Tropical Remote and Indigenous Health

Overview

This research group is committed to the advancement of research relevant to the communities of tropical Australia and the Asia Pacific region. It encompasses infectious tropical diseases that are endemic to this are as well as the health issues experienced in rural Australia with an empathsis on the health of Aboriginal peoples and Torres Strait Islanders.

Contact

Research Area Supervisor: John McBride

Professor McBride is an Infectious Diseases Physician and Clinical Microbiologist at the Cairns Base Hospital with research interests in dengue fever, Melioidosis, Mycobacterium ulcerans. and HIV infection and has is currently working on a large NHMRC study “Is male circumcision an acceptable and feasible intervention to reduce HIV transmission in Papua New Guinea?”

Other Researchers in Tropical, Remote and Indigenous Health

Associate Professor Graeme Maguire is a specialist physician in general internal and respiratory medicine with experience in health service provision, health-related research and health policy and protocol development in the north of Australia, particularly for Aboriginal and Torres Strait Islander peoples.

Dr Robert Norton is the Director of Microbiology at Pathology Queensland with research interests in melioidosis, Q fever and rheumatic fever.

Research Opportunities

Tropical Infectious Diseases

Cairns and Townsville, in north Queensland, are cosmopolitan cities and major tourism hubs with air connections throughout the Asia Pacific region. There are a number of Tropical infectious diseases that a higher degree research student could investigate.

Dengue fever is sporadically epidemic only in north Queensland. The diagnosis of a case in a traveller arriving from Australia would be unusual in the absence of a reported epidemic (updated at the Queensland Health website: http://www.health.qld.gov.au/dengue/outbreak_update/default.asp ). Fever, rash and headache are the usual symptoms. Laboratory testing reveals thrombocytopaenia and lymphopaenia. Elevated hepatic transaminase levels, with AST higher than ALT, is a valuable clue. The coastal cities of Cairns and Townsville are the most affected locations with significant activity also in the Torres Strait, where another vector for dengue, Aedes albopictus, has been recently identified. Darwin and other tropical areas are free of Aedes aegyptii currently. Studies of this disease in north Queensland could look at the prevailing seroprevalence after several major epidemics, in order to determine the risk of future epidemics of Dengue Haemorrhagic Fever. Little is known of the pathogenesis of DHF in adult populations (especially in people with premorbid conditions like diabetes). There is some evidence that secondary dengue infections may be more severe in adults, but falling short of the clinical definition of DHF. Genetic factors may play a role in the occurrence and severity of DHF. These are potential area for further study. New diagnostic tests, such as the NS1 antigen tests are being evaluated to assess their place in the early diagnosis of dengue fever. Scott Ritchie (at JCU, Cairns) is conducting studies on entomological aspects and there is scope to collaborate in a number of areas. Early detection of dengue fever is critical to the prevention of dengue fever epidemics and methods to improve the evaluation of fever in visiting travellers, is an area that should be investigated. Studies of Dengue fever in nearby Papua New Guinea have only recently begun, with a pilot project confirming dengue activity in Madang. It is anticipated that this research will be expanded and look more closely at the dynamics of Dengue fever epidemics in the Western province of Papua New Guinea – a common source of origin for dengue fever epidemics in north Queensland. As laboratory facilities expand on the Cairns campus it is possible that students could become involved in some of the more basic science aspects of Dengue fever.

Japanese encephalitis occurs in the Torres Strait. One case of JE has been acquired on mainland Australia. The reason that this infection has not spread more widely on Cape York is poorly understood. Pre-existing flavivirus antibodies in feral pigs may prevent infection in this species. More work is planned to evaluate newer vaccines in human populations. Japanese encephalitis almost certainly occurs in Papua New Guinea, however evaluation of the incidence is hampered by the lack of accurate diagnosis. Clinically focused research on the causes of encephalitis in PNG is a high priority.

Melioidosis, caused by Burkholderia pseudomallei, is a multisystem bacterial disease, with high morbidity and mortality. Although it most commonly affects adults with underlying disease such as diabetes or alcohol related disease, it can occur in children and healthy adults. It is an environmental soil organism and most infections are related to exposure during the wet season in northern Australia. The organism grows slowly in blood culture media and may be misidentified by laboratories with limited experience with this organism. It can be grown from other site specific specimens. Rarely, serology is required to make a diagnosis. Prolonged incubation is well described so that related travel may have occurred in the distant past. Our group has recently found some evidence that use of HMG CoA reductase inhibitors might reduce the incidence of Melioidosis in patients at risk. This work should needs to be supported by in vivo animal studies and collaboration with researchers in Townsville, who have developed animal models, is possible.

Leptospirosis occurs throughout Australia but is particularly common in north Queensland, where it is associated with rural occupations such as banana and dairy farming. Pulmonary haemorrhage is the most severe complication in our region, however the pathogenesis and treatment of this condition is poorly understood. Recently developed PCR techniques should assist in determining whether this complication is related to the pathogen or the immune response that is elicited. Additional studies could focus on the relationship between pathogenicity and the various serovars that occur.Clinical studies focusing on chemoprophylaxis in at-risk groups is currently being planned.

Mycobacterium ulcerans infection has a unique geographical distribution in Australia with 2 major foci. The area around Port Phillip Bay (close to Melbourne) is currently experiencing a significant increase in the number of notifications. The other location is around Mossman, north of Cairns. A smaller focus around Rockhampton has been described. Colleagues in Melbourne are actively investigating the potential routes of infection and it will be important to examine whether the same factors are involved in our region. A PhD student, Jennifer Vaughan, is currently investigating the environmental origins of the bacteria to see what similarities there are between Victorian and Queensland foci of the disease

Specific geographical history is useful in the diagnosis of Scrub typhus. This mite-borne disease is transmitted to humans when they venture into areas where transovarial transmission of Orientia tsutsugamushi occurs within populations of the mite vector Leptotrombidium diliense. These areas are located in rainforest and bush settings close to Cairns, Mission Beach, Mossman and the Torres Strait islands in north Queensland, plus the Litchfield national park outside Darwin. An eschar is present in about half of the patients, in others a rapid resolution of fever with Doxycycline and subsequent seroconversion is diagnostic. There are no readily available Australian isolates, and diagnostic methods need improvement. The most common tick borne rickettsial disease is Queensland tick typhus, caused by Rickettsia australis. Usually a mild disease, we have reported severe complications of the disease. Other rickettsiae in the Spotted fever group have been reported from such diverse locations as Flinders island, in the Bass Strait, the Tasmanian coast, the area around Adelaide, and the Torres Strait. There is much to be done to determine the relative importance of newly recognized rickettsiae of the spotted fever group in north Queensland.

It is likely that new pathogens are yet to be discovered in this region and in Papua New Guinea. An approach to this will involve an evaluation of patients with undiagnosed putative infections, and comparison with other geographical regions. A variety of genomic and proteomic techniques are now available to systematically approach this problem. This is research that ties in more broadly with an expansion of research at JCU in the area of biosecurity.

Other topics that would be suitable for study in our region include:

  • The significance of Eosinophilia in Indigenous populations, and related to this is the evaluation of the morbidity of Strongyloidiasis.

  • The natural history of the newly described helminthic pathogen Haycocknema perplexum.

  • Assessment of the role of cutaneous chancroid as a cause of skin ulcers in the south Pacific

  • Collaborative studies relating to circumcision in the prevention of HIV in PNG

  • Evaluation of antiretroviral programs in Papua New Guinea.

Indigenous, Rural and Remote Health

A broad range of opportunities exist for honours and post-graduate students. These may also include working outside northern Queensland with collaborators elsewhere in the north of Australia and Indonesia.

Honours student projects will typically build on existing projects to minimize set-up times and allow prospective students to complete work within timeframes. Potential projects include those relating to:

  • acute rheumatic fever and rheumatic heart disease recognition and management

  • access to and quality of specialist care in a remote setting

  • continuous quality improvement projects (quality assurance and systems appraisal) of chronic non-communicable disease care for Aboriginal Australians and Torres Strait Islander peoples

  • diagnosis of fetal alcohol spectrum disorder

  • COPD management in a remote Indigenous Australian setting

Masters and doctorate (PhD) projects will concentrate on larger evaluation studies/trials, prospective cohort studies and multicentre or international projects. Potential projects include:

  • Rheumatic Fever Follow-up Study (RhFFUS) – determining the optimal clinical response for minor heart valve abnormalities in an Indigenous Australian setting

  • Improving the uptake of secondary prevention for acute rheumatic fever – evaluation of a multidimensional intervention

  • Pathophysiologic, microbiologic and interventions studies for malaria and tuberculosis in Indonesia in collaboration with Menzies School of Health Research

Additional Information

Research at the School of Medicine in Cairns would be particularly suited to clinician researchers; however expansion of laboratory facilities (which currently include PC3 facilities) is planned in the near future, as is the appointment of senior research scientists. This will greatly expand the opportunities for laboratory-based research. Applicants for research at doctoral level may be eligible for internal or external research scholarships. Information regarding scholarships is available the graduate research school. International graduates should also look here.

Publications

Professor John McBride

Associate Professor Graeme Maguire

Dr Robert Norton