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

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

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.

The ConversationBy 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

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
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

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.

Taking a pathological approach to evolving AI

Science fiction doesn’t stay fiction for long these days, and in applying artificial intelligence (AI) and augmented intelligence applications in pathology we seem destined for the same.

Har­ness­ing AI to keep improv­ing our ser­vices and relieve staff from some of the tedious but nec­es­sary grunt work in our oper­a­tions is high on NSW Health Pathology’s (NSWHP) list of pri­or­i­ties, but it’s a care­ful jour­ney we are on to dis­cov­er what’s pos­si­ble with­out pos­ing risks.

NSWHP Chief Infor­ma­tion Offi­cer James Pat­ter­son says patient safe­ty and the high secu­ri­ty of sen­si­tive patient, foren­sic and sci­en­tif­ic data we admin­is­ter is para­mount when con­sid­er­ing what AI could offer.

“We’re at a point where we are assess­ing our organisation’s appetite for AI appli­ca­tions in pathol­o­gy,” James says.

“In some clin­i­cal set­tings it can rapid­ly speed up and fine-tune the diag­nos­tic process and pro­vide faster treat­ment for patients – mov­ing us fur­ther toward pre­ci­sion medicine.

“A good exam­ple of this is rapid AI review of thou­sands of tis­sue sam­ple slides and their com­par­i­son with new­ly arrived spec­i­mens to deter­mine if malig­nan­cy is present, there­by enabling anatom­i­cal pathol­o­gists to make faster diagnosis.”

Accu­rate diag­no­sis and treat­ment of genet­ic dis­or­ders could become faster as well, where AI is used to match phys­i­cal attrib­ut­es or phe­no­typ­ic traits often asso­ci­at­ed with spe­cif­ic genes.

It could also be a read­i­ly avail­able tool to assist in diag­no­sis that goes beyond our cur­rent reliance on human phe­no­typ­ic expertise.

“AI may sug­gest spe­cif­ic genet­ic tests to clin­i­cians soon­er based on phe­no­typ­ic traits that are present and avoid instances of unnec­es­sary test­ing. Ulti­mate­ly the patient ben­e­fits soon­er by get­ting the right treat­ments,” James says.

“At the moment, AI comes with plus­es and minus­es. It can save time and effort by min­ing our online store of knowl­edge. But emerg­ing gen­er­a­tions of pro­fes­sion­als will still need to accrue their own knowl­edge and exper­tise through prac­tice to ensure the pro­fes­sions don’t stag­nate and human curios­i­ty and cre­ativ­i­ty keeps being renewed.

“For now, in pathol­o­gy we are just dip­ping our toes into AI. We’re focus­ing main­ly on how it could help us in non-clin­i­cal set­tings such as in billing, or in pro­duc­ing reports drawn from data we accrue, to inform how we could do things bet­ter and plan strategically.”

Suran­ga Kas­turi who leads NSWHP’s Data and Insights team says safe ways of har­ness­ing gen­er­a­tive AI such as Chat GPT type mod­els were being explored to help clin­i­cians feel more com­fort­able using the emerg­ing technology.

“It’s a case of sup­port­ing cul­tur­al change by intro­duc­ing low-risk AI-dri­ven pro­ce­dures to our col­leagues who will have mixed expe­ri­ences work­ing with emerg­ing tech­nolo­gies and new ways of doing things,” Suran­ga said.

Broken Hill lab receives new analysers as a natural disaster sweeps through the town

The roll out of our $29 million investment in new chemical pathology analysers is progressing well, with Broken Hill Laboratory the latest laboratory to come online. It hasn’t been without its challenges.

In the lead up to the go live on 23 Octo­ber, months of hard work was spent prepar­ing the Bro­ken Hill lab­o­ra­to­ry for the new equip­ment – from declut­ter­ing the space, per­form­ing the instal­la­tion and val­i­da­tion, all while main­tain­ing busi­ness as usu­al operations.

But just as the new equip­ment was being installed, a destruc­tive mini cyclone swept through the Far West.

The pow­er went out from 17 Octo­ber, and the new analyser was installed as the team oper­at­ed under hos­pi­tal emer­gency power.

The destruc­tive winds are still hav­ing a dev­as­tat­ing effect on Bro­ken Hill and sur­round­ing dis­trict. The town has lost pow­er from the elec­tric­i­ty grid after the winds brought down high volt­age pow­er lines and sev­en mas­sive trans­mis­sion towers.

Bro­ken Hill Lab­o­ra­to­ry Man­ag­er Glen Symons said the team has over­come a lot of obstacles.

“It was a col­lab­o­ra­tive effort from sci­en­tif­ic and tech­ni­cal staff, pathol­o­gists and ICT – some very quick think­ing was put in place to resolve IT and con­nec­tion issues as the storm bat­tered the town,” he said.

“We also had no air-con­di­tion­ing dur­ing this time, and even now the pow­er goes out and kicks back in again at reg­u­lar inter­vals as it switch­es from mains to back-up.

“Many of our staff are with­out pow­er in their own homes, but they are still show­ing up to work for their patients and local community.”

Glen want­ed to give a huge shout out to Hos­pi­tal Sci­en­tist, Peta-Lea Collins, who made sure every­thing went as smooth­ly as pos­si­ble, along with the sup­port from ICT, the project team and Nepean Chem­i­cal Pathol­o­gy, espe­cial­ly Dor­ra Aar­vani­tis, Shar­matha Jeyasee­lan, Natasha Mariage, Josh Ryan, Han­nah Babkhan, Cankayan Sutha­haren, Tracey Cam­bourn, Fah­my Bal­ga­hom and Dominic Cookson.

It’s great to see so many peo­ple pull togeth­er to ensure patients receive time­ly results. Well done to all our staff at Bro­ken Hill!

Bourke, Deniliquin and Dub­bo labs are prepar­ing for the new chem­i­cal pathol­o­gy analy­sers to be installed by the end of this year.

Twisted powerlines on the ground at Broken Hill after a storm passed through the town in October 2024.
Twist­ed pow­er­lines on the ground at Bro­ken Hill after a storm passed through the town in Octo­ber 2024. (Pho­to cred­it: ABC Bro­ken Hill)

 

Prestigious health award for groundbreaking Hep C test

NSW Health Pathology and its partners have been recognised for their work in validating the Dried Blood Spot test for diagnosing hepatitis C.

The 2024 NSW Health Awards were held in Syd­ney last week, to recog­nise and cel­e­brate staff and vol­un­teers from across local health dis­tricts, pil­lars, net­works and health organisations.

NSW Health Pathol­o­gy had final­ists in three cat­e­gories – Health Inno­va­tion, Patient Safe­ty First and for Staff Mem­ber of the Year.

We’re proud to say we won the Health Inno­va­tion award along­side our part­ners, Jus­tice Health, Mid North Coast Local Health Dis­trict and the Min­istry of Health for our work in val­i­dat­ing a Dried Blood Spot (DBS) test for hepati­tis C (HCV).

The project is the first of its kind in Aus­tralia, aim­ing to make DBS test­ing a stan­dard diag­nos­tic tool and trans­form­ing HCV test­ing for at-risk populations.

Over six months, the NSW Min­istry of Health in part­ner­ship with four Local Health Dis­tricts, Jus­tice Health NSW and Clarence Cor­rec­tion­al Cen­tre, col­lect­ed 1286 samples.

NSW Health Pathol­o­gy analysed the sam­ples to deter­mine the sen­si­tiv­i­ty and speci­fici­ty of the DBS test and will use the results to apply to the Ther­a­peu­tic Goods Asso­ci­a­tion (TGA) for validation.

If approved, this will be the only HCV DBS test avail­able in Aus­tralia. The part­ner­ships between the NSW Health sec­tor have been essen­tial for the large-scale val­i­da­tion in a short amount of time.

The DBS test pro­vides access to test­ing for vul­ner­a­ble pop­u­la­tions includ­ing peo­ple in prison and peo­ple with a his­to­ry of inject­ing drugs and will help NSW Health meet its goal of elim­i­nat­ing HCV as a pub­lic health issue by 2028.

Con­grat­u­la­tions to all the teams involved in this vital work!

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