Enterovirus 71 outbreak in Northern Sydney, 2013: case series and initial response

AIM

Enteroviruses are a common cause of childhood disease which may manifest in a variety of ways. Enterovirus 71 (EV71) is a subtype of enterovirus which can cause meningoencephalomyelitis resulting in neurological sequelae including lethargy, weakness, ataxia, sleep myoclonus, urinary retention and, in severe cases, cardiorespiratory collapse due to neurogenic pulmonary oedema. EV71 was responsible for outbreaks in South East Asia in 1997-1998, in Western Australia in 1999 and in Sydney in 2000-2001. In 2013, we are experiencing another EV71 outbreak in Sydney. This study describes the discovery of a new outbreak in Sydney's Northern Beaches, the clinical findings as well as the public health response.

METHODS

Thirty-seven children in total presented with presumed EV71 to the Northern Beaches Health Service from December 2012 to April 2013. Most children presented with a prodrome lasting 2-7 days prior to seeking medical attention. Sleep myoclonus was a common presenting sign occurring in 65%. Neurological signs were subtle in the majority of children and were at times missed by clinicians on a child's first presentation. Forty-six per cent of children who presented to Northern Beaches Health Service during this outbreak required a transfer to a tertiary paediatric centre for more intensive care.

RESULTS

The public health investigation was important in establishing that the disease was widespread throughout the community and not as a result to exposure to a single child care setting. Identification of risk factors enabled more targeted communication to medical practitioners, child care centres and parents within the local community.

CONCLUSIONS

EV71 is in Australia and all clinicians seeing children in primary, secondary and tertiary care centres need to be aware of the disease, the subtle nature of initial symptoms and the potentially devastating consequences.

The genome of the social amoeba Dictyostelium discoideum

The social amoebae are exceptional in their ability to alternate between unicellular and multicellular forms. Here we describe the genome of the best-studied member of this group, Dictyostelium discoideum. The gene-dense chromosomes of this organism encode approximately 12,500 predicted proteins, a high proportion of which have long, repetitive amino acid tracts. There are many genes for polyketide synthases and ABC transporters, suggesting an extensive secondary metabolism for producing and exporting small molecules. The genome is rich in complex repeats, one class of which is clustered and may serve as centromeres. Partial copies of the extrachromosomal ribosomal DNA (rDNA) element are found at the ends of each chromosome, suggesting a novel telomere structure and the use of a common mechanism to maintain both the rDNA and chromosomal termini. A proteome-based phylogeny shows that the amoebozoa diverged from the animal-fungal lineage after the plant-animal split, but Dictyostelium seems to have retained more of the diversity of the ancestral genome than have plants, animals or fungi.

Gingko biloba (Rökan) therapy in tinnitus patients and measurable interactions between tinnitus and vestibular disturbances

Tinnitus is one of the most important symptoms in neurootology after vertigo, nausea, and hearing loss. In most cases, the origin of the tinnitus remains inexplicable. Well-known, however, is that tinnitus may arise in any part of the hearing pathway (i.e., both within the cochlea receptor and in the temporal lobe and projections). Tinnitus also is associated frequently with vertigo, nausea and hearing loss. An age predominance exists, with tinnitus more common among those older than 40 years. From this starting point, a great demand exists today for new ideas and developments in the diagnosis and treatment of tinnitus.

Competitive-kinesthetic interaction therapy

The competitive-kinesthetic interaction therapy is based on several clinical observations of patients who are treated with the Brügger therapy in the "Murnau approach" and who are suffering from different pain syndromes in their movement system. These patients reported definite lessening of their tinnitus, including (in some cases) a complete cessation of their subjective ear noise, as a result of our therapy on the movement system. Our goal is to modulate and automate the civilizatory unforable engraved individual global movement patterns. This success, which accompanied the therapeutic removal of movement imbalance and related posture and motion disorders, suggests the possibility of influencing the balance-surveying organs of the complex equilibrium system, summarizing the information from the equilibrium tetrad within a central space-oriented data processing system, via the muscles of the entire locomotor system. A very important point is that the subjective improvements can be objectified in brain electrical activity mapping of vestibular evoked potentials. Two-hundred patients were treated with this therapy and were examined between April 1998 and April 1999.

[Cardiac effects of Cordemcura in vitro]

Cordemcura has a dose-dependent inotropic effect in the Langendorff-perfused guinea pig heart, in the isolated spontaneously active atria of the guinea pig as well as in the isolated electrically stimulated rabbit papillary muscle. Tachyphylaxy symptoms and arrhythmogene side-effects have not been observed. The dose-dependent coronardilatory effect caused by Cordemcura as observed at the isolated heart of a guinea-pig appears intensely. The positive inotropic effect by Cordemcura on an isolated electrically stimulated papillary muscle of a rabbit is linked with a significant decrease of the relaxation time t2, whereas there is no change in the time to peak force t1. Both mean velocity of force development S1 as well as the mean velocity of relaxation S2 are increased by Cordemcura.