Tropical Medicine - COnnecting REpositories · Gas gangrene (Cl. myonecrosis) Geotrichosis...

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Tropical Medicine

This scene is from

Germany!

Theme Park inBrandenburg,

Germany!

Welcome to Brisbane

almost-tropics Peter O’Donoghue

University of

Queensland

Tropical Medicine

perspective:

• personalized

Self-introduction

Brisbane

personalized

• narcissitic

MY FAMILY’S TROPICAL ODYSSEY

Background

ScottishIrish

Ozh b id

moved to

Brisbane

(almost-tropics)

hybrid

UncleSean

Scotland India died!(tea plantations)

Familial experiences with ‘TROPICS’

ague[malaria]

(protozoa)

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Germany Africa died!(cattle)


UncleDavid

anthrax(bacteria)

France Egypt died!(work on dam)

UncleJean-Paul


bilharzia(helminth)

Holland East Indies died!(spice plantations)

UncleRutger


crypto-coccosis

(fungus)

USA Panama died!

(work on canal)

UncleClint


yellow fever(virus)

China New Guinea died!

(gold mines)

UncleJet


screwworm

(arthropod)

Tropics can be dangerous!

Presence of nasty infectious diseases

(six exemplars linked to colonial development)

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Tropical Medicine

Field developed to protect health of colonists

early Schools/Institutes not in tropics

Tropicsbound by latitudes where sun is directly overhead for at least one day per year

23 4N T i f C

36% of land mass

23.4N Tropic of Cancer

23.4S Tropic of Capricorn

Population

40% of people

~3 billion

Temperature

warm (year-long)

no winter

Rainfall

wet (60% global rainfall)

≥ 1 m per year

subsistence level (where possible)

Agriculture

bulk cropping in temperate zones

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Economic wealth

poor (25% global GDP)

many developing countries

Healthcare

10% global expenditure (per capita)

poor infrastructure

Tropical Medicine

radical changes in knowledge and beliefs

diseases not caused by spirits, spells, miasmas, etc...

Micro-parasites

viruses bacteria protozoa fungi

Germ theoryMacro-parasites

helminths arthropods

multiplicative in hostsevere acute diseases

cumulative in hostchronic diseases

milli-metres centi-metres nano-metres micro-metres

# infectious diseasesAcinetobacterActinomycosisAfrican trypanosomiasisAcquired immunodeficiency syndromeAmoebiasisAnaplasmosisAngiostrongyliasisAnisakiasisAnthraxArcanobacterium haemolyticumArgentine haemorrhagic feverAscariasisAspergillosisAstrovirusBabesiosisBacillus cereusBacterial pneumoniaBacterial vaginosisBacteroidesBalantidiasis

ChromoblastomycosisClonorchiasisClostridium difficile colitisCoccidioidomycosisColorado tick feverCommon cold (acute viral rhinopharyngitis, acute coryza)Creutzfeldt-Jacob disease (CJD)Crimean-Congo haemorrhagic feverCryptococcosisCryptosporidiosisCutaneous larval migransCyclosporiasisCysticercosisCytomegalovirusDengue feverDesmodesmusDientamoebiasisDiphtheriaDiphyllobothriasisDracunculiasis

Haemophilus influenzaeHand, foot & mouth diseaseHantavirus pulmonary syndromeHeartland virus diseaseHelicobacter pyloriHaemolytic uremic syndromeHaemorrhagic fever withrenal syndromeHepatitis AHepatitis BHepatitis CHepatitis DHepatitis EHerpes simplexHistoplasmosisHookwormHuman bocavirusHuman ewingii ehrlichiosisHuman granulocytic anaplasmosisHuman metapneumovirusHuman monocytic ehrlichiosis

Meningococcal diseaseMetagonimiasisMicrosporidiosisMolluscum contagiosumMonkeypoxMumpsMurine typhus (endemic)Mycoplasma pneumoniaMycetomaMyiasisNeonatal conjunctivitisNew –variant CJDNocardiosisOnchocerciasisOpisthorchiasisParacoccidioidomycosisParagonimiasisPasteurellosisPediculosis capitisPediculosis corporisPediculosis pubis

SchistosomiasisSepsisShigellosisShinglesSmallpoxSporotrichosisStaphylococcoal food poisoningStaphylococcusStrongyloidiasisSubacute sclerosing panencephalitisSyphilisTaeniasisTetanusTinea barbae Tinea capitisTinea corporisTinea crurisTinea manumTinea nigraTinea pedis

[Wiki N = 240]

BalantidiasisBartonellosisBaylisascarisBK virusBlack piedraBlastocystosisBlastomycosisBolivian haemorrhagic feverBotulismBrazilian haemorrhagic feverBrucellosisBubonic plagueBurkholderiaBuruli ulcerCalcivirus (Norovirus, Sapovirus)CampylobacteriosisCandidiasis (moniliasis, thrush)CapillariasisCarrion’s diseaseCat-scratch diseaseCellulitisChagas diseaseChancroidChickenpoxChikungunyaChlamydiaChlamydophila pneumoniae Cholera

DracunculiasisEbola haemorrhagic feverEchinococcosisEhrlichiosisEnterobiasisEnterococcusEnterovirusEpidemic typhusErythema infectiosum (fifth disease)Exathem subitum (sixth disease)FasciolasisFasciolopsiasisFatal familial insomniaFilariasisFood poisoning (Cl. perfringens)Free-living amoebaeFusobacteriumGas gangrene (Cl. myonecrosis)GeotrichosisGerstmann-Straussler-Scheinker syndromeGiardiasisGlandersGnathostomiasisGonorrhoeaGranuloma inguinale (donovanosis)Group A StreptococcusGroup B Streptococcus

Human monocytic ehrlichiosisHuman papillomavirusHuman parainfluenza virusHymenolepiasisEpstein-Barr virus infectiousmononucleosisInfluenzaIsosporiasisKawasaki diseaseKeratitisKingella kingaeKuruLassa feverLegionellosis (Legionnaire’s disease)Legionellosis (Pontiac fever)LeishmaniasisLeprosyLeptospirosisListerosisLyme diseaseLymphatic filariasisLymphocytic choriomeningitisMalariaMarburg haemorrhagic feverMeaslesMiddle-East respiratory syndromeMelioidosisMeningitis

Pediculosis pubisPelvic inflammatory diseasePertussisPlaguePneumococcusPneumocystis pneumoniaPneumoniaPoliomyelitisPrevotellaPrimary amoebic meningoencephalitisProgressive multifocal leukoencephalopathyPsittacosisQ feverRabiesRelapsing feverRespiratory syncytial virusRhinosporidiosisRhinovirusRickettsiaRickettsialpoxRift valley feverRocky Mountain spotted feverRotavirusRubellaSalmonellosisSevere acute respiratory syndromeScabies

Tinea pedisTinea unguiumTinea versicolorToxocariasis (ocular)Toxocariasis (visceral)TrachomaToxoplasmosisTrichinosisTrichomoniasisTrichuriasisTuberculosisTularemiaTyphoid feverTyphus feverUreaplasma urealyticumValley feverVenezuelan equine encephalitisVenezuelan haemorrhagic feverVibrio vulnificusVibrio parahaemolyticusViral encephalitisViral pneumoniaWest Nile feverWhite piedraYersinia pseudotuberculosisYersiniosisYellow feverZygomycosis

# infectious diseasesAcinetobacterActinomycosisAfrican trypanosomiasisAcquired immunodeficiency syndromeAmoebiasisAnaplasmosisAngiostrongyliasisAnisakiasisAnthraxArcanobacterium haemolyticumArgentine haemorrhagic feverAscariasisAspergillosisAstrovirusBabesiosisBacillus cereusBacterial pneumoniaBacterial vaginosisBacteroidesBalantidiasis




SchistosomiasisSepsisShigellosisShinglesSmallpoxSporotrichosisStaphylococcoal food poisoningStaphylococcusStrongyloidiasisSubacute sclerosingpanencephalitisSyphilisTaeniasisTetanusTinea barbaeTinea capitisTinea corporisTinea crurisTinea manumTinea nigraTinea pedis

37% bacterial (86) 29% viral (65)13% helminth (30) 12% fungal (28)7% protozoan (17) 2% arthropod (5)

[Wiki N = 240]

BalantidiasisBartonellosisBaylisascarisBK virusBlack piedraBlastocystosisBlastomycosisBolivian haemorrhagic feverBotulismBrazilian haemorrhagic feverBrucellosisBubonic plagueBurkholderiaBuruli ulcerCalcivirus (Norovirus, Sapovirus)CampylobacteriosisCandidiasis (moniliasis, thrush)CapillariasisCarrion’s diseaseCat-scratch diseaseCellulitisChagas diseaseChancroidChickenpoxChikungunyaChlamydiaChlamydophila pneumoniaeCholera

DracunculiasisEbola haemorrhagic feverEchinococcosisEhrlichiosisEnterobiasisEnterococcusEnterovirusEpidemic typhusErythema infectiosum (fifth disease)Exathem subitum (sixth disease)FasciolasisFasciolopsiasisFatal familial insomniaFilariasisFood poisoning (Cl. perfringens)Free-living amoebaeFusobacteriumGas gangrene (Cl. myonecrosis)GeotrichosisGerstmann-Straussler-ScheinkersyndromeGiardiasisGlandersGnathostomiasisGonorrhoeaGranuloma inguinale (donovanosis)Group A StreptococcusGroup B Streptococcus




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VIRUSES: genetic vagrants!

influenza virus

herpes coldsore

BACTERIA: biochemical bags!

anthrax

in cytoplasm

FUNGI: zombie-eaters!

filamentous hyphaefilamentous hyphae

ovoid yeasts athlete’s foot

PROTOZOA: ‘first animals’!flagellates

ciliates

leishmaniasis

ciliates

amoebae

sporozoa

hookworm - larval migrans

HELMINTHS: squirmy worms!

nematodes

cestodes

trematodes

ARTHROPODS: mini-vampires!

insects

tick bite

arachnids

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Exemplars of dermal lesions

Usually sensationalize topic with gory images

Lucky it is a publicpre-dinner talk

(sanitized images)

Vascular

Visceral Enteric

VenerealMost common causes of mortality due to infectious diseases(where cause of death is known, ~ 16 million per annum):• acute respiratory infections 4,000,000• acquired immunodeficiency syndrome 3,000,000• diarrhoeal diseases 1,800,000• tuberculosis (TB) 1,600,000• malaria 1,300,000• measles 600,000• pertussis (whooping cough) 300 000

Cost of tropical diseases

• pertussis (whooping cough) 300,000• tetanus 200,000• meningitis, bacterial 200,000• hepatitis, all types 160,000• syphilis 150,000• trypanosomiasis, all types 100,000• chlamydiasis 20,000• schistosomiasis 15,000• Japanese encephalitis 14,000• dengue 13,000• other communicable diseases 1,700,000

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Followed 3 main periods in human history:

Epidemiology

1. Foundation (thousands of years ago)

2. Empire (hundreds of years ago)

3. Second Foundation (tens of years ago)

apologies to Asimov

1. FOUNDATION

Humanoid African origins > 10,000 YA hunter/gatherersOld World diseases (fevers, dysentery, lesions)Out-of-Africa migrations >7,000 YA farmers villagersNew World ‘crowd’ diseases (rashes, poxes, plagues, pneumonias)Separation of New and Old Worlds (Sahara desert)

2. EMPIRE

>300 YA Explorers ‘discover’ tropical landsencounter Old World diseases, spread New World diseases

200 YA Slave trade, labour force tougher, more resistant mixing of New and Old World peoples and diseases

3. SECOND FOUNDATION

Emerging/re-emerging diseases, esp. zoonoses (rats/bats/birds)

50 YA Globalization, population translocations (wars, migration,international travel, trade, commerce, tourism, work, etc)

Disease management through:

• Drugs

What can be done?

• Vaccines

• Biological interventions

Drug discovery

Kinch et al. 2014Drug Discovery Today

New

Molecular

Entities

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Infectious diseases (n=240)AcinetobacterActinomycosisAfrican trypanosomiasisAcquired immunodeficiency syndromeAmoebiasisAnaplasmosisAngiostrongyliasisAnisakiasisAnthraxArcanobacterium haemolyticumArgentine haemorrhagic feverAscariasisAspergillosisAstrovirusBabesiosisBacillus cereusBacterial pneumoniaBacterial vaginosisBacteroidesBalantidiasis




SchistosomiasisSepsisShigellosisShinglesSmallpoxSporotrichosisStaphylococcoal food poisoningStaphylococcusStrongyloidiasisSubacute sclerosing panencephalitisSyphilisTaeniasisTetanusTinea barbae Tinea capitisTinea corporisTinea crurisTinea manumTinea nigraTinea pedisBalantidiasis

BartonellosisBaylisascarisBK virusBlack piedraBlastocystosisBlastomycosisBolivian haemorrhagic feverBotulismBrazilian haemorrhagic feverBrucellosisBubonic plagueBurkholderiaBuruli ulcerCalcivirus (Norovirus, Sapovirus)CampylobacteriosisCandidiasis (moniliasis, thrush)CapillariasisCarrion’s diseaseCat-scratch diseaseCellulitisChagas diseaseChancroidChickenpoxChikungunyaChlamydiaChlamydophila pneumoniae Cholera

DracunculiasisEbola haemorrhagic feverEchinococcosisEhrlichiosisEnterobiasisEnterococcusEnterovirusEpidemic typhusErythema infectiosum (fifth disease)Exathem subitum (sixth disease)FasciolasisFasciolopsiasisFatal familial insomniaFilariasisFood poisoning (Cl. perfringens)Free-living amoebaeFusobacteriumGas gangrene (Cl. myonecrosis)GeotrichosisGerstmann-Straussler-Scheinker syndromeGiardiasisGlandersGnathostomiasisGonorrhoeaGranuloma inguinale (donovanosis)Group A StreptococcusGroup B Streptococcus




Diseases for which drugs are available (n=160)AcinetobacterActinomycosisAfrican trypanosomiasisAcquired immunodeficiency syndromeAmoebiasisAnaplasmosisAngiostrongyliasis

AnthraxArcanobacterium haemolyticum

AscariasisAspergillosis

BabesiosisBacillus cereusBacterial pneumoniaBacterial vaginosisBacteroidesBalantidiasis

ChromoblastomycosisClonorchiasisClostridium difficile colitisCoccidioidomycosis

Cryptococcosis

Cutaneous larval migransCyclosporiasis

Dientamoebiasis

Diphyllobothriasis

Haemophilus influenzae

Helicobacter pyloriHaemolytic uremic syndrome

Hepatitis C

HistoplasmosisHookworm

Human ewingii ehrlichiosisHuman granulocytic anaplasmosis

Human monocytic ehrlichiosis

Meningococcal diseaseMetagonimiasis

Murine typhus (endemic)

MyiasisNeonatal conjunctivitis

NocardiosisOnchocerciasisOpisthorchiasis

ParagonimiasisPasteurellosisPediculosis capitisPediculosis corporisPediculosis pubis

SchistosomiasisSepsisShigellosis

SporotrichosisStaphylococcoal food poisoningStaphylococcusStrongyloidiasis

SyphilisTaeniasisTetanusTinea barbae Tinea capitisTinea corporisTinea crurisTinea manumTinea nigraTinea pedis

67%BalantidiasisBartonellosisBaylisascaris

Black piedra

Blastomycosis

Botulism

Brucellosis

Buruli ulcer

CampylobacteriosisCandidiasis (moniliasis, thrush)CapillariasisCarrion’s disease

CellulitisChagas diseaseChancroid

Chlamydia

Cholera

EchinococcosisEhrlichiosisEnterobiasisEnterococcus

Epidemic typhus

FasciolasisFasciolopsiasis

FilariasisFood poisoning (Cl. perfringens)

FusobacteriumGas gangrene (Cl. myonecrosis)Geotrichosis

Giardiasis

GnathostomiasisGonorrhoeaGranuloma inguinale (donovanosis)Group A StreptococcusGroup B Streptococcus

Human monocytic ehrlichiosis

Hymenolepiasis

Isosporiasis

KeratitisKingella kingae

Legionellosis (Legionnaire’s disease)Legionellosis (Pontiac fever)LeishmaniasisLeprosyLeptospirosisListerosisLyme diseaseLymphatic filariasis

Malaria

MelioidosisMeningitis

Pediculosis pubisPelvic inflammatory disease

PlaguePneumococcusPneumocystis pneumoniaPneumonia

Prevotella

PsittacosisQ fever

Relapsing fever

RickettsiaRickettsialpox

Rocky Mountain spotted feverRotavirus

Salmonellosis

Scabies

Tinea pedisTinea unguiumTinea versicolorToxocariasis (ocular)Toxocariasis (visceral)TrachomaToxoplasmosisTrichinosisTrichomoniasisTrichuriasisTuberculosisTularemiaTyphoid feverTyphus feverUreaplasma urealyticumValley fever

Vibrio vulnificusVibrio parahaemolyticus

White piedraYersinia pseudotuberculosisYersiniosis

Zygomycosis

means33% are

untreatable

Diseases with drug-resistance problems (n=55)AcinetobacterActinomycosisAfrican trypanosomiasisAcquired immunodeficiency syndromeAmoebiasis

Babesiosis

Bacterial pneumoniaBacterial vaginosisBacteroides

Chromoblastomycosis

Coccidioidomycosis


Helicobacter pyloriHaemolytic uremic syndrome

Meningococcal disease

MyiasisNeonatal conjunctivitis

Nocardiosis

Pediculosis capitisPediculosis corporisPediculosis pubis

SepsisShigellosis

Staphylococcoal food poisoningStaphylococcus

Syphilis

34%Brucellosis

Buruli ulcer

CellulitisChagas diseaseChancroid

Enterococcus

FasciolasisFasciolopsiasis

Food poisoning (Cl. perfringens)

Giardiasis

Gonorrhoea

Group A Streptococcus

KeratitisKingella kingae

LeishmaniasisLeprosy

Lymphatic filariasis

Malaria

Meningitis

Pediculosis pubisPelvic inflammatory disease

Pneumococcus

Pneumonia

Salmonellosis

Scabies

Trichomoniasis

Tuberculosis

Typhoid fever

Valley fever

Vibrio vulnificus

Vaccines

Infectious diseases (n=240)AcinetobacterActinomycosisAfrican trypanosomiasisAcquired immunodeficiency syndromeAmoebiasisAnaplasmosisAngiostrongyliasisAnisakiasisAnthraxArcanobacterium haemolyticumArgentine haemorrhagic feverAscariasisAspergillosisAstrovirusBabesiosisBacillus cerreusBacterial pneumoniaBacterial vaginosisBacteroidesBalantidiasis

ChromoblastomycosisClonorchiasisClostridium difficile colitisCoccidiomycosisColorado tick feverCommon cold (acute viral rhinopharyngitis, acute coryza)Creutzfeldt-Jacob disease (CJD)Crimean-Congo haemorrhagic feverCryptococcosisCryptosporidiosisCutaneous larval migransCyclosporiasisCysticercosisCytomegalovirusDengue feverDesmodesmusDientamoebiasisDiphtheriaDiphyllobothriasisDracunculiasis


Meningococcal diseaseMetagonimiasisMicrosporidiosisMolluscum contagiosumMonkeypoxMumpsMurine typhus (endemic)Mycoplasma pneumoniaMycetomaMyiasisNeonatal conjunctivitisNew –variant CJDNocardiosisOnchocerciasisOpisthorchiasisParacoccidiomycosisParagonimiasisPasteurellosisPediculosis capitisPediculosis coprporisPediculosis pubis

SchistosomiasisSepsisShigellosisShinglesSmallpoxSporotrichosisStaphylococcoal food poisoningStaphylococcusStrongyloidiasisSubacute sclerosing panencephalitisSyphilisTaeniasisTetanusTinea barbae Tinea capitisTinea corporisTinea crurisTinea manumTinea nigraTinea pedisBalantidiasis

BartonellosisBaylisascarisBK virusBlack piedraBlastocystosisBlastomycosisBolivian haemorrhagic feverBotulismBrazilian haemorrhagic feverBrucellosisBubonic plagueBurkholderiaBuruli ulcerCalcivirus (Norovirus, Sapovirus)CampylobacteriosisCandidiasis (moniliasis, thrush)CapillariasisCarrion’s diseaseCat-scratch diseaseCellulitisChagas diseaseChancroidChickenpoxChikungunyaChlamydiaChlamydophila pneumoniae Cholera

DracunculiasisEbola haemorrhagic feverEchinococcosisEhrlichiosisEnterobiasisEnterococcusEnterovirusEpidemic typhusErythema infectiosum (fifth disease)Exathem subitum (sixth disease)FasciolasisFasciolopsiasisFatal familial insomniaFilariasisFood poisoning (Cl. perfringens)Free-living amoebaeFusobacteriumGas gangrene (Cl. myonecrosis)GeotrichosisGerstmann-Straussler-Scheinker syndromeGiardiasisGlandersGnathostomiasisGonorrheaGranuloma inguinale (donovanosis)Group A StreptococcusGroup B Streptococcus

Human monocytic ehrlichiosisHuman papillomavirusHuman parainfluenza virusHymenolepiasisEpstein-Barr virus infectiousmononucleosisInfluenzaIsosporiasisKawasaki diseaseKeratitisKingella kingaeKuruLassa feverLegionellosis (legionnaire’s disease)Legionellosis (Pontiac fever)LeishmaniasisLeprosyLeptospirosisListerosisLyme diseaseLymphatic filariasisLymphocytic choriomeningitisMalariaMarburg haemorrhagic feverMeaslesMiddle-East respiratory syndromeMelioidosisMeningitis



Vaccination-preventable diseases (n=24)

Diphtheria


Hepatitis AHepatitis B

Hepatitis D

Meningococcal disease

Mumps

Tetanus

Chickenpox

Cholera

Ebola haemorrhagic fever Human papillomavirus

Influenza

Measles

Pertussis

Pneumococcus

Poliomyelitis

Rabies

RotavirusRubella

Tuberculosis

Typhoid fever

Viral encephalitis

Yellow fever

10%

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Biological interventions

Sources

• people

• animals

t

(break cycle)

• water• food

• air

Biological interventionsTarget:

• hygiene

• sanitation

• vectors• vectors• reservoir hosts

• environments

• behaviours

It is all about education!‘night-soil’ pots

Life in the tropics is tough!

ENJOY THE CONGRESS!

Tropical Medicine - COnnecting REpositories · Gas gangrene (Cl. myonecrosis) Geotrichosis...

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