A tale of two tropical fevers

Aerial image of Balimo, Western Province, Papua New Guinea.

Supplied by Jeffrey Warner.

Personnel Image

Written By

Tianna Killoran


College of Public Health, Medical and Veterinary Sciences

Publish Date

5 May 2022

Related Study Areas

Enigmatic infections: Tuberculosis and melioidosis

JCU Associate Professor Jeffrey Warner is a microbiologist who has spent decades researching tuberculosis and melioidosis, two enigmatic tropical infectious diseases. Jeffrey says understanding these diseases, and others like them, is the key to supporting healthier communities in the Tropics.

Jeffrey says that he was always aware of the significance of tropical infectious diseases and wanted to undertake research in the Tropics; working and studying at JCU enabled him to do this. “Before I came to JCU, I worked in Sydney in medical laboratories and pathology for well over a decade. I always wanted to do research, so I started my PhD at JCU as a mature age student. I’ve been here now teaching and researching for the past 25 years,” he says.

In recognizing the importance of research into tropical infectious diseases, we put the spotlight on tuberculosis and the urgent need to invest in resources to fight against this disease. Jeffrey highlights the importance of laboratory resources in places such as regional Papua New Guinea, located in the remote Tropics. Tuberculosis cases in remote Papua New Guinea are almost double the national incidence at 700-900 cases per every 100,000 people every year.

However, Jeffrey says tuberculosis is just one disease affecting individuals in the rural Tropics, where his groundbreaking PhD research focused on melioidosis. "Part of my PhD involved establishing labs in Papua New Guinea and conducting research there. This is where my research career really began. We revealed the presence of melioidosis in a remote community in the western province of Papua New Guinea for the first time.”

Melioidosis is a disease caused by a bacterium that usually live in the soil and groundwater, often appearing after intense periods of rain; it can cause fever and inflammation and is life-threatening.

In a recent journal article, Jeffrey and fellow JCU researcher Catherine Rush discussed how, in communities where tuberculosis was endemic, individuals with melioidosis were being mistakenly diagnosed and treated for tuberculosis.

“Both of these diseases mimic each other in terms of presentation. But they need to be treated very differently with a different set of medication,” he says. “So, if a child in a remote community like Balimo, in the Western Province of Papua New Guinea presents at a clinic with the signs and symptoms typically associated with tuberculosis, they are treated with medication for tuberculosis. In most instances they respond positively to treatment; but sometimes that isn’t the case.”

Jeffrey’s research highlights the importance of supporting laboratories in the rural tropics with the capacity for accurate and early diagnosis, leading to life-saving treatments for people in these communities.

Smear of sputum from a tuberculosis patient showing blue and red patterns.
An agar plate with purple round shapes of bacteria with a red agar background.
Left: A sputum (sample from pus in lungs) sample from a tuberculosis patient showing Mycobacterium tuberculosis (the small, narrow red stained bacteria). Right: Culture of Burkholderia pseudomallei (the bacteria that causes melioidosis) from a child who had a TB misdiagnosis. Supplied by Jeffrey Warner.

The story of tropical laboratories

Jeffrey says the key to positive health outcomes in the remote Tropics is understanding the unique context of these remote communities and developing the capacity with them. Laboratory services are often recognised as contributing services, but they are vital. “However, we cannot assume that the right laboratory solutions in the developed world — which are usually technology driven — are also able to be delivered sustainably in remote locations,” he explains.

“Just as in medicine, nursing and pharmacy, providing health care in urban environments is different to providing care for rural and underdeveloped environments. With our research at JCU, we understand that difference and that context is very important in diagnostics and medical laboratory science.”

Associate Professor Jeffrey Warner

“In Australia, the solution to getting quick, specific and reliable pathology results is technology,” Jeffrey says. “This is incredibly important, and for example, many of our COVID-19 polymerase chain reaction (PCR) tests are conducted this way. The tests are run on large commercial molecular diagnostic equipment that enables thousands of tests to be conducted in a single day. It’s very important technology.

“But the problem is that you unplug this equipment, take it up to Papua New Guinea, plug it in there attached to a generator set in a non air-conditioned room, and it will probably only last two to three runs before it stops working,” Jeffrey says.

In the absence of sustainable and reliable laboratory technology, Jeffrey says laboratory scientists’ expertise — including their knowledge of local tropical infections and relevant bacteriology skills — is lifesaving. “Taking these skills and applying them to rural environments can make an enormous difference,” he says.

Laboratory scientists at JCU learn how to work in advanced labs and also develop critical laboratory skills that don't rely on specialist technology.

Researching tropical infections in the lab

Jeffrey is passionate about research that supports medical laboratory scientists’ expertise in tropical infectious diseases. “Rural medicine, rural regions and rural communities need focused people that understand these contexts so they can serve their communities well, and that is also the case for diagnostics.

“Microbiology scientists can provide very important clinical data by determining the anti-microbial susceptibility profile of pathogens. It can support clinicians in providing the right kind of care if a disease is drug-resistant, for example” he says. “The only way you can find out the anti-microbial resistance patterns and levels is to have a lab-based microbiologist or medical laboratory scientist who has the right skills and knowledge of the region.”

“As well as preparing our students to work in advanced labs, at JCU we teach our students important techniques in microbiology and other medical science disciplines that can be applied in remote locations and that don't rely on specialist technology."

Associate Professor Jeffrey Warner

Jeffrey says clinical awareness of the region is the key to saving lives. “Although it is a serious disease, the health outcomes for people diagnosed with melioidosis and tuberculosis in places such as Townsville and Cairns are very good. This is because of clinical awareness and laboratory scientists’ expertise,” Jeffrey explains.

“We have many people who research melioidosis here in Townsville and Cairns, including our work on environmental studies focusing on the groundwater, but also clinical microbiologists and doctors that understand the disease extremely well and laboratory-based scientists who are excellent at isolating and identifying the organisms. There is a clinical awareness in the region that produces accurate diagnosis and ultimately directed therapies as quickly as possible, which is saving lives.”

JCU’s research and expertise into tropical infectious disease takes place out in the field and on the JCU campuses. “Recently during the rain in Townsville, we’ve been using local creeks to understand the prevalence of the organism that causes melioidosis in the groundwater,” Jeffrey says. “We’ve been running this study for only a few weeks and we’re finding that usually after the first big run-off in creeks there is a higher incidence of this organism that causes melioidosis. This work is only preliminary but may help us better understand how people get exposed to and develop the disease.”

Jeffrey says this type of research into infectious diseases such as tuberculosis and melioidosis are critical to ensuring better health outcomes in the Tropics. “JCU’s emphasis on infectious disease research speaks to the importance of skilled and experienced lab-based microbiology services in rural and remote regions in the Tropics.”

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