We spoke to Pathology Awareness Australia ambassador, Dr Penny Yarrow (pictured left) to find out about some of her recent, unusual diagnoses.

“We recently had a case of leprosy which is quite unusual. The patient had been living in Tasmania for about 18 months but was a refugee from the middle east. Although the patient had been seeing a doctor for a little while leprosy wasn’t suspected, the doctor was really kicking themselves when we came back with the diagnosis.”

Leprosy is rare in Australia. It is a chronic bacterial infection caused by Mycobacterium leprae and affects the nervous systems of the body. Contrary to popular belief, leprosy is curable and is not highly contagious, but can be passed on by close and frequent contact with an infected person and may cause nerve damage if not treated.

The most common symptom is skin lesions. The case that Dr Yarrow found was detected in a skin biopsy taken by the patient’s doctor.

Dr Yarrow told us of another unusual case also detected via a skin sample. The patient was also a refugee but was a more recent arrival. The sample was taken from the patient’s lip and the diagnosis was leishmaniasis.

The condition is caused by Leishmania parasites. It can cause painful skin sores and ulcers leaving lifelong scars. If left untreated it can spread to the organs and may be fatal.

Both diagnoses required the skill of an anatomical pathologist examining the samples under a microscope looking for particular features, then applying additional chemical stains to highlight the bacterial and parasitic organisms.

“These cases are a great example of anatomical pathology, microbiology and the patients’ doctors working together. With good communication, a good history and sending the right tissue to the pathology lab to be tested we were able to make those diagnoses. In both cases knowing that the patients were recently arrived refugees was a crucial clue.

This was so important for the patients to get the right treatment and also to prevent any spread of disease.”

Dr Yarrow also recently found an unexpected tumour. She was sent an appendix for examination, which is standard practice when someone has had their appendix removed, and found a carcinoid tumour less than two centimetres in diameter.

“Whenever an appendix is removed it is examined by a pathologist to check for anything of concern, they can contain pinworms and other organisms as well as tumours.

This patient had acute appendicitis but there was no suspicion of a tumour. Tumours in the appendix are not uncommon but he was lucky we caught it early. He probably won’t need further treatment as there were no worrying features to the tumour. Fortunately, the cancer hadn’t spread to the fat around the appendix, if that happens it can spread further and be fatal. It was a lucky escape.”

The post A dangerous parasite, a hidden tumour and leprosy….pathology in Tasmania first appeared on Know Pathology Know Healthcare.

Up until 2011 fascioliasis was rare in Australia with only a few cases being reported, mostly amongst sheep farmers in Victoria. However, the MJA case series, “Fascioliasis in Australian travellers to Bali” found there were six diagnoses between 2011 and 2014. Given the popularity of Bali as a holiday destination and the specificity of the testing needed to diagnose fascioliasis it is important that Australian GPs are aware of the infection.

Fascioliasis is an infectious disease caused by Fasciola hepatica parasites, which are flat worms known as liver flukes, found in the bile ducts and liver of infected animals such as sheep and cattle.

The flukes are transmitted from animals to people via ingesting contaminated watercress, salads and other freshwater plants or contaminated water, (either by drinking it or by eating vegetables that were washed with it). Up to 40% of Bali cattle are reportedly infected with a form of Fasciola known as Fasciola gigantica, hence the presence of infection in Australians who have visited Bali.

According to the MJA case report pathology plays an important role in correctly diagnosing fascioliasis and therefore ensuring patients receive timely and appropriate treatment. Common symptoms of the infection include fever and abdominal pain, but these could be attributed to a multitude of infections.

Dr Miles Beaman is a pathologist specialising in microbiology who was one of the paper’s authors. Dr Beaman said. “Pathology is able to offer answers that other medical investigations may otherwise miss.

Radiological findings, for example, are often non-specific for fascioliasis. Ultrasonography and CT scans can be used to look for lesions on the patient’s liver caused by the infection. However, images from these are inconclusive in many cases.”

The infection can be diagnosed by examining stool specimens under a microscope (the diagnosis is confirmed if Fasciola eggs are seen) but it takes approximately 4 months for eggs to appear in the stool and therefore this approach is not appropriate for an early diagnosis. In the cases reported in the MJA study, stool microscopy did not yield positive results for any of the six patients.

Instead, the six recent cases of fascioliasis in Australian patients were all diagnosed by specific serology to identify Fasciola antibodies in the blood serum. Results of serological testing may become positive 2–4 weeks after infection, preceding the presence of eggs in the stool. Currently, however, in Australia, serological testing is only available at the Institute for Clinical Pathology and Medical Research at Westmead.

Luckily, fascioliasis is treatable, however an accurate diagnosis is important because the drug used to treat the infection, Triclabendazole, is difficult to obtain in Australia for human use, and therefore has to be either imported or acquired through veterinary supply. Prescription requires Special Access Scheme approval and hospital ethics approval for use in humans.

It is important that doctors in Australia are aware that fasciolasis has now been found in Australian travellers and have an up to date knowledge of the recommendations on testing and treatment. An increased awareness of parasitic causes is important in facilitating timely referral to an infectious diseases or microbiology service for assistance with diagnosis and management and although previously no cases had been reported, our love for Bali doesn’t seem to be shifting. There are likely to be further cases affecting locals and tourists.

The post How pathology is helping to ensure travellers to Bali aren’t left with an unwanted souvenir first appeared on Know Pathology Know Healthcare.