7 months to 59 years., Results: Infected patients included nine Aborigines and two Vietnamese refugees, both high-risk groups. Of three Caucasians diagnosed, one was a war veteran, but the other two did not have significant travel histories; all three had lived or worked under insanitary conditions. In only one case was strongyloidiasis suspected; in most, it was diagnosed because of diarrhoea or blood eosinophilia which could not be related to the presenting illness. Thiabendazole treatment was effective in most cases., Conclusion: In northern Australia, strongyloidiasis can be acquired locally by Caucasians who live in unhygienic circumstances. It should be suspected in any person with unexplained abdominal pain, diarrhoea, cutaneous symptoms or blood eosinophilia, and the laboratory must be informed of the provisional diagnosis.

An epidemic of eosinophilic enteritis (93 cases) has occurred in Townsville, northern Queensland, Australia. A hookworm was found attached to a resected, inflamed ileal segment from 1 patient but the species could not be identified. An adult hookworm of species Ancylostoma caninum was recovered at colonoscopy from the terminal ileum of a later patient. All of 38 patients interviewed in an epidemiological survey described behaviour which could have exposed them to infective larvae of this widespread dog parasite.

During a 12-month period, feces from 780 persons from the Townsville region were evaluated by the Kinyoun acid-fast strain, and 36 (4.6%) immunocompetent patients were found to have Cryptosporidium oocysts. Twenty-five index cases were identified; 13 (8.6%) cases from 151 patients were from Palm Island, an isolated Aboriginal community in the wet tropics and 12 (1.9%) cases from 629 patients were from the dry tropics of Townsville. All 11 secondary cases were associated with a person-to-person outbreak in the nursery of a Townsville day-care centre. Infection occurred mainly in two distinct age groups: the under five-year-old (27 cases), and the 25 to 35-year-old (six cases). A prodrome of dry cough, rhinorrhea and vomiting often preceded symptoms of fever, weight loss, abdominal pain, persistent cough and vomiting, and acute diarrhea with frequent, non-bloodstained, watery, mucous stools. Although 13 patients were hospitalised because of their illness, the infection was self-limiting and all 36 patients recovered with symptomatic treatment. Cryptosporidium was the third most commonly identified enteric pathogen after Rotavirus and Giardia. Infection did not appear to depend on seasonal variation and no animal or environmental sources of infection were identified. Cryptosporidiosis in immunocompetent persons is endemic and common in North Queensland and routine investigations for this parasite in symptomatic patients are warranted.