2015 2 s Newsletter

World Pathology Day 3 Sjogren’s syndrome 4 SA antibiogram 6 Inside Pathology at your fingertips 8 Donating bone tissue 10 Genetic testing 10 Respiratory virus update 12

For our patients and our population www.sapathology.sa.gov.au From the Respiratory serology changes SA Pathology is decommissioning two antibody test services, the inside Chlamydophila pneumoniae and Respiratory Viruses by Complement This is a time of massive change for the Fixation Tests (CFT). From the Executive Director health system, including for SA Pathology, with the impacts of a burgeoning older Alternatives population and increased demand for You are encouraged to request timely access to affordable and quality PCR tests for faster, more sensitive pathology services, coupled with budget diagnosis of respiratory viruses, pressures on the health system and the M. pneumoniae and B. pertussis. implementation of new computer systems Serological tests for other pathogens and improved pathology automation. including Legionella, M. pneumonia and B. pertussis are not affected. In line with the Transforming Health initiative’s need to provide ‘the best care, Respiratory virus and Chlamydophila first time, every time’, our services will serology is now only available on continuously evolve and improve to focus paired samples and if required, CFT on achieving better outcomes for our testing can be arranged. patient population in partnership with all our Local Health Networks and clinicians. Why the change? Whilst antibody testing can provide With the delivery of new e-Health systems a diagnosis of a definitive we are pleased to bring you this and analysers designed to handle millions result requires evidence of rising issue of the SA Pathology Newsletter, of tests every year, it is imperative our antibody levels in specimens collected the first for 2015, and trust you will organisation is ready when the new Royal two weeks apart. Paired samples are find it filled with relevant and useful Hospital opens its doors in infrequently received and patients information. 2016. have usually recovered from illness, As you will be aware from reports in the You can be assured we will continue hence follow-up testing is rarely media, the efficiency and effectiveness of to deliver accurate, timely results to sought, resulting in low test volumes. SA Pathology was externally reviewed last support you in the care of your patients, year by SA Health. As ’s maintaining our critical support of During 2013-14, SA Pathology public and most comprehensive medical staff in both the private and received over 4,500 samples for pathology provider it is appropriate that public sectors, and our reputation for Chlamydophila pneumoniae and our performance is reviewed regularly, scientific and clinical excellence. over 3,000 samples for respiratory particularly in the face of rapidly changing virus testing, from which only one technology and demographics. Mr Ken Barr patient showed evidence of infection based on paired specimens.

New Patient Centres With the introduction of the molecular For your patients’ convenience SA Pathology has opened two new assay, a test for respiratory pathogens patient centres. is now available for reliable diagnosis of acute viral infection on a range of Campbelltown Port Augusta samples. Located within the Health Centre Located within the Ghan Medical 58 Newton Road, Campbelltown Centre, 16 Young Street, Port Augusta More Information Monday – Friday 8.30am to12.30pm Mondays, Tuesdays and Thursdays If you wish to speak to a pathologist, from 8.30am to 11.30am call SA Pathology on 8222 3000 and ask for the on-call microbiologist. ¥ For a complete list of our Patient Centres visit www.sapathology.gov.au

SA Pathology Newsletter Contact Design Published by SA Pathology [email protected] Sue Dyer Design Editorial Committee Photography Cover Our new Pathology Guide, Mark Fitz-Gerald, Ming Qiao, SA Pathology Photo and Imaging all our tests and mobile friendly too Dianne Zurcher, Kieran Weir Printing ISSN 2203 – 2339 Print and David Johnston Fivestar Print ISSN 2203 – 2347 Online

SA Pathology Newsletter > 2 – 2015 PAGE 2 WORLD PATHOLOGY DAY Across the nation and around the world, the inaugural World Pathology Day was held on 5th of November 2014. Commencing the week with ‘Open On World Pathology Day, the ABC Many people passing through the Lab’ on November 3rd, SA Pathology 891Mornings radio program featured area took the opportunity to talk to our invited clinicians and medical students Professor Howard Morris and Doctor scientists and look through microscopes to see its main Frome Road Adelaide Penny Coates, who explained at images of cells and tissue, and to laboratories and automated pathology pathology’s critical role in patient discuss pathology’s role in health care. systems in operation. diagnosis and treatment. We enjoyed providing the South Feedback from attendees was Offering the public a unique insight Australian public a unique insight into extremely positive and SA Pathology into pathology’s role in medical the critical service pathology offers and plans to hold similar Open Lab events diagnosis, SA Pathology mounted a thank our partner organisations RAH later this year. display of anatomical specimens in and RCPA for their support. ¥ the foyer.

Parasite testing Medicare rebate changes

SA Pathology has introduced a new In December 2014 Medicare n taking medication known to molecular testing regime for faecal announced that Folate, Vitamin D, decrease 25OH-D levels such as parasites. B12 and Haemoglobin A1c (HbA1c) anticonvulsants tests would only be covered by rebates n having chronic renal failure or renal For routine initial testing Polymerase for patients with specified clinical transplant recipients. Chain Reaction (PCR) molecular conditions. tests have now replaced traditional Haemoglobin A1c microscopy. PCR detects significantly For patients who meet these changed For diagnosis of diabetes mellitus in more parasite for most conditions, please include appropriate asymptomatic at-risk patients, HbA1c common pathogens including G clinical notes. is rebated once every 12 months only. intestinalis, E histolytica, D fragilis In patients known to have diabetes, and Cryptosporidium spp. It can Folates the HbA1c is still rebated up to four distinguish between pathogenic and Red Cell Folate and Serum Folate are times per year for the management non-pathogenic Entamoeba and offers covered by Medicare if the patient is of their condition. faster turnaround times. deemed at risk of folate deficiency due to anaemia, pregnancy, malabsorption B12 What to collect or malnutrition. Up to 30% of patients with B12 Collect unpreserved faecal specimens; deficiency may show serum B12 levels there is no requirement for a special Vitamin D in the lower normal range. For better faecal parasite collection kit. Where A suite of conditions apply; all are diagnosis of this patient group, indicated by a patient’s clinical history, covered in the Path Brief currently SA Pathology will automatically add such as recent overseas travel, or if available on the SA Pathology website. a Holotranscobalamin in all pathology the patient is a migrant or refugee, Some examples of patients’ clinical tests with low or borderline B12 levels. microscopy tests will be performed in conditions include those; This will provide a more accurate addition to PCR. n suffering from malabsorption estimate of tissue B12 availability for (e.g. due to cystic fibrosis, short these patients. For further information about PCR bowel syndrome, inflammatory testing contact SA Pathology on bowel disease or untreated coeliac You do not need to change your 8222 3000 and ask for the on-call disease etc.) current ordering practice. ¥ clinical microbiologist. ¥ n having deeply pigmented skin, or chronic and severe lack of sun exposure

SA Pathology Newsletter > 2 – 2015 PAGE 3 www.sapathology.sa.gov.au

Sjogren’s

John Bahnisch syndrome

Sjogren’s syndrome (SS) is a slowly progressive and currently incurable autoimmune disorder characterised by the presence of autoantibodies and immune cells that target epithelial exocrine glands, specifically the salivary and lacrimal glands. Whilst lifespan is not generally reduced quality of life may diminish.

Presentation The secondary form involves gland decreased tear production, ulcers inflammation associated with and cornea abrasion. The principle features, known as the another autoimmune disorder such sicca complex, are: − xerostomia (failure of salivary as rheumatoid arthritis, SLE and glands) may cause mouth and n dry mouth scleroderma. throat dryness, speaking and n dry eyes swallowing difficulties, dental SS is characterised by two n lymphocytic infiltration of the decay, candidal mouth infections. phenomena. exocrine glands. − failure of other exocrine glands, 1 Lymphocyte infiltration of the including skin, respiratory tract, After systemic lupus erythmitosis exocrine glands with predominantly digestive system and genital (SLE), SS is the second most T cells, and progressive destruction tract. common autoimmune disorder, of the glands. Inflammatory n Systemic systems affecting 1% – 2% of the population. changes may block smaller gland Middle-aged women are most ducts. − Arthritic joint and muscular pain commonly affected with a female:male 2 B cell hyperactivity with − Lymphadenopathy ratio of 9:1. It also affects about circulating auto-antibodies − Renal disease 50% of rheumatoid arthritis patients directed against immunoglobulins and 30% of patients with other (rheumatoid factors) and − Vasculitis autoimmune diseases. cytoplasmic ribonucleoprotein − Nervous system. (anti-SSA and anti-SSB). Sjogren’s syndrome may be classified Recommended investigations as primary or secondary, both forms Clinical features The disease can be very difficult occuring with similar frequency. In most patients primary SS develops to diagnose. Symptoms are often very slowly and symptoms are not subclinical or vague, patients present Primary SS involves gland initially severe. Whilst the disease may to various specialists, dentists or inflammation (eyes and mouth) with take up to 10 years to develop from optometrists and no two people no other underlying autoimmune initial presentation some subjects have exactly the same symptoms or disorder. show characteristic serology years medical history. Investigations should before any symptoms develop. include:

n Schirmer test, for lack of secretions Did you know? Manifestations of SS include: > Sjogren’s syndrome is or dry eyes n non-specific systemic symptoms named after the Swedish n salivary gland investigation such as fatigue, arthalgia, myalgia ophthalmologist, − radiology and saliva production Henrik Sjogren, who first and Raynaud’s phenomenon. described it in 1933. n glandular symptoms − Lip or salivary gland biopsy − keratoconjunctivitis n ANF and autoantibodies to SSA (inflammation of the tear and SSB glands) may cause eye irritation, infection, blurred vision,

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Positive findings in four of these The combination of dry eyes, Treatment investigations represent a definite xerostomia, positive Schirmer’s 1 test There is at present no treatment diagnosis, while three represents and positive anti-SSA or anti-SSB that changes the course of the a possible diagnosis. antibodies is sufficient to make the disorder and treatment is targeted diagnosis of Sjogren’s syndrome. In n other common blood test results at symptom relief e.g. artificial tears conjunction with dry eyes, xerostomia (see IMVS Newsletter Issue 70) − autoantibodies to RF (80%), and positive Schirmer’s 1 test anti- and saliva, good dental hygiene, AMA and TPO SSA and anti-SSB have a sensitivity of prevention of infections and NSAIDs − anaemia (20%) 94% for SS. However these antibodies for arthritic relief. − raised ESR and normal CRP (90%) may be negative in up to 20% of patients with Sjogren’s syndrome in Lifespan is not usually reduced − polyclonal which case labial gland biopsy needs but quality of life may diminish. hypergammaglobulinaemia (80%) to be considered. B cell lymphoma may develop in − cryoglobulins (20% primary 5% of cases. ¥ disease).

CASE STUDY

A 49 year old female patient presented to her GP with a three month history of increasing muscular and joint pain, lethargy and tiredness, small joint arthralgia, dry mouth, eye irritation and recurrent conjunctivitis.

The clinical picture of dry mouth, Table 1 Initial laboratory results gritty eyes and small joint arthralgia raised the possibility of Sjogren’s RESULT RANGE syndrome. However a similar picture can be found in many other Routine chemistry normal conditions including antidepressant Haemoglobin 111 g/L 115 – 155 g/L side effects and as part of the fibromyalgia / fatigue symptom ESR 94 mm /hour 0 – 20 mm complex. Other conditions that C reactive protein < 6mg/L 8 mg/L need to be excluded include Immunoglobulin lymphoma, AIDS, sarcoidosis, • IgG 42.9 g/L 6.5 – 16 g/L graft versus host disease, hepatitis C infection and use of drugs for • IgA 2.67 g/L 0.6 – 4.0 g/L hypertension. • IgM 2.42 g/L 0.5 – 3.0 g/L Rheumatoid factor (RF) 1420 IU/mL < 14 IU/mL A subjective feeling of dry eyes is very common in the general Anti nuclear antibody (ANA) Speckled 1/160 Negative population so how should the differential diagnosis be Although ANA and RF are found in 80% of patients with SS, these antibodies established? An important step are found in patients suffering from other systemic rheumatic diseases before any investigation is including rheumatoid arthritis. If sicca is confirmed testing for specific carried out is to objectively autoantibodies associated with Sjogren’s syndrome, anti-SSA and anti-SSB measure decreased tear and antibodies, is indicated. saliva production. Further tests Initial laboratory Table 2 Follow up laboratory results investigations TEST RESULT The Schirmer’s test is used to measure tear production but it Anti-ENA antibodies anti-SSA and anti-SSB positive should be noted that the test can be rendered falsely positive by Serum protein electrophoresis No paraprotein detected, polyclonal many drugs. increase in lgG

Final diagnosis: Sjogren’s syndrome.

SA Pathology Newsletter > 2 – 2015 PAGE 5 www.sapathology.sa.gov.au

SA antibiogram – UTI therapy choices Dr Morgyn Warner

Urinary tract infection (UTI) is a very common type of bacterial infection seen in general practice. Effective empiric treatment for symptomatic infection is aided by information on epidemiology and local antimicrobial susceptibility patterns for common uropathogens.

To produce the antibiogram Escherichia coli was the most uropathogens versus 6% in females, antimicrobial susceptibility data common bacteria isolated in both and P. aeruginosa being isolated in was extracted from SA Pathology’s genders and all age groups (66% 5.6% of males versus 1.6% of females. laboratory information system for of isolates) accounting for >75% of urine bacterial isolates in samples sent uropathogens in females under 55. Therapy from general practices in metropolitan Prior to initiating treatment, it is Adelaide and rural South Australia Staphylococcus saprophyticus was important to consider whether in 2013. the second most common isolate in antibiotic treatment is necessary at women aged 15-55, accounting for 7% all, as asymptomatic bacteriuria is Antibiotic susceptibility testing is of UTI. In all other groups (females common but antibiotic therapy is performed primarily by antibiotic disc of other ages, males of all ages), not warranted when there are no and in accordance with the Clinical enterococci were the second most urinary symptoms, except in pregnant Laboratory Standards Institute (CLSI) common bacteria isolated from all women and patients about to undergo guidelines. Isolates are characterised urinary specimens, overall comprising urologic procedures. For symptomatic as sensitive, intermediately sensitive 8.5% of isolates. In males, enterococci patients requiring treatment, previous or resistant to a particular antibiotic. and P. aeruginosa featured more urine cultures if available, should be Most antibiotics (e.g. beta-lactams, prominently than in females, with reviewed. trimethoprim, quinolones) used to enterococci comprising 14% of all treat UTI concentrate in urine, so for UTI, antibiotics to which organisms Figure 1 (pie chart) Infection rates by gender and age; (bar chart) Relative have intermediate susceptibility are frequency of bacterial isolates (male/female) effective. For this urinary antibiogram, 15–55 yrs 18% isolates designated susceptible include 4–15 yrs 2% fully susceptible and intermediately >55 yrs <4 yrs 5% 80 75% susceptible isolates. >55 yrs <4 yrs 3% 70 54% Male 4–15 yrs 4% Susceptibility patterns 60 14%

Susceptibility patterns for the top 12 50 bacteria isolated from urine specimens 40 Female received from general practices in 86% 15–55 yrs South Australia are presented (Figure 30 39% 2). Of all urine specimens submitted Female to SA Pathology from general practice, 20 Male about one quarter grew bacteria 10 on which susceptibility tests were performed. 0 . c o l i 86% of specimens were from females E Enterococci with the majority for both males and Klebsiella sp. Enterobacter sp. females coming from those over age Proteus mirabilis Enterococcus sp. CitrobacterKlebsiella koseri oxytoca Klebsiella pneumoniae 55 (Figure 1). Pseudomonas aeruginosa Strep. agalactiae (Group B) Staphylococcus saprophyticus

SA Pathology Newsletter > 2 – 2015 PAGE 6

Patients with recurrent UTI For pyelonephritis, intravenous An antibiotic is generally considered previously treated with antibiotics amoxycillin plus gentamicin is appropriate empirical therapy for may show resistance to first-line recommended as first line therapy uncomplicated UTI when it is likely to agents and therapy should be with step down to oral therapy be effective versus around 80% of the tailored according to previous known once clinical improvement is seen. most likely pathogens. The antibiogram susceptibilities. Recommended duration of therapy presented in figure 2 supports the is 10-14 days. An alternative for TG:antibiotic recommendations for Therapeutic guidelines:antibiotic pyelonephritis treatment for patients trimethoprim or cephalexin as first (TG:antibiotic) recommend with significant renal impairment line agents, particularly as laboratory trimethoprim as first line empiric or penicillin allergy is ceftriaxone, antibiograms may over-represent treatment for uncomplicated however empiric use of ceftriaxone antibiotic resistance in community UTI, with alternatives being as a single agent may not cover all patients (for example, if a GP cephalexin, amoxycillin-clavulanate uropathogens, particularly in older empirically treats most patients and or nitrofurantoin. Recommended males where enterococci and only sends urine cultures duration of therapy is 3-5 days. P. aeruginosa are more frequently for patients identified, both of which are who fail initial Fluoroquinolones such as norfloxacin intrinsically resistant to ceftriaxone. therapy). ¥ or ciprofloxacin should not be used as first line drugs for UTI as they are the only oral option for treatment of Fluoroquinolones should not be P. aeruginosa and other multi- resistant gram-negative organisms. used as first line drugs for UTI

Figure 2 General practice urine culture antibiogram (metropolitan and rural) 2013

Narrower spectrum Broad spectrum antibiotics antimicrobials for selective use only AMP CEP TMP GEN NFT AUG TRI NOR Organism n % %S %S %S %S %S %S %S %S E. coli 11921 65.8 58 86 84 97 97 90 98~ 96 Enterococci 1565 8.6 98 R – – 98 – – 81 Proteus mirabilis 604 3.3 86 96 79 99 R 97 100 99 Klebsiella pneumoniae 564 3.1 R 95 88 98 52 97 >95* 97 Klebsiella sp. 560 3.1 R 96 93 99 73 96 >90* 99 Staphylococcus saprophyticus 466 2.6 99 99* 97 – – 100* 100* 100 Strep. agalactiae (Group B) 415 2.3 100 100* – – – 100 100* – Pseudomonas aeruginosa 394 2.2 – – – 97 – – R 95 Enterobacter sp. 272 1.5 R R 92 99 45 R – 99 Citrobacter koseri 187 1.0 R 96 98 100 83 97 100 100 Klebsiella oxytoca 159 0.9 R 65 97 97 88 94 89 100 Staphylococcus aureus 57 0.8 24 100 97 99 91 100 – 96 ˜ Ceftriaxone is not tested at all laboratories on routine urine specimens. AMP amoxycillin/ampicillin NFT nitrofurantoin This result represents testing from a single laboratory on approximately CEP cephalexin AUG amoxycillin-clavulanate 500 general practice E. coli specimens TMP trimethoprim TRI ceftriaxone * Not directly tested, result extrapolated from amoxycillin or cephalexin GEN gentamicin NOR norfloxacin

Colour Key n ≥ 90% susceptible R Intrinsic resistance is – Antibiotic not tested/ n Antibiotic not present with this no breakpoints available/ recommended to be 70-89% susceptible n organism-antibiotic not recommended used in children without n ≤ 70% susceptible combination specialist advice

Only species for which there are 30 or more isolates are reported. Percentages are shown only where more than 90% of isolates were tested for each organism unless specified above. Susceptibility Testing Method: CLSI

SA Pathology Newsletter > 2 – 2015 PAGE 7 www.sapathology.sa.gov.au

Pathology at your fingertips

SA Pathology’s website has recently undergone a major rebuild. A portal to all the information you need about our services, research and latest news, the site’s content and improved functionality makes it an invaluable asset for clinicians and patients alike. Key functions such as test and Patient Centre search are accessible directly from the home page, and the three column layout for News, Patients and Clinicians makes navigation easy.

News Patients Clinical support All the latest news in one place and Aimed squarely at your patients, The new Pathology Collection Guide is you can filter it to display just the column two presents all the information a quantum shift in how we present our clinical news for easy reading. they need to find our patient centres entire catalogue of tests, related data and prepare for their tests. and documents like test and patient Even better the site is scalable for information sheets and relevant links mobile devices, try it! to Medicare. Fast easy access to all the data you need. If you have any questions, phone Enquiries on (08) 8222 3000.

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• Enter the test name (or acronym/ partial name) • Click GO

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Looking for a pathologist? Mobile friendly

If you want to find one of our Find a Patient pathologists you can do it direct Centre near you from our home page. You’ll find their career background, qualifications and contact details – and you can sort by location and specialty.

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• Search results • Click on any test to open

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• Selected test is highlighted with a yellow border

• Related documents • Click to open

• MBS code • Links to Medicare

SA Pathology Newsletter > 2 – 2015 PAGE 9 www.sapathology.sa.gov.au Donating Bone Tissue

Like blood, bone is a precious The donation process is easy and If patients answer ‘no’ to both these resource and supply is critical only requires a blood test. To check questions, they are able to donate whether bone is healthy and will not bone tissue, which is thoroughly and many people depend on harm recipients, SA Pathology asks tested to ensure it is suitable for it for their operations. potential donors two questions; donation to patients needing surgery.

Do you have patients needing n Have they had a blood transfusion A simple blood test is all that’s hip or spinal surgery? Would or received any blood products in required after patients have donated the last six months? you consider asking them bone tissue. n Have they lived, visited, or received to make a donation of their blood in the United Kingdom for a If you do have a patient who may be excess bone tissue to the South period of over six months between interested, ask them to talk to their Australian Tissue Bank? 1st of January 1980 and 31st of orthopaedic surgeon. If you have December 1996? (This includes any clinical questions, please call the England, Scotland, Wales, Ireland, South Australian Tissue Bank on the Isle of Man and Channel (08) 8222 3301. ¥ Islands).

In NGS, DNA analysis is performed in Research improves routine a ‘massively parallel’ fashion, taking advantage of tremendous advances genetic tests in microfabrication, optics, and computing algorithms. Each DNA Most genetic conditions are complex and may be caused by mutations in any one sample is first barcoded so that patient or more of our thousands of genes. For this reason, diagnosis to date of many samples from different patients can genetic conditions has been extremely difficult, trying to select responsible genes be tracked; it is then processed so from a vast array of possibilities. that only those regions of interest are amplified and analysed. Careful clinical workup and review waiting for a diagnosis for many has often been insufficient to months, even years, while testing Testing can range from single genes appropriately prioritize genes for continued, and costs escalated. to the full protein-coding repertoire diagnostic testing. With each negative – the ‘whole-exome’ – involving up to result, a new test would be ordered, A breakthrough in DNA sequencing 20,000 human genes. The final step leaving some families technology has now fundamentally involves sophisticated bioinformatics changed this paradigm. ‘Next- that reassembles the millions of DNA generation sequencing’ (NGS) regions back together highlighting offers the ability to sequence many changes, or mutations. genes at once, eliminating the need to pick a likely gene at the start of Building on research expertise and the diagnostic investigation if the infrastructure in the Centre of Cancer diagnosis is not obvious. Biology’s ACRF Genome Facility, SA Pathology is proud to be at the For patients the cost of multi-gene forefront of implementing these testing with NGS is around the same technologies into our routine genetic as the cost of single gene sequencing pathology testing service. ¥ using previous technology.

SA Pathology Newsletter > 2 – 2015 PAGE 10 BLOOD NEWS

The project extended and formalised National Blood Award this practice across country SA, An important SA Pathology collaboration BloodMove is an innovative program a significant achievement involving to reduce blood wastage that won the ‘Non-Clinical Service Delivery Award’ 62 hospital sites and 17 metropolitan at the annual Australian Council on Healthcare Standards (ACHS) Quality and regional transfusion labs. Improvement Awards. Blood and blood products are precious The wastage minimisation program standard practice at all SA Pathology and costly resources and SA Pathology now operates across SA hospitals in metropolitan and regional transfusion is proud to be part of this major partnership with metropolitan and laboratories. conservation project. regional SA Pathology transfusion laboratories and achieved zero per cent (0%) red cell wastage in country SA in 2014.

The program’s success across the Country Health network is built on their partnership with SA Pathology in particular its Regional Services and Haematology Directorates and Calibration and Testing Laboratory.

The initiative began in a number of SA Pathology regional laboratories where local blood savings programs were already operating.

Blood stewardship through product L-R Lucas Semmler (Directorate Manager Regional Services SA Pathology), Roslyn Chataway, rotation subsequently became Rick Tocchetti, Merrilee Clarke, David Rosenthal

SA Pathology staff at Berri celebrate their Bloodnet Award and lowest blood wastage in the state Autoimmune Blood Bank South Australia’s first autoimmune Autoimmune diseases currently affect There is currently no cure for these blood bank has been set up by about 5% of the Australian population diseases and it is hoped the new scientists at SA Pathology for research and cost the community an estimated autoimmune blood bank will lead to into autoimmune diseases including $4.3 billion annually. a better understanding of the systemic lupus erythromatosis, diseases, their development and The group will collect blood to store systemic sclerosis, Sjogren’s syndrome hence the opportunities for new serum and nucleated blood cells from and vasculitis. therapeutic approaches. patients diagnosed with autoimmune disease to investigate new genotype and autoantibody diagnostic markers.

SA Pathology Newsletter > 2 – 2015 PAGE 11 www.sapathology.sa.gov.au i i i i i i H3N2Respiratoryi H3N2 9i virus H1N1update

In the 2014 winter we experienced the biggest influenza season ever in South Australia. The total H1N1test number exceeds 60000 compared to 43000 in the last pandemic influenza season in2009 . Influenza A (H1N1) pdm09 is the predominant strain (approx 70%) where H3N2 accounts for approx 30%. There has been very little activity of Influenza B viruses so far in the season (approx 7%).

Several other respiratory pathogens Antiviral drug effectiveness have also been active including Neuraminidase inhibitor susceptibility studies performed at WHO Influenza Respiratory Syncytial virus (RSV) in Centre indicated that only a small number of viruses tested showed highly early winter, Parainfluenza type 3 in reduced inhibition to the neuraminidase (Table 2). spring, Rhinovirus, Metapneumovirus and Adenovirus all year round. Table 2: Viruses tested for susceptibility to neuraminidase inhibitors (WHO Influenza Centre) Table 1 list all respiratory viral activity (including Mycoplasma pneumoniae Number of viruses with highly reduced inhibition and Bordertella pertussis) in 2014. Type/subtype No. viruses Oseltamivir Peramivir Zanamivir Laninamivir Table 1: Respiratory viral and bacterial tested pathogens A(H1N1)pdm09 839 4 (0.5%) 3 (0.4%) 0 0 Respiratory Viral Positive A(H3N2) 275 0 0 0 0 PCR Tests 2014 B/Victoria 35 1 (2.9%) 2 (5.7%) 1 (2.9%) 1 (2.9%) Influenza A 8106 B/Yamagata 188 0 2 (1.1%) 0 0 Influenza B 682 RSV 3313 VACCINATIONS Parainfluenza 1 803 Parainfluenza 2 101 2015 WHO Southern Hemisphere recommendations Parainfluenza 3 1373 It is recommended that trivalent vaccines for use in the 2015 influenza Adenovirus 1640 season (southern hemisphere winter) contain the following: Metapneumovirus 2253 an A/California/7/2009 (H1N1)-like virus Rhinovirus 9879 an A/Switzerland/9715293/2013 (H3N2)-like virus M pneumoniae 366 a B/Phuket/3073/2013-like virus B pertussis 265 It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Brisbane/60/2008-like virus.

All Enquiries 8222 3222 WE CAN HELP [email protected] SA Pathology’s Marketing and Business Business development Business Development Officers Services group can provide support and Marketing Director Emma Przibilla 0401 120 833 assistance to ensure your practice and patients David Johnston Steven Moore 0478 405 694 gets the very best pathology service. 0402 387 870 David Connolly-Hay 0401 120 712

If you would like to know more about how we can help please call us today

SA Pathology enquiries > Metropolitan 8222 3000 > Regional and Country 1800 188 077

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