Bacterial infections

Legionella bacteria can cause 2 illnesses in humans:

• Legionella pneumonia (Legionnaires’ disease) and
• a mild flu-like illness (Pontiac fever).

Legionnaires’ disease (legionellosis) is an infection of the lung (pneumonia) caused by the Legionella bacteria.

Exposure to the Legionella bacteria will not necessarily lead to the disease, but the bacteria can cause a type of pneumonia that can be fatal. It can take 2 to 10 days for the symptoms to develop after inhaling the bacteria however symptoms usually appear within 5 to 6 days.

Over the last 5 years, there have been a total of 29 cases of legionellosis reported in the Northern Territory (NT), with around 350 to 500 cases notified nationally each year during this period.

Pontiac fever is not associated with pneumonia or death. Symptoms appear 5 to 66 hours after exposure to the Legionella bacteria, most often between 24 and 48 hours and resolve without treatment.

Where Legionella bacteria comes from

Legionella bacteria are found naturally in low levels in the environment. There are several species of Legionella, but the ones associated with human disease are Legionella pneumophila and Legionella longbeachae.

Legionella pneumophila may be found in environments such as water cooling systems (cooling towers), warm water systems or water heaters, shower heads and spa pools and outdoor fountains. In the absence of effective maintenance and cleaning, high numbers of the bacteria may be found.

Legionella longbeachae occur in potting mix or soils.

The most common way Legionella infection is contracted is by breathing air contaminated with Legionella bacteria. Air is contaminated when aerosols (very fine droplets of water) containing Legionella bacteria are released. The aerosol needs to be very small so that it can penetrate deeply into the lung.

Evaporative cooling units sometimes used in home air conditioning units have not been known to cause Legionnaires’ disease. Legionnaires’ disease is not transmitted from person to person.

Symptoms

Non-specific ‘flu-like’ symptoms usually occur in the first 24 to 48 hours.

Common symptoms of Legionnaires’ disease include:

• high temperature (fever)
• stomach cramps and diarrhoea
• dry cough or a cough that may produce sputum
• shortness of breath
• aches and pains in the muscles
• chills
• feeling confused
• headache
• feeling tired and loss of appetite.

Not all of the symptoms need to be present for diagnosis. People with these symptoms should see their doctor immediately.

The symptoms of Pontiac fever include:

• feeling tired and loss of appetite
• high temperature (fever)
• chills
• headache
• aches and pains in the muscles.

Pontiac fever does not present as pneumonia and has not been associated with death.

Diagnosis

Specialised laboratory tests using blood, urine or lung secretions (sputum) are necessary to establish a definite diagnosis of Legionella infections.

Note: Legionnaires’ disease is a notifiable disease under the Notifiable Diseases Act so all cases are reported to the Centre for Disease Control.

Who is most at risk

Those at risk include:

• older people (aged over 50 years)
• people with chronic lung disease
• people with diseases that weaken the immune system such as diabetes and chronic kidney disease
• people who are taking medications which suppress the immune system, including corticosteroid tablets
• liver or kidney transplant patients and cancer patients
• smokers.

Treatment

Treatment for Legionnaires’ disease is with an antibiotic. For those people with serious symptoms such as severe difficulty in breathing admission to hospital may be required.

People with Pontiac fever generally recover spontaneously within 2 to 5 days and antibiotic treatment is not required.

Prevention

Best practice guidelines include regular treatment, cleaning, maintenance and monitoring of water-cooling systems, warm water systems and water storage units performed by the proprietor of a building in accordance with national standards and work health and safety requirements.

An operation and maintenance manual should be kept by the building proprietor and be readily accessible at all times.

People are encouraged to avoid direct inhalation of potting soil or to wear protective coverings over their nose and mouth. People are also encouraged to wash their hands thoroughly after handling potting mix or soil, especially before eating or drinking.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information contact your nearest Centre for Disease Control.

Q fever is an acute febrile illness caused by the bacterium Coxiella burnetii.

Where is the disease found

Q fever is present in all countries except New Zealand. In Australia the disease is present in all jurisdictions including the Northern Territory, although is more commonly found in northern New South Wales and Queensland.

How it is spread

The bacteria are most commonly carried by cattle, sheep and goats but may also be carried by a wide variety of other species of livestock, domesticated pets and wild animals. Infected animals are often well and may show no signs of the disease.

Infection in humans usually occurs by inhalation of the bacteria contained in fine aerosol particles from infected animals shed in placental tissue and amniotic fluid, blood, milk, urine or faeces.

Humans can also be infected indirectly by exposure to contaminated dust in the environment, which may be a long way from the original source. These organisms can survive in the environment for a long period of time as they are resistant to heat, drying and common disinfectants.

Less commonly Q fever may be caused by drinking unpasteurised infected milk, by bites from infected ticks or through cuts or skin wounds from contaminated equipment or the environment. Human to human transmission is not thought to occur.

Incubation

Symptoms occur 2-4 weeks after infection occurs.

Symptoms

About 50% of people with Q fever will have no symptoms at all. Others may develop a brief and mild illness. Q fever can however present with an acute severe influenza-like illness, commonly resulting in infection of lungs or liver.

Patients may develop one or more of the following symptoms:

• sudden onset of acute fever greater than 39ºC (usually lasts 1-2 weeks)
• chills or rigors
• profuse sweating
• non-productive cough
• chest pain
• severe headache
• photophobia
• confusion
• muscle pain
• fatigue
• nausea / vomiting / loss of appetite
• diarrhoea
• jaundice
• rash.

Death from acute Q fever is rare.

In 1-5%, Q fever may persist and cause chronic infection. Most commonly this affects the heart valves, particularly if there is already underlying valve damage, and can lead to heart failure. Chronic bone infection can also occur.

Sometimes the only symptom is fever lasting for more than a week, so it is important to make your doctor aware of any potential animal exposure so that Q fever can be considered.

Up to 20% of those infected develop a post Q fever fatigue syndrome.

Who is at risk

Occupational groups most commonly at risk include:

• abattoir workers
• meat processing workers
• livestock workers
• veterinarians and veterinary nurses
• people visiting stockyards or those coming in contact with infected animal secretions and products of conception.

Treatment

Antibiotic treatment, usually doxycycline, given within 3 days of onset and continuing for 14-21 days is the most effective treatment for acute Q fever. Further treatment may be needed in chronic Q fever or if there are complications.

Prevention

• educate workers and the public on the sources of infection
• emphasis needs to be placed on the importance of showering after working in at risk settings and washing clothes as infected particles may be carried on clothing
• appropriate disposal of birth products from any animals that come in contact with humans
• unpasteurised milk products should not be consumed.

Vaccinations

• vaccination is available for those at increased risk of Q fever
• to avoid unnecessary reactions to the Q fever vaccine a screening pre-vaccination skin test and a blood test are performed
• a national Q fever vaccination register stores information about vaccination, and testing - go to the Australian Q fever register website.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information contact your nearest Centre for Disease Control.

Listeriosis is an uncommon disease caused by the bacteria Listeria monocytogenes. In the Northern Territory 3 cases of listeriosis have been reported in the past 10 years. Over the same time period there has been an average of 73 cases per year reported throughout Australia.

How it is spread

The disease is generally spread by eating food contaminated with the bacteria, most commonly ready-to-eat meats, and unpasteurised milk or other dairy products particularly soft cheeses.

It can also pass from a pregnant woman to her unborn baby via the placenta, or to the baby during birth.

As the bacteria are widespread in nature and commonly found in soil, water, sewage and most animals, some exposure to these bacteria is generally unavoidable.

Symptoms

Symptoms may develop from a few hours to 3 months after exposure to the bacteria, but most often occur around 3 weeks later. Young, healthy people may have few if any symptoms, but the disease can be severe in at-risk groups.

If symptoms do develop, these often include fever, headache, tiredness, muscle aches, abdominal cramps, nausea and diarrhoea.

If infection spreads to the nervous system, symptoms such as stiff neck, confusion, loss of balance and convulsions may occur.

Who is at risk

The following groups are at greatest risk of severe disease:

• anyone who has a weakened immune system, due to chronic disease, diabetes, alcoholism or steroid treatment
• the elderly
• newborn babies
• pregnant women and their unborn babies.

Although a pregnant woman may have few or no symptoms, the risk of passing the infection on to her unborn baby is high. Infection of the unborn baby usually occurs about 3 days after the mother is infected, and may lead to miscarriage, stillbirth, premature birth or a seriously ill newborn.

Infectious period

Infected people can shed the bacteria in their faeces for several months. Mothers of infected newborns may pass on the bacteria in vaginal discharges and urine for 7 to 10 days after giving birth.

Treatment

Listeriosis can be effectively treated with antibiotics if treatment is given promptly. Newborn infants have a high mortality rate (20-30%) despite antibiotic treatment.

Prevention

Unlike most other food-contaminating bacteria, listeria can survive and grow in the refrigerator, although it is readily killed during cooking.

General food hygiene measures should be followed, including:

• thoroughly cook raw food from animal sources, such as beef, pork or chicken
• wash raw vegetables thoroughly before eating
• keep uncooked meats separate from vegetables, cooked foods and ready-to-eat foods
• avoid unpasteurised milk products
• wash hands, knives and cutting boards after handling uncooked foods.

Additional precautions for pregnant women and those with weakened immune systems include:

• eat only freshly prepared foods
• re-heat left over foods or ready-to-eat foods such as hot dogs until steaming hot
• avoid ready-to-eat foods which have been refrigerated more than a day
• avoid eating dips and salad dressings which have previously been exposed to raw vegetables even if they have been refrigerated
• avoid high risk foods such as pâté, pre-packed sliced meat products, cooked diced chicken (as used in sandwich shops), soft cheeses (such as Brie, Camembert and ricotta), previously prepared coleslaws and salads, uncooked smoked fish, smoked shellfish and any food with an extended shelf life
• avoid contact with animal placenta (afterbirth) and with aborted birth products.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information call your nearest Centre for Disease Control.

Pertussis is a highly contagious disease of the respiratory tract (nose and throat) caused by the bacteria Bordetella pertussis.

How is it spread

The bacteria are found in respiratory secretions of infected people. These people can pass the infection to other people by coughing or sneezing.

Pertussis can also be spread by direct contact with infected mouth or nose secretions e.g. by sharing eating utensils during a meal, sharing food or kissing.

Symptoms

The symptoms generally develop 7 to 10 days after exposure, but may take up to 20 days.

Pertussis usually starts with cold-like symptoms and an irritating cough, or the cough may be the first symptom. The irritating cough gradually changes over 1 to 2 weeks into episodes of coughing bouts, often followed by dry retching or vomiting. These coughing bouts can be very severe and frightening.

In some people, particularly children, they may end with a crowing noise (the whoop) as air is drawn back into the chest, and the child may vomit.

Very young babies may hold their breath instead of whooping and may sometimes turn blue. Adolescents and adults may only have a persistent cough.

How serious is pertussis

Pertussis is an important cause of infant death worldwide even in countries where many people are vaccinated. The case fatality rate in unvaccinated infants <6 months is estimated to be 0.8%. Death from pertussis is rare in people aged 10-70 years.

A high proportion of hospitalisations and almost all deaths from pertussis occur in infants too young to have received the required number of vaccines to protect them.

The most common complication of pertussis in infants is pneumonia that can be complicated by seizures and prolonged decreased oxygen to the head causing brain damage.

Infectious period

A person is infectious during the cold-like symptoms in the early stages, through to 5 days after starting antibiotics or, if left untreated, for the first 3 weeks of coughing.

Who is at risk

Epidemics usually occur every 3-4 years and in 2011 38,732 cases were reported in Australia. Pertussis can affect any age group, Adults can give the infection to young babies before they are fully protected by vaccination. These young babies are at risk of severe disease.

What is the treatment

An antibiotic called azithromycin is usually prescribed to prevent the disease from being passed on to others; however it has little effect on the course of the illness for the individual. The coughing may last for weeks or months.

How can pertussis be prevented

Immunisation works to prevent a person contracting disease or can reduce the severity of the illness. For children, the pertussis component is combined with diphtheria and tetanus vaccine (DTPa) (and sometimes hepatitis B, Haemophilus influenzae type B (Hib) and polio vaccine) and is given as a series of injections in infancy and in early childhood as part of the Immunise Australia Program.

Those few children who develop pertussis, even though they have been immunised, have a much milder infection with fewer complications than those children who do not receive the vaccine at all.

A booster vaccine formulated for adults (dTpa vaccine consisting of adult diphtheria, tetanus and acellular pertussis) became available for use in Australia, in 2003.

Vaccinations

The following groups are eligible to receive the free adult diphtheria, tetanus, pertussis (dTpa) vaccine:

• all children 12 years of age (offered to students in year 7 in the Northern Territory)
• pregnant women – the best time to administer the dTpa vaccine is between 20 and 32 weeks of pregnancy but it can be given anytime from 20 weeks of pregnancy up to and immediately after delivery. Pertussis vaccine should be given to women every pregnancy

The booster vaccination is free for the above clients and can be obtained from a General Practitioner (GP), remote health clinic or Community Care Centre.

The adult diphtheria tetanus and pertussis (whooping cough) vaccine is also recommended* for the following:

• any adult caring for young children including fathers, households carers, healthcare workers and childcare workers
• adults requiring a booster dose of diphtheria and tetanus containing vaccine for wound management
• those planning to travel overseas
• anyone who wants to be vaccinated.

*If they have not had a pertussis containing vaccine in the last 10 years.

The booster vaccination for these people will incur a cost and is available from a GP.

The dTpa vaccine can be administered at any time following a previously administered dose of tetanus toxoid containing vaccine.

How can pertussis be controlled

People with infectious pertussis (prior to and for the first 3 weeks of the cough) should stay away from work, school and childcare until they have completed 5 days of appropriate antibiotics.

Preventive antibiotic treatment is recommended for ‘high risk’ contacts of infectious pertussis cases e.g. young babies and for people from households or other settings who could pass on the disease to young babies.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information contact your nearest Centre for Disease Control.

Trachoma is a preventable infectious eye disease caused by repeated infections with eye strains of the bacteria Chlamydia trachomatis. It causes painful blindness in older people who have had severe active trachoma usually in childhood.

How it is spread

Trachoma occurs in areas with overcrowded housing where personal and community hygiene are difficult to maintain. The Chlamydia trachomatis bacterium is easily spread through infected eye secretions.

These secretions are passed back and forth between young children during close contact such as playing and sharing the same bedding. Flies can also spread the bacterium.

Children are the main reservoir of infection. Dirty faces are the most important risk factor in the transmission of trachoma.

Symptoms

It is important to note that active trachoma in children often causes no symptoms. Trachoma can be present even in children with clean faces. However, children with active trachoma may have red, sore, sticky eyes and nasal discharge.

Follicles and inflammation under the upper eyelids are the hallmarks of active trachoma.

As trachoma progresses, scarring develops under the eyelids. The eyelashes turn in and rub on the cornea. This abnormal condition is called trichiasis. This may be painful and will cause corneal scarring, followed by visual loss and then blindness.

Who is at risk

Aboriginal people in remote Australia are most at risk of developing trachoma. Young children, especially those with poor personal and family hygiene practices are at the highest risk.

Australia is the only developed country with blinding trachoma. Trachoma is a common cause of blindness in Aboriginal adults.

Active trachoma is usually seen in young children and adolescents. The highest rates of disease are found in children aged 3-8 years.

The cycle of repeated active infection and resolution occurs over many years. Teenagers and adults have the scarring stage of trachoma. Without treatment, adults may develop trichiasis which can ultimately lead to blindness.

Infectious period

Trachoma is highly infectious in its early stage and may be infectious intermittently as long as active trachoma infection persists. People who are at risk experience repeated episodes of infection.

Adults and those without clinical signs may still have episodes of infection and be infectious.

Treatment

The antibiotic azithromycin is used to treat active trachoma. A single dose is given, and may be repeated in 6 to 12 months.

Azithromycin is the recommended treatment for all people diagnosed with trachoma as well as their contacts. A contact is anyone who is living and/or sleeping in the same house as a person with trachoma.  If the person lives or sleeps in multiple households, then all members of each household are regarded as contacts.

If there is a high rate of trachoma in a community, then all Aboriginal members of the community should be treated. Indigenous adults over 40 years of age from communities in which trachoma is endemic should be screened annually for trichiasis. Additionally, adults who complain of a sore eye need to be examined for trichiasis. Health services need to ensure that a process is in place for timely surgical referral and treatment of people with trichiasis.

The World Health Organisation and the Communicable Disease Network Australia recommend the SAFE strategy:

• Surgery – surgical correction for trichiasis
• Antibiotics - azithromycin for cases of active trachoma and their contacts (that is all household members)
• Facial cleanliness – promote clean faces to reduce spread of infection
• Environmental improvements – Improve overcrowding, water and sanitation facilities. It is especially important to address barriers to face washing.

These 4 actions are aimed at eliminating trachoma by reducing the risk and frequency of transmission and preventing trichiasis with surgery.

Prevention

The promotion of clean faces in children along with environmental improvements to reduce overcrowding and to support good hygiene practices are the best ways to control trachoma.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information contact the Centre for Disease Control or the Northern Territory Trachoma Program.

Group A streptococcus (GAS) is a type of bacteria that can live in your throat or on your skin.

GAS can cause non-invasive health conditions like:

• sore throats
• skin infections.

These are usually mild conditions when treated by your doctor or health clinic.

In some people, GAS can cause invasive infections and sometimes people can have immune reactions, these can be life threatening conditions.

How it is spread

The bacteria can be passed from person to person by:

• talking
• coughing
• sneezing
• kissing.

Skin infections can be passed through skin to skin contact and sharing items like:

• clothing
• towels
• bedding.

Symptoms

Symptoms of a GAS throat infection may include:

• a sore, red throat or tonsils
• pus on the throat or tonsils
• pain when swallowing
• fever and chills.

GAS can also cause a red rash, sometimes known as scarlet fever. It is a mild illness if treated by your doctor or health clinic. Read more about scarlet fever on the health direct website.

If you have a GAS infection on the skin, it can cause 2 different conditions:

• streptococcal impetigo, also known as school sores, symptoms can include:
  • itchy, red skin with blisters that crust and scab
  • swollen and tender lymph nodes
  • fever.
• streptococcal cellulitis, symptoms can include:
  • skin that feels warm and tender with redness or pain
  • swollen and tender lymph nodes
  • fever.

Treatment

It's important to see a doctor or go to a health clinic for treatment of a GAS infection.

Antibiotics will be prescribed to treat it.

To reduce the risk of complications, it's important you:

• take the medicine exactly as prescribed by your doctor
• return to the doctor or health clinic if you don't feel better or you get worse.

Invasive GAS

Invasive GAS is when the infection severely infects any part of the body, such as the:

• lungs
• blood
• bones
• joints
• flesh
• brain.

This happens when your immune system cannot fight off the infection.

It can lead to:

• pneumonia
• sepsis
• streptococcal toxic shock syndrome
• meningitis
• osteomyelitis
• post-partum infection
• necrotising fasciitis (flesh eating infection)
• deep tissue abscess.

These are life threatening conditions.

Symptoms of invasive GAS

People who develop iGAS need urgent medical care in hospital.

Symptoms will depend on where your GAS infection started.

Symptoms can include:

• fever and chills
• general feeling of un-wellness
• dizziness
• headache and muscle ache
• breathlessness and chest pain
• neck stiffness and sensitive to light
• vomiting and nausea
• stomach pain
• redness, warmth and tenderness or pain at the site of infection
• bleeding or pus at the site of infection.

Who is at risk

If you were recently treated for a GAS infection and you don't get better or feel worse, you can be at risk of invasive GAS and should return to your doctor.

Most healthy people who have good access to healthcare won't develop complications from a GAS infection.

You may be more at risk of complications if you:

• do not treat the infection
• do not finish a full course of the right antibiotics
• have a weakened immune system
• have a chronic condition
• take regular steroid medication
• drink a lot of alcohol
• are under the age of 5 or over the age of 65
• a child who has had chickenpox in the last 2 weeks
• are an Aboriginal or Torres Strait Islander person.

Immune responses to GAS

In some people, GAS infection can lead to serious complications such as:

• Acute post-streptococcal glomerulonephritis (APSGN)
• Acute rheumatic fever (ARF) and rheumatic heart disease (RHD).

Prevention

To reduce your risk of a GAS infection you should:

• regularly wash your hands
• treat and cover skin cuts or sores.

How to stop the spread

If you or someone you live with has a GAS infection, you should:

• take your medicine as prescribed
• shower everyday
• wash clothes before wearing them again
• regularly wash bedding and towels
• cover the nose and mouth when coughing or sneezing
• clean surfaces such as bathroom sinks, taps and door handles.

Avoid sharing:

• clothes
• beddings
• towels
• baths.

You should see a doctor or go to a health clinic if you don't feel better or start to get worse.

Information for professionals

To find out more go to the NT Health website.

Contact

For more information contact your nearest Centre for Disease Control.

Pneumococcal disease is an acute infection caused by the Streptococcus pneumoniae bacteria.

It can cause a variety of severe illnesses including:

• lung infection (pneumonia)
• infection around the brain (meningitis)
• blood poisoning (septicaemia).

Pneumonia is the most common in the Northern Territory (NT).

The bacteria can also cause less severe but troubling illness such as sinus and ear infections.

More information

For more information, contact your nearest Centre for Disease Control.

To find out more go to the NT Health website.

NTM stands for nontuberculous mycobacteria. NTMs are a group of bacteria in the same family as the organism that causes tuberculosis (TB).

Over 140 NTMs have been identified, though only 20 to 30 have been linked to human disease. NTM lung disease is not really a single disease entity, but a group of lung conditions caused by a range of NTMs.

These conditions vary in terms of their symptoms, severity, treatment and outcomes. NTM lung disease is uncommon, however the condition is increasingly being diagnosed, as the role NTMs play in human disease is better understood.

Who gets NTM lung disease

NTMs are found worldwide in the natural environment, particularly in the soil and water.

People are regularly exposed to NTMs via skin contact, from breathing in or swallowing the organisms. In most individuals, this poses no risk of disease and the NTMs are readily killed or eliminated by the body’s immune defences.

Occasionally NTMs will not be eliminated from a person’s lungs, in which case there are 2 possible outcomes.

In some people, the NTMs survive in their airway either temporarily or permanently without being the causative agent of symptoms. These persons are said to be colonised with NTMs and do not have NTM disease. These people make up the largest group who culture NTMs from their sputum.

The second outcome for certain individuals, however, may develop lung disease following exposure and infection with NTMs. Those with existing chronic lung conditions such as emphysema, bronchiectasis, severe asthma and cystic fibrosis are at higher risk of NTM disease.

Persons who are immunosuppressed such as those undergoing chemotherapy, organ transplant recipients and persons with HIV are also at increased risk, both for lung disease and NTM infection of multiple other organs. Rarely, persons without any of these risk factors may also develop NTM lung disease.

People with NTM lung disease repeatedly, over time, have the same NTM cultured from their sputum and exhibit progressive clinical symptoms and radiological signs of lung disease.

Symptoms

The symptoms of NTM lung disease usually develop slowly over weeks to months. Specific symptoms can vary greatly among individuals and may be subtle, particularly if a patient normally experiences chronic symptoms from an existing underlying lung condition. Eventually, people with NTM lung disease usually report at least some of the following symptoms:

• shortness of breath, either new or worsening
• productive cough for more than 3 weeks
• weight loss
• fevers
• night sweats
• coughing up blood
• lethargy/fatigue.

Diagnosis

Making a diagnosis of NTM lung disease can be challenging and often takes several months. This is because many patients already have pre-existing lung conditions with chronic symptoms.

In such situations, it can be difficult to determine whether new or worsening symptoms are simply due to progression of the pre-existing lung condition or due to something new entirely.

It is known that compromised lungs are frequently colonised by NTMs, but unless these NTMs are causing disease, antibiotic treatment will not be of any benefit.

Because of these challenges, 3 criteria must be satisfied before a diagnosis of NTM lung disease is made:

1. A patient should report new or worsening symptoms over time.
2. Multiple sputum samples, taken several weeks apart, should consistently grow the same species of NTM bacteria in a laboratory.
3. Imaging of the lung, either on e.g. X-ray or CT scan, should demonstrate abnormalities known to be associated with NTM lung disease.

Treatment

NTM lung disease is usually treated with a combination of 3 to 4 different antibiotics. The specific choice of antibiotics will depend on the type of NTM and individual patient factors.

Most antibiotics are prescribed in oral tablet form, taken daily. While receiving treatment, if symptoms allow, patients may return to their regular activities, including work.

NTM lung disease requires a prolonged treatment course that often lasts longer than 12 months. During this time, sputum samples are regularly collected to look for evidence of persistent or clearing infection. Patients are usually reviewed on a monthly basis at a specialist clinic. Regular blood tests and imaging are also required to monitor the response to treatment and detect any potential drug side effects.

Treatment is usually continued until a patient’s symptoms have improved and sputum samples have stopped growing NTM bacteria for at least 12 months.

Can NTM infection spread to others and is there any prevention

NTM lung disease is not transmitted from person to person.

NTM infection is usually acquired from the environment. As these organisms are found in almost all natural environments, there are limited viable strategies to prevent exposure to the NTM organisms. There are no vaccines against NTM disease.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information contact your nearest Centre for Disease Control.

Scrub typhus is a disease caused by bacteria called Orientia tsutsugamushi, which is in the rickettsia family.

How it is spread

The germ infects people when they are bitten (usually painlessly) by an infected larval mite called Leptotrombidium deliense. The mite is very small (0.2 to 0.4mm) and can only be seen through a microscope or magnifying glass.

The mites live in grassland areas at the edge of dense monsoon forests or forested creeks. Mites usually feed on marsupials and other native animals such as rats but they can attach to passing humans and bite for a blood meal.

Scrub typhus cannot spread from one person to another.

Where is the disease found

Scrub typhus is found in Asia and the Pacific region including northern Australia. The endemic area extends from south-eastern Siberia and northern Japan, through eastern and south-east Asia, to Vanuatu in the east and Pakistan in the west. Other countries may have small foci. Thailand has the highest prevalence of disease.

There have been numerous reported cases of infection in the Top End of the Northern Territory since 1990 with at least one fatality.

More than half of the reported cases were infected in Litchfield National Park. Other areas associated with infection include all of the following:

• Batchelor area
• Melville Island
• Groote Eylandt
• Emu Point near Peppimenarti in the Daly River area.

Risk areas in the Top End are described as locations near well-watered escarpment slopes that have associated creeks and seepage areas with monsoon forest and grasslands in close proximity.

Symptoms

The symptoms usually occur within 1 to 2 weeks of being bitten. They may include fever, chills, sweating, headache, cough, swollen glands and sometimes a dull red skin rash. The bite site often ulcerates and becomes red with a central black scab, called an “eschar”.

Any person with these symptoms who has recently visited a risk area, in particular Litchfield Park, should mention the possibility of scrub typhus to their doctor. The diagnosis is made by a blood test.

Who is at risk

Anyone visiting areas near well watered escarpment slopes of the Top End that have associated creeks and seepage areas with monsoon forest and grasslands in close proximity are at risk.

The warning particularly applies for:

• bushwalkers
• off road tourists
• Aboriginal people pursuing traditional lifestyles
• military personnel on bush exercises
• park rangers
• people clearing virgin land in high risk areas.

Treatment

Treatment with antibiotics is necessary and very effective. Doxycycline is the drug of choice. Often people require treatment in hospital.

Prevention

You should take precautions to avoid being bitten by mites when visiting 'at risk' areas. These include:

• wear footwear such as runners or boots with socks rather than walking barefoot or wearing sandals. Long trousers are preferable when bushwalking
• apply insect repellent that contains DEET or picaridin to all exposed skin areas on the legs, onto socks and the bottom half of trousers (this is the same repellent you use to prevent mosquito bites)
• do not sit or lie on bare ground or grass, use a suitable ground sheet or other ground cover
• camp in cleared areas away from dense forests. Use tents with attached floors. People who are working in infested areas should consider wearing permethrin impregnated clothing.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information contact the Centre for Disease Control.

Leprosy is an infection caused by the bacteria, Mycobacterium leprae.

The bacteria look very similar to Mycobacterium tuberculosis but leprosy is a very different disease from tuberculosis. M. leprae often affects the nerves of the hands, feet and face, and also the skin.

There is often much fear and misunderstanding about leprosy because it can cause disabilities, however it is not very contagious and it is easily treatable with antibiotics.

Leprosy is curable and treatment provided in the early stages prevents or minimizes permanent damage to the skin, nerves, limbs and eyes.

Distribution

Approximately 219,000 new cases of leprosy were reported worldwide during 2011, occurring mainly in Africa, Asia and South America.

Control of leprosy has improved significantly over the last 20 years due to national campaigns in many countries around the world.

In Australia leprosy is rare and found mainly in Northern Australian Aboriginal people and migrants from overseas countries in Asia, the Pacific and Africa where leprosy is more common.

Infectivity

Leprosy is not a very contagious infection. It is probably transmitted by droplets from the nose and mouth when people are in close and frequent contact with an infectious person.

The great majority of people who come in contact with untreated leprosy are unlikely to become infected. In fact, it is close family contacts who are most at risk of catching the infection.

Infectious cases become non-infectious soon after starting regular treatment.

Types of leprosy

Manifestations of leprosy are determined by a person’s immune response to the disease.

If the infected person has little resistance the bacteria multiply and this end of the spectrum of disease is called multibacillary leprosy (previously referred to as lepromatous leprosy).

If the infected person has a high level of resistance, most of the bacteria are destroyed and this end of the spectrum of disease is called paucibacillary leprosy (previously referred to as tuberculoid leprosy).

Diagnosis

The diagnosis of leprosy is often delayed because it is not considered, especially in countries like Australia where it is rare. Some people with leprosy may have a close family member with the disease, but often people do not know the source of their disease.

A discoloured skin patch, often, but not always without sensation, may be the first sign of leprosy.

A doctor or nurse will ask about and look for numbness in the hands or feet, swollen nerves, eye problems, wounds or deformities on the hands or feet or skin changes that might indicate leprosy.

A doctor or nurse may make a tiny cut in the skin to take a small sample of fluid under the skin to send to a laboratory for testing.

If the leprosy bacteria, M. leprae are detected in the sample or other biopsy specimen, then leprosy is diagnosed.

If a person suspects he/she has leprosy, advice can be sought from the Centre for Disease Control (TB/Leprosy Unit), Building 4, Royal Darwin Hospital phone (08) 8922 8804 or from any Centre for Disease Control in Nhulunbuy, Katherine, Tennant Creek or Alice Springs.

People who live remotely may consult the Remote Medical Officers who regularly visit many of the rural community care centres in the Northern Territory.

Discussion with General Practitioners (GPs) or Infectious Disease physicians may also be appropriate.

Treatment

M. leprae bacteria can be completely cured with multidrug therapy (MDT).

MDT means taking 2 or 3 special antibiotics (rifampicin, dapsone and sometimes clofazamine) for between 6 months and 2 years, depending on the type of leprosy.

After only a few doses of MDT people with leprosy are no longer infectious to others, but to cure their disease they need to take all the antibiotics as prescribed by their doctor.

People with leprosy usually do not need to stay in hospital for treatment.  Treatment is free.

Treatment and care for deformities and disabilities

Leprosy can often damage nerves and cause deformities, especially if the diagnosis of the disease is delayed. Unfortunately the damage that results, often to the hands or feet cannot be cured with the antibiotics: these are the scars of leprosy.

Occupational therapists and physiotherapists can help people take special care of their hands and feet to avoid developing further problems.

Reconstructive surgery can be done for people with a range of deformities and disabilities from leprosy making it possible for them to live independent and productive lives.

Control

Leprosy is becoming less common around the world. Screening programs in the past have resulted in early detection of leprosy.

Effective treatment programs with MDT therapy have reduced transmission of the disease. People living in the same house as a person with leprosy should be examined and followed up by a doctor or nurse.

Information for health professionals

To find out more go to the NT Health website.

Contact

For further information contact the TB Clinic in your region.

Leptospirosis is a disease caused by a group of bacteria called Leptospira.

Humans can get Leptospirosis by coming into contact with the urine of infected animals.

Rats are a common source of the disease.

Leptospirosis in the Northern Territory (NT)

In the NT, there are usually 1 to 4 cases every year.

In 2021, there was an outbreak of 10 cases among cattle workers.

Other cases have included people from:

• rural area of Darwin
• Fogg Dam and Harrison Dam area
• Oenpelli
• Finniss River
• Katherine district.

Areas with high rat populations may increase the risk of the disease. The native dusky rats (Rattus colletti) are common to the Fogg Dam and Harrison Dam area.

Cases in the NT have also been related to :

• turtle hunting
• duck and goose hunting
• working with crocodile, including egg collection.

How it is spread

Leptospirosis is spread by the urine of infected animals.

Domestic and wild animals can spread the disease.

While rats are often the cause of an infection, the disease is spread by other animals, such as:

• pigs
• cattle
• dogs
• possums
• bats.

Infected animals pass the bacteria through their urine into:

• water
• wet soil
• vegetation.

People can be infected when coming into contact with contaminated sources.

The bacteria gets into your body through:

• cuts in the skin and open sores
• the  mouth (swallowing water)
• the lining of the eyes, mouth and nose.

Leptospirosis is not spread person to person.

Most at risk

The risk of becoming infected with Leptospirosis is higher in areas around water and after flooding.

People most at risk are those who:

• have close contact with animals
• are exposed to :
  • water
  • wet soil
  • vegetation

Some occupations can increase your risk of infection, these include:

• abattoir workers
• farmers
• veterinarians
• rice and sugarcane field workers.

Recreational activities can also increase your risk of exposure, these include:

• camping
• bushwalking
• gardening
• white water rafting
• kayaking
• hunting.

Symptoms

Most people who are infected will have mild or no symptoms. Rarely does it cause death.

Symptoms typically start around 5 to 14 days after coming into contact with the infected urine. However, they can start anywhere between 2 to 30 days later.

The duration of sickness can vary from a few days to 3 weeks or more.

If symptoms start, they can come on suddenly, you may experience:

• fever
• headaches
• chills
• severe muscle pain, especially in the legs
• red eyes.

Other symptoms can include:

• cough
• chest pain
• stomach pain
• diarrhoea
• vomiting.

Sometimes the infection can become more serious, this is called Weil’s disease. Symptoms include:

• yellow skin or eyes, known as jaundice
• bleeding
• trouble breathing
• confusion.

Treatment

Leptospirosis is treated with antibiotics.

It is important to get treatment as soon as possible to reduce the risk of developing severe illness.

Prevention

There is no human vaccination against the disease.

You can reduce your risk of Leptospirosis by:

• avoiding swimming, working or playing in flood waters
• covering cuts or scrapes with waterproof dressings
• washing hands and arms after handling animals or carcasses
• showering if you come into contact with water or soil contaminated with animal urine
• wearing the following when handling animals:
  • gloves
  • eye shields
  • aprons
  • boots
• speaking with your vet about pet and farm animal vaccination
• controlling working dogs and feral or wild animal around the home
• avoiding feeding pets raw offal or feral meat as it may infect them.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information call your nearest  Centre for Disease Control.

Melioidosis is a serious disease caused by bacteria that live in the soil.

After rain the bacteria comes to the surface.

It is found in mud and water on the ground.

When it’s windy, the bacteria can get blown around in the air.

Domestic, farm and zoo animals can also be infected.

It’s important to get medical treatment if you think you have melioidosis because it can be life threatening.

Prevalence in the Northern Territory (NT)

The bacteria causing melioidosis is found in warm and humid areas worldwide, particularly in Southeast Asia and northern Australia.

It is more common in the Top End, but cases have also been reported as far south as Tennant Creek.

Seasonal risk

There is a higher chance of getting sick with melioidosis during the wet season from October to April.

NT Health will issue a health alert during this time or if there is a rise in cases.

For more information on current health alerts, go to the NT Health website.

How you can get melioidosis

You can get melioidosis by:

• having the bacteria enter your body through cuts or scratches on your skin
• breathing in the bacteria from soil carried by the wind
• breathing in contaminated water droplets during storms or from high-pressure hoses.

Getting melioidosis from drinking unchlorinated water is rare.

The disease does not typically spread from one person to another, or from animals to humans.

Understanding your risk

If you have existing health conditions or a weakened immune systems you are more at risk of melioidosis.

Conditions that increase your risk include:

• diabetes
• kidney disease
• lung disease or cancer
• high alcohol intake
• having had an organ transplant
• taking medicines that weaken your immune system.

Even if you're healthy, you can still get melioidosis, especially if you work outside in muddy or wet conditions.

Healthy children have a lower risk.

Safe work practices on job sites

People who work on job sites might be more likely to get melioidosis because the work environment can get wet, muddy or dusty.

Read more about how you can lower your risk in the workplace, go to the NT Worksafe website.

Symptoms

Symptoms of melioidosis will usually appear between 1 and 21 days after exposure.

Symptoms can be sudden, but can also start slowly.

The first sign is usually an infection in the chest, called pneumonia.

You might also experience breathing difficulties, a cough that brings up mucus and a fever.

Other symptoms can include:

• headache
• confusion
• difficulty passing urine for men
• joint pain or swelling
• skin sores that don’t heal.

It can affect different parts of your body, based on how you got infected with it.

Symptoms can last for 2 or more months.

Some people get chronic melioidosis, this means symptoms can be long lasting.

In rare cases, you may become ill several years after coming into contact with the bacteria. This happens when the bacteria stays inside your body, but only causes sickness if your body's defense system gets weaker.

Melioidosis is a dangerous illness, it can be life threatening. If you experience any of these symptoms, it is important to go to a doctor as soon as possible.

Treatment

If you have melioidosis, you will receive treatment for the next 2 to 4 weeks in hospital.

Treatment is with antibiotics given through your veins.

When you go home you will still need to take tablet antibiotics for another 3 months.

Prevention

Melioidosis does not have a vaccine.

If you have had melioidosis before, you can get it again.

To protect yourself against melioidosis you should:

• wash all cuts, grazes and wounds with soap and water
• keep cuts covered with a clean dressing when going outside
• wear waterproof shoes or boots in wet and muddy conditions
• wear rubber gloves when handling soil
• wear a mask when using high pressure hoses
• take it easy with alcohol - even one big drinking session can increase your risk.

People with existing health conditions should take extra precautions by:

• staying in doors during storms, heavy wind or rain
• ensuring drinking and bathing water are safe and free of contamination
• disinfect bore water, or use a combination of rain water and bottled water for drinking and showering
• boil your water if you are unsure.

Information in multiple languages

You can download important information about melioidosis in the following languages:

• Arabic PDF (143.7 KB)
• Bahasa PDF (30.2 KB)
• Dari PDF (130.3 KB)
• Farsi PDF (172.8 KB)
• Kurdish PDF (92.0 KB)

Audio files in Aboriginal languages

You can download audio information about melioidosis in the following languages:

• Anindilyakwa WAV (3.7 MB)
• Eastside Kriol WAV (3.9 MB)
• Murrinh-Patha WAV (4.1 MB)
• Warlpiri WAV (4.1 MB)
• Yolngu Matha WAV (4.1 MB)

Transcript

Melioidosis is a disease caused by a germ that lives in the soil. The germ comes out when there’s heavy rain and can make you sick so don’t go out in the heavy rain and wind. Always wear shoes when you’re walking outside to protect yourself from getting cuts and scratches. If you become sick with shortness of breath, a productive cough or fever see your doctor or go to the health clinic

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information call your nearest Public Health Unit’s Centre for Disease Control.

Typhoid fever is a disease caused by the bacteria Salmonella Typhi, while paratyphoid fever is caused by Salmonella Paratyphi. They are both known as ‘enteric fevers’ and are common in some developing countries.

Typhoid and paratyphoid fever do not normally occur in Australia but are infections usually acquired in countries where they are endemic.

Symptoms

The symptoms of typhoid and paratyphoid fever are similar although paratyphoid tends to be less severe than typhoid.

Those infected can experience fever, headache, lack of appetite and perhaps a dry cough. Some people may experience diarrhoea but on the other hand some may get constipation.

Some cases, particularly those with light skin, may develop pink spots on the trunk.

A few people who become infected may only have a short mild illness or no symptoms at all, but continue to harbour the bacteria for long periods of time. These ‘carriers’ can pass the typhoid bacteria on without knowing that they are infected.

A small number of people may develop severe complications such as intestinal perforation, pneumonia, meningitis or kidney failure.

Typhoid and paratyphoid fever are diagnosed from a blood or faeces (stool) specimen.

How it is spread

Spread of disease occurs when people consume food or water that has been contaminated by the faeces of other people carrying the disease.

Raw fruits and vegetables, milk and shellfish are the types of food most associated with the illness.

Infectious period

The time between infection and the appearance of symptoms can vary, but generally people show symptoms around 8 to 14 days after they were infected but it can be up to 2 months.

People with typhoid can shed the bacteria in their faeces for 2 to 6 weeks. Between 1 to 4% of people continue to shed the bacteria for months or years if not treated with antibiotics.

Who is at risk

Anyone can be infected with typhoid or paratyphoid, however people most at risk are travellers to countries where typhoid is common. Household contacts and co-travellers of cases are also at risk.

People with a lowered immune system may become infected with typhoid much more easily and can develop a more severe disease. Anti-ulcer and anti-reflux medications can increase the risk of typhoid fever by lowering the acid level in the stomach.

Treatment

Some people may require hospitalisation and treatment with antibiotics. Others who may not show symptoms of typhoid but are carriers of the disease will also require treatment with antibiotics.

Prevention

People travelling in developing countries where typhoid is common should be vaccinated prior to travel and:

• avoid uncooked foods, including fruit unless it is able to be peeled
• avoid untreated water, including ice
• drink beverages from sealed containers
• wash their hands after going to the toilet and before eating
• avoid eating from street stalls
• ensure hot food is thoroughly cooked and eaten while hot.

Typhoid vaccine is available from your local General Practitioner (GP) or travel clinic and is either a 1 dose injection or a course of 3 capsules.

Even if you have previously lived in an area where typhoid is common, you will need to be vaccinated if you travel back on holiday.

The vaccine only covers typhoid fever, but not paratyphoid fever, and is not 100% effective. It is therefore extremely important to follow the food and hygiene recommendations, even if you have had the vaccination.

The vaccine only gives protection for about 3 years so it is important to check that you are up to date with your vaccinations every time you travel abroad, as booster doses may be needed.

How it can be controlled

It is very unusual for typhoid and paratyphoid fever to spread in Australia.

People with typhoid or paratyphoid fever are followed up to ensure that they have cleared the disease. In addition, their travelling companions and, in certain circumstances, their household contacts are screened for the disease. Cases should not prepare food for others.

A number of stool tests will be required to assess when a person is cleared of infection with Salmonella Typhi; this is done in collaboration with the local Centre for Disease Control and the case’s doctor.

All doctors and laboratories in the Northern Territory must notify cases of typhoid fever to the local Centre for Disease Control. Laboratories are also required to notify cases of paratyphoid fever.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information contact the Centre for Disease Control.

Vibrio bacteria are a family of bacteria that live in warm sea water. They can cause disease including vibrio cholera, which causes cholera.

Vibrio bacteria can contaminate seafood, particularly oysters and shellfish.

How it is spread

You can get vibrio infections by:

• skin cuts or wounds that are exposed to sea water
• consuming food or water that has been contaminated with the bacteria.

Who is at risk

People with poor immunity, such as those with chronic liver disease, have a higher risk of becoming sick.

It can start as a wound infection and quickly spread into the bloodstream. Once in the bloodstream, the infection becomes life threatening, even with the best treatment.

Healthy people who eat food contaminated with vibrio bacteria may get gastro symptoms such as vomiting and diarrhoea. These usually settle without treatment. The severity of the illness depends on the:

• type of vibrio
• person’s immune system.

Where it is found

Vibrio bacteria are found in tropical waters so the risk of being exposed is higher along the north Australian coast.

In the Northern Territory (NT), serious infections were picked up in the sea or rivers around the south-western shore of the Gulf of Carpentaria – near the Sir Edward Pellew Group and Limmen Bight.

Severe infections with vibrio are rare. Since 2000, there have been 12 serious infections of people in the NT.

Prevention

If you come into contact with rivers, estuaries or gulfs, you should:

• avoid exposing open wounds or broken skin to sea or river water
  • if exposed, wash the wound with soap and clean water
• thoroughly cook all seafood caught in coastal and estuarine waters
• not eat any raw oysters or other raw shellfish
• avoid contaminating other food when handling raw shellfish.

If you're immune compromised

If you have a compromised immune system, you should also:

• avoid swimming in rivers estuaries or sea, especially in and around the Gulf of Carpentaria
• minimise contact with tropical coastal sea water, particularly in and around the Gulf of Carpentaria
• treat any wound that becomes infected following exposure to tropical waters and seek medical advice if it gets worse.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information contact your nearest Public Health Unit - Centre for Disease Control on the Department of Health website.

This page has information on non-healing ulcers, including those that are caused by nontuberculosis mycobacteria (NTM).

There are many causes of non-healing (chronic) ulcers and they include:

• problems with blood supply or drainage
• nerve damage
• excess pressure
• cancer
• infection.

When determining the cause of a non-healing ulcer, it is always important to assess the blood supply and nerve function to the area. If cancer or unusual infection is suspected, a skin biopsy may be required. It is important to seek medical attention early for non-healing ulcers, so that appropriate diagnostic testing can be done and treatment commenced at an early stage. 

Ulcers that are not healing or improving in a 2 week period should be assessed by a clinician.

Vascular disease

Chronic leg ulcers are commonly due to poor drainage of blood from the legs (venous insufficiency) and/or poor blood supply to the legs (peripheral vascular disease). 

Older people, particularly smokers and ex-smokers, may have narrowing of the blood vessels leading to decreased blood flow to the lower legs and feet. This can lead to symptoms of cold feet and pain with walking. 

Minor trauma to the lower limbs can become a non-healing ulcer. The poor blood supply reduces the body’s ability to heal following an injury. Rarely, blood vessels can become inflamed as part of an autoimmune disease. This can cause a rash, and chronic ulcers can form.

Diabetes

Non-healing ulcers commonly occur in people with diabetes, particularly if their blood sugar levels are too high or there is a history of smoking. Poorly controlled diabetes is a risk factor for narrowing of the large arteries that supply blood to the legs (see above). It also leads to damage of much smaller blood vessels. This can damage nerves and leads to loss of sensation in the feet making the feet vulnerable to trauma. 

Poor wound healing may be an indication to check for elevated blood sugar levels.

Pressure areas

Poor mobility, due to frailty or spinal cord damage, may lead to excess pressure on the sacrum, heals and other parts of the body. This can lead to skin breakdown and formation of a non-healing ulcer. Ill-fitting shoes or casts or splints may also cause ulcers. 

Unless the pressure point is relieved, the wound will not heal. Sometimes a skin graft is required to close the wound.

Skin cancer

Skin cancers can present as a non-healing, sometimes ulcerated lesion, and early medical attention is particularly important. Skin cancers treated at an early stage are often curable. A delay in treatment may result in the need for more extensive surgery or in spread to other parts of the body.

Underlying infection of the bone

Chronic ulcers can become deep and extend to the bone. This allows bacteria to infect the bone. Once this is established, the ulcer will not heal unless the bone infection is treated (often with a combination of surgery and antibiotics). Sometimes infection spreads to the bone through the bloodstream. Pus can build up and drain through the skin; this can also present as a non-healing skin lesion.

Melioidosis

Melioidosis is a disease caused by a tropical, soil-dwelling, bacterium found across the Top End of the Northern Territory (NT) and Northern Australia. It is much more common during the rainy season. 

Skin and soft tissue infections usually occur following breaks in the skin due to injury. The bacteria can then also enter the bloodstream and cause disease in other parts of the body, which can be life-threatening.  

Wearing gloves and shoes to prevent injury and exposure to soil is important.  

Diagnosis is made by growing the bacterium from clinical specimens (such as a swab). Treatment involves intravenous antibiotics followed by a long course of oral antibiotics. Infectious Diseases specialist involvement is required.

Read more on melioidosis.

Nontuberculous mycobacteria (NTM)

NTM are found in soil and water in tropical and temperate parts of Australia and infect the lungs and lymph nodes, and can cause non-healing skin ulcers. NTM skin and soft-tissue disease occur when NTM enter through a break in the skin from trauma or as a complication of a surgical procedure. There are sometimes geographical clusters of cases, however the causes of this clustering remains unclear.

Mycobacterium ulcerans skin lesions typically start as a painless, small spot similar in appearance to a mosquito bite that increases in size and then the skin breaks down and an ulcer forms. M. ulcerans skin lesions usually remain painless and have edge that are often rolled. If untreated, the lesion continues to increase in size and can extend down to tendons, ligaments and bone.

Other NTM that cause skin and soft tissue infections include the rapidly growing mycobacteria and M. marinum.

NTM skin and soft tissue infections are diagnosed by the presence of acid fast bacilli on microscopy, culture and/or PCR from an ulcer swab or biopsy. 

Treatment of NTM depends on the type of NTM and involves antibiotic treatment, sometimes in combination with surgery. Surgery is sometimes required depending on the extent of infection. 

In the NT treatment of NTM is usually under the management of the Centre for Disease Control.

Leprosy

Leprosy is a chronic mycobacterial infection of the skin and peripheral nerves. 

Leprosy is now uncommon in the NT, however it still needs to be considered especially in skin and neurologic disease in Aboriginal or overseas born people. 

Damage to nerves can lead to loss of sensation in the hands and lower limbs. People with leprosy are more prone to trauma of these non-feeling areas, which may lead to non-healing ulcers.

Read more on leprosy.

Other infections

Non-healing ulcers can be caused by other infections, including sporotrichosis and other fungi, Nocardia, actinomycosis and chromoblastomycosis. Some of these are environmental organisms, and should be suspected if there is exposure to soil, mulch, hay or other plant material. 

The diagnostic laboratory should be made aware so that clinical samples can be set up for appropriate testing. If confirmed, involvement of an Infectious Diseases specialist is advised.

Contact

For more information contact the TB Clinic in your region.

Meningococcal disease is a rare but serious bacterial disease.

About one in every 10 people carry this germ in the nose and throat.

Although most people who 'carry' this germ don't get sick, they are able to spread it to other people who, if infected, may become very unwell very quickly.

There are 5 main strains that cause meningococcal disease - A, B, C, W and Y.

The most common strain currently in the NT is W.

Symptoms

Symptoms of the disease may include:

• fever
• headache
• confusion or drowsiness
• neck stiffness
• joint pains
• rash
• dislike of bright lights
• vomiting.

When diagnosed and treated with antibiotics quickly, most people will make a full recovery. However, in some cases, it can lead to the following:

• hearing loss
• fits
• limb amputation
• renal failure
• skin scarring.

About 8 to 10% of cases may result in death.

Prevention

Meningococcal disease can be prevented by vaccination.

The meningococcal ACWY vaccine is free for:

• babies at 12 months
• young people aged 14 to 19
• people with certain medical conditions (all ages).

If you're not eligible for a free vaccine, you can see your doctor for a private script.

The meningococcal B vaccine is free for:

• Aboriginal children up to the age of 2
• people with certain medical conditions.

Anyone else aged 6 weeks and over who are not eligible for the vaccine can see their GP for a private script.

Information for health professionals

To find out more, go to the NT Health website.

Contact

Find a community care centre or remote health service.

For more information, get the meningococcal disease fact sheet from the Department of Health ePublications website. You can also call your nearest Centre for Disease Control.

For information on sore throat, including scarlet fever, refer to page 157 of the 'Staying Healthy' brochure on the Australian Government National Health and Medical Research Council website.

For information on roseola read page 146 in the 'Staying Healthy' brochure on the Australian Government National Health and Medical Research Council website.

Acute post-streptococcal glomerulonephritis (APSGN) is an inflammatory disease of the kidneys. It is typically caused by skin sores or a sore throat.

APSGN is an immune system response to an infection with streptococcus bacteria.

The NT has one of the highest incidence rates of APSGN in the world. It most commonly affects Aboriginal children but can be experienced by anyone.

While severe outbreaks are rare, you should take precautions and preventative measures.

How it is spread

APSGN occurs between 2 to 3 weeks after skin or throat infection of group A streptococcus bacteria. It can also occasionally be spread through groups C or G streptococcus.

You can't catch APSGN from someone else because it is your body’s immune response to bacteria and not an infection by itself.

However, someone with a streptococcus infection can spread the bacteria to others, mainly through respiratory droplets.

Who it affects

APSGN most commonly affects children between 12 months and 17 years, but can occur at any age. Aboriginal children are a high-risk group.

Symptoms

Symptoms of APSGN can include:

• puffy or swollen eyes or face
• dark coloured urine.

Treatment

If you think you or your child may have APSGN, contact your local clinic or health professional to get checked.

Take kids to the clinic if they have skin sores, scabies or sore throats to get them treated early.

Skin sores (a common symptom of APSGN) are treatable with benzathine penicillin, which you can get through a prescription.

Prevention

There is currently no vaccine for group A streptococcus.

Good hygiene is the main way to prevent all forms of bacterial infections.

To reduce the spread of bacteria, wash your hands regularly, especially:

• after coughing and sneezing
• before preparing, eating or serving foods.

People with 'strep throats' should avoid contact with others.

Information for health professionals

To find out more go to the NT Health website.

Contact

Contact your nearest Centre for Disease Control on the NT Health website.

In the Northern Territory (NT), around 20 to 40 cases of tuberculosis (TB) are reported each year. However, in other countries, TB is a widespread disease.

It is an infectious disease caused by the bacterium mycobacterium tuberculosis.

It mostly affects the lungs, but it can affect other parts of the body.

There are 2 forms of TB:

• active TB
• latent TB.

How it is spread

When someone has TB in their lungs, they can release tiny droplets containing the bacteria into the air by:

• coughing
• sneezing
• talking
• singing.

These infected droplets can be inhaled by another person, which can cause them to develop latent or active TB.

Someone with lung TB can keep spreading it to other people until the person starts antibiotic treatment and enough bacteria is destroyed in their body.

You can't get TB from:

• touching objects that have been handled by someone with active TB
• someone with latent TB.

Latent TB

You might not know if you have latent TB, it means the bacteria is inside your body but you have not yet developed an illness.

Latent TB means you:

• were exposed to TB in the past
• have no TB symptoms
• can't spread TB to anyone else.

You can still be at risk of developing active TB in the future. Risk factors can include a weakening immune system caused by:

• ageing
• serious illnesses
• diabetes
• medication such as steroids
• drug or alcohol use
• HIV infection
• treatments for cancer such as chemotherapy.

Sometimes there are no risk factors for TB becoming active.

Active TB

If you have active TB it means you have developed TB after:

• having latent TB, or
• being in close contact with someone who has active TB.

Active TB means you might:

• have TB symptoms
• spread it to other people.

Symptoms

If you have active TB you may experience:

• a persistent cough for more than 2 weeks, sometimes with blood
• fevers
• weight loss
• night sweats
• tiredness and weakness
• loss of appetite
• swollen glands.

If you have latent TB, you will have no symptoms.

Treatment

TB is treated with antibiotics for a period of time.

If you have latent TB, you may not need treatment. This will depend on various factors related to your health risks and circumstances.

For treatment to be effective for both active and latent TB, you must follow your treatment plan. This means taking your antibiotics:

• correctly
• consistently
• until finished.

Active TB treatment can last for at least:

• 4 months for children
• 6 months for adults.

Appointments are made with the TB clinic for regular check-ups.

If you have active lung TB, the first part of your treatment may need to be in hospital. This reduces your risk of spreading it to other people. After you leave hospital, you must finish your treatment plan. Otherwise, you risk:

• prolonging your illness
• getting sicker
• spreading the illness.

Prevention

To prevent spreading TB to others, practise good hygiene by doing the following:

• Cover your mouth and nose when coughing and sneezing.
• Use a tissue and throw it in the bin immediately.
• Wash your hands with water and soap, especially after coughing and sneezing.
• Wear a mask if you have any type of respiratory illness.

If you have latent TB, you may be offered medication to prevent getting active TB.

If you have active lung TB, you may be asked to isolate until you are no longer infectious.

Immunisation

The BCG vaccine can offer protection and is available for people who meet the eligibility criteria. To find out more, get the fact sheet from the NT Health digital library.

Find out more by contacting the Darwin or Alice Springs TB clinic.

Information for health professionals

To find out more go to the NT Health website.

Contact

For more information about TB or to get tested, contact the TB clinic.

You can also call your nearest Public Health Unit’s Centre for Disease Control.