Ticked off: the tiny terror of the bush

December 6, 2024 by Liz Farquhar Leave a Comment

Did you know that a small creature found along the eastern coast of Australia can be deadly? With its bite, it can harm humans and pets, trigger a red-meat allergy, and even spread a life-threatening disease.

Meet Ixodes holocyclus, also known as the Australian Paralysis Tick.

From September to December, you’re most likely to encounter it in its most dangerous form.

A female paralysis tick on a leaf. — An adult female paralysis tick.

The paralysis tick is often encountered by people exploring the Australian bush, especially in moister coastal forests. It has four stages: egg, tiny six-legged larvae (known as the ‘seed’ or ‘grass’ tick), eight-legged nymph, and eight-legged adult.

The 1mm-long larval stage is most active in autumn, the 2mm nymph in winter, and the 4mm adult in spring. Since the adult is larger, it poses the greatest risk.

When a tick bites, it inserts needle-like mouthparts and injects venom in its saliva. If left attached, this can lead to paralysis, and in the past, has even caused fatalities. Repeated bites can lead to severe allergic reactions, including life-threatening anaphylaxis.

Ticks can also transmit a compound called alpha-gal, which can make you allergic to red meat from animals like cows, pigs, and sheep. Symptoms of this allergy can include stomach aches, bloating, vomiting, and diarrhea.

Ticks are also known to transmit Rickettsia, a bacterial organism treatable with antibiotics. If you develop a fever, rash, or other symptoms following a tick bite, consult your doctor immediately.

Small larval ticks on a leaf. — The tiny six-legged larvae (known as the ‘seed’ or ‘grass’ tick).

How can you avoid the paralysis tick?

A man sitting in a laboratory — Stephen Doggett in his medical entomology laboratory at Westmead.

Stephen Doggett, Director of Medical Entomology at NSW Health Pathology, recommends avoiding tick-prone areas, especially after rain, when ticks are most active.

If you do venture into these areas, apply a repellent with DEET, picaridin, or oil of lemon eucalyptus. Follow reapplication instructions and any safety precautions. Wearing clothing treated with permethrin, which can be done with store-bought kits or pre-treated clothing, adds extra protection.

When you return home, remove clothing, and place into a hot dryer cycle to kill any ticks that may still be present. Carefully inspect yourself and your children for any signs of ticks.

What should you do if you find a tick?

An engorged female tick — An engorged female paralysis tick.

Avoid touching it or pulling it out with tweezers, as this can cause it to inject more venom (remember, tweezers are tick squeezers!). Instead, kill the tick while it’s still attached by dabbing it with a permethrin-based cream or spraying it with an ether-based spray used for treating warts, both available over the counter at pharmacies.

If you have a severe allergic reaction, it’s best to see your GP, who can safely treat the tick and ensure your wellbeing.

Stay tick-safe and enjoy your time in the bush with peace of mind!

Want more information? Check out the NSW Health website.

NSW Perinatal Postmortem Service hits the road

November 27, 2024 by Tina Sorenso Leave a Comment

We welcome the chance to share the expertise of our specialised statewide services with colleagues in rural and remote NSW.

Our statewide Perinatal Postmortem Service recently hit the road to deliver new face-to-face training for the Broken Hill and Dubbo maternity units.

The service provides compassionate support and answers for families experiencing the death of a baby shortly before or after birth.

It helps hundreds of NSW families each year from 3 specialised centres at Westmead, Randwick and Newcastle, which for some, is a long way away at such a difficult time.

Recognising this, Fiona O’Shannessy, an expert midwife from our Newcastle service, is bringing face-to-face training to midwives, doctors, and social workers at rural and regional hospital maternity units.

“It was a valuable opportunity to meet staff and build relationships with the clinicians who use our service,” Fiona said.

“Rural hospitals face different challenges than metropolitan centres, not the least of which is the distances families must travel to access healthcare.

“When a pregnancy ends in bereavement, these distances create an additional burden. Knowing who to reach out to and how we can help during such challenging times is reassuring for all involved.”

At Broken Hill, Fiona worked with staff to develop resources and review procedures, including transport to Children’s Hospital Westmead. Although it was a busy day at the hospital there was a fantastic turnout for both sessions, highlighting the commitment of the staff to ongoing learning.

At Dubbo, Fiona provided education to a large group of midwives emphasising the importance of collaboration in providing the best care. Fiona also had the opportunity to meet senior staff, which allowed for further discussions on improving services. Further education is planned via Teams to ensure all staff can benefit from these education opportunities.

More visits to other areas across NSW are planned for 2025 to improve support for staff and families in rural communities. These visits pave the way for improved connections and understanding within the healthcare system of the perinatal postmortem.

Hard work pays off for Abigail and Mandy – our newest RCPA Clinical Scientist Trainees

November 25, 2024 by Kristy Waddell Leave a Comment

A big congratulations to Abigail Elias and Mandy Hubbard, the first Clinical Scientist trainees in Haematology who recently passed their Royal College of Pathologists of Australasia (RCPA) Fellowship FSC Part II examinations.

Not for the faint-hearted, this achievement is the culmination of four years of hard work undertaking robust advanced training in haematology, including transfusion.

They have gained in-depth knowledge and expertise and demonstrates NSW Health Pathology’s (NSWHP) commitment to developing our scientific leaders.

Abigail is a Trainee Clinical Scientist based at NSWHP’s Liverpool Laboratory in the Haematology Department. Her RCPA training is in haematology and transfusion.

“The training program digs deeper and equips you with more knowledge in both areas, and has cemented my knowledge of all testing areas in haematology and transfusion. Being able to write and publish in reputable journals and communicating my work with all scientific professionals was an icing on the cake,” she said.

Abigail said it wasn’t without challenges, as she juggled fellowship study with work and family life, but it was worth it.

“There is a really high workload so it requires good time management and dedication. There would be sleepless nights at times and a lot of writing, but I always believe that you need to finish what you have started, even when the going is tough.

“The knowledge you get from training and working in different areas is priceless. The program has rewarded me with new friends and has given me the opportunity to meet other reputable scientists and clinicians in the organisation and nationwide.”

Mandy is a Senior Scientist in Haematology, based at NSWHP’s lab at Coffs Harbour Base Hospital. She said the Clinical Scientist traineeship has been a wonderful experience.

“It’s not only increased my knowledge base, but it has also allowed me to meet and work with various talented scientists within our organisation. As a trainee based in a regional area, I was required to travel to various location experiencing the diversity of laboratories and their management styles in places like John Hunter, Liverpool, Prince of Wales and Royal Prince Alfred Hospitals,” she said.

Mandy was grateful for the support of many supervisors and mentors.

“In particular, I would like to acknowledge my supervisors Dr Martin Browne and Dr Anoop Enjeti, who have been instrumental in guiding me through this process. I’m also grateful to the people I work with at Coffs Harbour who have supported me,” Mandy said.

Abigail and Mandy encouraged anyone who is considering the RCPA FSC Fellowship to go for it.

“All you need is passion and dedication, as you would get help from other trainees, scientists, RCPA and NSWHP,” Abigail said.

Mandy’s tip was to reach out to anyone else at NSWHP who was completing the program, as they can be your new friend and study-buddy.

“Having Abigail as this person has been priceless and I am forever grateful for her knowledge, experience and encouragement. The Clinical Scientists that you will meet will be like a new family, people that understand the challenges and demands of this training, and who are always willing to help,” she said.

Abigial was grateful to her support crew who cheered her on and helped keep her motivated.

“Thank you so much to my supervisor Dr Penelope Motum, for helping and supporting me to achieve this and I will forever be grateful for mentoring and trusting in me. Thank you so much to my partner in training, Mandy Hubbard from NSWHP’s Coffs Harbour Laboratory. I wouldn’t have achieved this without your help. Our endless meetings and hard work have paid off. Finally, a huge thank you to all Liverpool Haematology and Transfusion staff for assisting with my training,” Abigail said.

Abigail and Mandy were also grateful for the support of NSWHP’s Director of Scientific and Technical, Vanessa Thomson.

“Vanessa for her support in all the areas of our training – your belief in empowering scientific leaders is admirable and thank you for always being there whenever I needed your advice,” Abigail said.

“Vanessa’s belief in the ability of Clinical Scientists and the way that we can contribute to our organisation continues to motivate me,” said Mandy.

Abigial and Mandy agreed it’s been fantastic to learn about the various Haematology departments, making new friends, exchanging ideas with other scientists, contributing to various research projects and showing that completing this program is also possible for scientists no matter if you live in metropolitan or rural and regional sites.

Well done to Abigail and Mandy. Your hard work and dedication has paid off and we look forward to seeing what you do next!

What causes the itch in mozzie bites? And why do some people get such a bad reaction?

November 15, 2024 by Liz Farquhar Leave a Comment

Are you one of those people who loathes spending time outdoors at dusk as the weather warms and mosquitoes start biting?

Female mosquitoes need blood to develop their eggs. Even though they take a tiny amount of our blood, they can leave us with itchy red lumps that can last days. And sometimes something worse.

So why does our body react and itch after being bitten by a mosquito? And why are some people more affected than others?

What happens when a mosquito bites?

Mosquitoes are attracted to warm blooded animals, including us. They’re attracted to the carbon dioxide we exhale, our body temperatures and, most importantly, the smell of our skin.

The chemical cocktail of odours from bacteria and sweat on our skin sends out a signal to hungry mosquitoes.

Some people’s skin smells more appealing to mosquitoes, and they’re more likely to be bitten than others.

Once the mosquito has made its way to your skin, things get a little gross.

The mosquito pierces your skin with their “proboscis”, their feeding mouth part. But the proboscis isn’t a single, straight, needle-like tube. There are multiple tubes, some designed for sucking and some for spitting.

Once their mouth parts have been inserted into your skin, the mosquito will inject some saliva. This contains a mix of chemicals that gets the blood flowing better.

There has even been a suggestion that future medicines could be inspired by the anti-blood clotting properties of mosquito saliva.

A pale brown mosquito — A common pest mosquito around the world, *Culex quinquefasciatus*.
Cameron Webb (NSW Health Pathology), CC BY

It’s not the stabbing of our skin by the mosquito’s mouth parts that hurts, it’s the mozzie spit our bodies don’t like.

Are some people allergic to mosquito spit?

Once a mosquito has injected their saliva into our skin, a variety of reactions can follow. For the lucky few, nothing much happens at all.

For most people, and irrespective of the type of mosquito biting, there is some kind of reaction. Typically there is redness and swelling of the skin that appears within a few hours, but often more quickly, after just a few minutes.

Occasionally, the reaction can cause pain or discomfort. Then comes the itchiness.

Some people do suffer severe reactions to mosquito bites. It’s a condition often referred to as “skeeter syndrome” and is an allergic reaction caused by the protein in the mosquito’s saliva. This can cause large areas of swelling, blistering and fever.

The chemistry of mosquito spit hasn’t really been well studied. But it has been shown that, for those who do suffer allergic reactions to their bites, the reactions may differ depending on the type of mosquito biting.

We all probably get more tolerant of mosquito bites as we get older. Young children are certainly more likely to suffer more following mosquito bites. But as we get older, the reactions are less severe and may pass quickly without too much notice.

How best to treat the bites?

Research into treating bites has yet to provide a single easy solution.

There are many myths and home remedies about what works. But there is little scientific evidence supporting their use.

The best way to treat mosquito bites is by applying a cold pack to reduce swelling and to keep the skin clean to avoid any secondary infections. Antiseptic creams and lotions may also help.

There is some evidence that heat may alleviate some of the discomfort.

It’s particularly tough to keep young children from scratching at the bite and breaking the skin. This can form a nasty scab that may end up being worse than the bite itself.

Applying an anti-itch cream may help. If the reactions are severe, antihistamine medications may be required.

To save the scratching, stop the bites

Of course, it’s better not to be bitten by mosquitoes in the first place. Topical insect repellents are a safe, effective and affordable way to reduce mosquito bites.

Covering up with loose fitted long sleeved shirts, long pants and covered shoes also provides a physical barrier.

Mosquito coils and other devices can also assist, but should not be entirely relied on to stop bites.

There’s another important reason to avoid mosquito bites: millions of people around the world suffer from mosquito-borne diseases. More than half a million people die from malaria each year.

In Australia, Ross River virus infects more than 5,000 people every year. And in recent years, there have been cases of serious illnesses caused by Japanese encephalitis and Murray Valley encephalitis viruses.

By Cameron Webb, Medical Entomologist, NSW Health Pathology and Clinical Associate Professor and Principal Hospital Scientist, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

International Pathology Day 2024 – Investing in labs of the future with automation in chemical pathology

November 6, 2024 by Kristy Waddell Leave a Comment

Today is International Pathology Day, a time to celebrate the invaluable contribution that our pathology and forensic and analytical sciences staff make to healthcare.

Did you know that almost 70% of medical decisions rely on pathology? Pathology plays an invaluable role in the detection, diagnosis and treatment of disease.

Staff working in our laboratories are critical to most aspects of clinical decision-making in hospitals and healthcare settings. Whether it’s a routine health screen, cancer diagnosis, or blood donation— patients depend on pathology and our people are here for you at every stage of life.

Having the latest technology to keep up with the growing demands for diagnostic technology is critical to ensuring patients get timely care.

NSW Health Pathology is investing more than $29 million to upgrade chemical pathology analysers across Sydney and regional NSW, bringing in new levels of automation and standardisation.

Local Pathology Director and Chemical Pathology Clinical Stream Lead Dr Margaret Janu said chemical pathology has one of the highest throughputs in pathology testing.

“It’s highly automated and underpins the critical and urgent testing of blood specimens. Automation is key to us being able to make best use of our people’s time and expertise, and this significant investment is already providing faster, more efficient services,” Dr Janu said.

people in lab standing in front of machine — Concord Laboratory with their new Chemical Pathology analysers. Left to right: Marsha De Bono, Smita Tangri, Priyani Seneviratne, Rana Suilman, Astrid Ferenczy, Samantha Kousoulos, Ad Hercules Blanco, Alex Vong.

Marsha De Bono, Senior Hospital Scientist at Concord Hospital said the new equipment is already making a huge difference since it was installed earlier this year.

“The new equipment is enhancing the staff’s workflow in the laboratory and streamlining pathology testing, which are essential for detecting, diagnosing, and treating diseases. Our team at Concord has successfully adapted to the new workflows, enabling them to deliver a high standard of service to our patients,” Marsha said.

“The current equipment had reached its end of life, and replacing the high-volume chemistry and immunoassay testing equipment now will ensure we continue to deliver timely, reliable test results to the local community.”

Director of Clinical Transformation Professor Rob Lindeman said it’s one of the biggest equipment replacement projects NSW Health Pathology has ever undertaken.

“We’ve made great progress over the past 18 months,” he said.

“We have installed new chemical pathology analysers at Blue Mountains, Lithgow, Nepean, Bega, Moruya, Blacktown, Mount Druitt, Canterbury, Auburn, Goulburn, Queanbeyan, Cooma, Westmead, Wollongong, Tumut, Mudgee, Wagga Wagga, Young, Orange, Bathurst, Forbes, RPA, Concord, Walgett and Broken Hill.

“This week we go live at the brand-new laboratory at the Liverpool Health and Academic Precinct as well as Bourke. Looking ahead to the next six months, work is progressing with upgrades being planned at Deniliquin, Randwick and Dubbo,” Professor Lindeman said.

Randwick Lab — The walls have come down in the Randwick lab to make way for the new chemical pathology analysers.

Thanks to the dedication, expertise and effort of everyone from our laboratories teams, Clinical Operations, ICT and Project Management teams who are working tirelessly on this important project.

Each lab has its own logistics and site-specific challenges and disruptions to overcome (such as referring specimens to other nearby labs for testing while equipment is installed), but it’s been a great team effort to date. Well done everyone!

Staff from Broken Hill Lab installed new chemical pathology analysers in October 2024. Left to right: Feiya Su, Peta-Lea Collins, Glen Symons, and Andrew from Roche.

What is Chemical Pathology?

Chemical pathology underpins the care and management of many common conditions:

High blood glucose levels can mean diabetes.
Elevated troponin enzyme can indicate recent or current heart attack.
Measuring proteins in cancer tumours can determine if treatments are working.

NSW Health Pathology’s chemical pathology teams help diagnose:

infertility
Cystic Fibrosis in newborns
kidney failure
high cholesterol
viral and bacterial infection
thyroid issues and more.

Chemical pathologists have complex clinical and laboratory skills needed to perform biochemical tests on human body fluids and tissues.

They examine blood, tissues and urine, and other body fluids such as cerebrospinal fluid.

Changes in enzymes, proteins, electrolytes and other substances in these fluids and tissues give clues they need to diagnose illness and recommend patient care and treatment.

(Top image: staff at Tumut Laboratory)

Our new Alzheimer’s testing service a NSW first

November 5, 2024 by Tina Sorenso Leave a Comment

We’re proud to be the sole NSW provider of a new accredited cerebrospinal fluid (CSF) test for diagnosis of Alzheimer’s disease, a specific type of dementia characterized by progressive memory loss and cognitive decline.

Cerebrospinal fluid (CSF) biomarkers are currently the only clinically validated biofluid diagnostic test for Alzheimer’s Disease available in Australia. Until now, specimens from NSW had to be sent away to a private institute in Victoria for testing.

With dementia cases set to double across Australia by 2058 and new treatments for Alzheimer’s under development, demand for diagnoses is expected to soar.

Our Concord Hospital Diagnostic Pathology Unit has positioned itself ahead of the game to meet this need, commissioning this new NATA-accredited CSF test that is fast, accurate and affordable.

Dr Margaret Janu, NSW Health Pathology’s Chemical Pathology Clinical Stream Lead, said patients and referring clinicians can expect results within 1 business day of receipt of specimens.

But the real benefit of the CSF test is earlier detection, which Alzheimer’s experts agree is the key to better management of the condition and the success of eventual treatments.

“The test detects the Alzheimer biomarkers Beta Amyloid and Tau in patients at an earlier stage of disease progression. It has up to 90 percent sensitivity and specificity,” Dr Janu said.

Microsopy Image of beta amyloid and tau courtesy of Dementias Platform UK — Beta amyloid and tau (image owned by Dementias Platform UK).

“Patients will have easier and more affordable access to a test that can distinguish with a high degree of probability if they have Alzheimer’s or not.

“If new Alzheimer’s drugs become available, patients will need an evidence-based diagnosis to access treatment. At present, diagnostic biomarkers are limited to the CSF test which costs $350, and amyloid PET scans which can cost several thousand dollars.

“The other disadvantage of PET scans is that by the time enough amyloid plaque has accrued in the brain to be detected, the neurodegeneration is such that were treatment to be available, it may possibly come too late.”

NSW Health Pathology’s $29 million investment in the rollout of new chemical pathology analysers came at exactly the right time for the Concord team.

“We were able to develop the new test because the test is only available on the Roche analyser. The test is TGA-approved and measures three proteins improving diagnostic accuracy,” Dr Janu said.

“We’re at the cutting edge. It’s another string in our bow in terms of our instrumentation and we have the expertise among our Chemical Pathologists to set up these new tests and be ready.”

The comprehensive and tertiary level aged care service and specialized cognitive and memory clinics, together with our experienced neurologists at Concord Hospital, allow the laboratory and clinicians to work very closely together to provide clinical interpretation and advice to our referees.

The test will be available for all NSW public hospital patients and will also take private referrals from geriatricians and other specialists. At the moment there is no Medicare rebate for the test, but this is anticipated in the future.