Laboratory Diagnosis of AllergyDr David Heyworth-Smith, QML Pathology

INSIDE THIS ISSUE:> Laboratory Diagnosis of Allergy

> Faecal Calprotectin: A Biomarker of Bowel Inflammation

> Blood Tests in Investigation of Coeliac Disease

The geography and climate of Queensland provides favourable conditions for house dust mite habitation, and perennial grass pollens that contribute to chronic allergic rhino conjunctivitis and other respiratory allergies and atopic dermatitis.

The management of allergic disorders requires accurate diagnosis of the offending triggers or allergens provoking the condition. QML Pathology provides tests for allergy diagnosis including In vitro Specific IgE (RAST) detection, and specific IgE for native and recombinant component allergens. Our methodology utilises world leading technology including Phadia ImmunoCAP and ISAC systems.

The detection of specific IgE is integral to the assessment and management of allergic disorders including those of:

• Allergic rhino conjunctivitis

• Atopic eczema

• Asthma

• Food allergy

• Stinging insect allergy

• Certain drug allergies

• Certain occupational allergies

Allergic disorders are increasingly prominent in Australia and globally. This reflects both a true increase in the burden of allergic disease, especially that of childhood food allergy in the last 2 decades, and also increased awareness of allergy amongst health care and community members. Correspondingly, advances in allergy diagnosis and management have occurred over this period.

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ISSUE 2, 2017

>>> CONTINUED OVERLEAF

FEATURE ARTICLE

ALLERGEN-SPECIFIC IGE

An allergen-specific IgE test is used to measure the amount of IgE antibody in the serum that is specific to a particular allergen. In clinical practice, 0.35 kU/L has commonly been used as a cut-off for allergen-specific IgE to separate positive from negative results. Measurement of low levels of IgE (between 0.10 and 0.50 kU/L) have recently been shown to be important in some patients for particular allergens and QML Pathology now reports these results down to a concentration of 0.10kU/L. These are most relevant for some drug and venom allergens. Specific IgE results of <0.10 kU/L on the Phadia ImmunoCAP platform indicate low probability of clinical allergy to a specific allergen, whereas high antibody levels to an allergen show good correlation with clinical allergy to a specific allergen. Significance may also be affected by total IgE levels, which is a useful additional test to assist with interpretation. Very elevated levels of total IgE (e.g. > 5000 kU/L) may lead to low level false positive specific IgE results.

Table a: Interpretive table for allergen-specific IgE

Allergen-specific IgE result (kUA/L) IgE Ab Level Symptom relation

< 0.1 undetectable unlikely

0.1-0.5 very low uncommon

0.5-2 low possible

2-15 moderate common

15-50 high high

> 50 very high very high

NOTE: Asymptomatic allergen sensitisation is not an indication for allergen avoidance.Avoidance should be recommended only when clinical symptoms of reactivity to allergen exposure develop.

SELECTION OF ALLERGENS FOR TESTING FOR SPECIFIC IGE DIAGNOSIS

Allergen selection is directed by the clinical scenario of the patient. The most common inhalant allergen sensitivities are house dust mite, grass pollens, mould spores and animal danders. The most common food allergen sensitivities are egg, nuts and seeds, seafood, cow’s milk and wheat. A guide to requesting tests for allergy based on the clinical presentation follows. Serum will be held for up to 12 months to allow for additional add-on testing.

SUGGESTIONS BASED ON CLINICAL PRESENTATION

1. Infant-12 months: In this age group food allergens predominate with usually little sensitisation to inhalant allergens.

Suspected Allergens Recommendations for testing

Milk Suspected allergens can be requested individually or request ‘food mix’(milk, egg, soy, peanut, fish (cod), wheat) if triggers are unclearEgg

Soy

Peanut

Fish

Wheat

Nuts Nut mix (peanut, almond, coconut, hazelnut, brazil)

Cereals Cereal mix (wheat, oats, buckwheat, corn, sesame) Request the above tests OR Extended RAST panel – Allergenic Foods 20

2. Early childhood: 1-5 years: In this age group both food and inhalant allergy occurs. Test choice should be determined by the clinical picture.

Suspected Allergens Recommendations for testing

Milk Suspected allergens can be requested individually or request ‘food mix’(milk, egg, soy, peanut, fish (cod), wheat) if triggers are unclear Egg

Soy

Peanut

Fish

House dust mite House dust mite (D. pteronyssinus)

Grass pollens Grass pollen mix (couch, timothy, johnson, rye, paspalum, meadow)

Animal allergens Animal mix (cat, dog, horse, cow)Request the above tests OR Extended RAST panel(s) – Childhood allergy 15, Inhalant allergy 10

3. Older children and adults: In this age group environmental (inhalant) allergy predominates with lesser frequency of food allergy. Test choice should be determined by the clinical picture.

Environmental (inhalant) allergy

Suspected Allergens Recommendations for testing

House dust mite House dust mite (D. pteronyssinus)

Grass pollens Grass pollen mix (couch, timothy, johnson, rye, paspalum, meadow)

Danders Animal mix (cat, dog, horse, cow)

Moulds Mould mix (penicillium, cladosporium, alternaria, aspergillus)Request the above tests OR Extended RAST panels – Inhalant allergy 10, Moulds and Mites 10

Nut allergy

Suspected Allergens Recommendations for testing

Peanut Peanut

Nuts Cashew, walnut, macadamia + nut mix (peanut, almond, coconut, hazelnut, brazil)

Soy Soy

Sesame SesameRequest the above tests OR Extended RAST panels – Childhood allergy 15, Allergenic foods 20

Seafood allergy

Suspected Allergens Recommendations for testing

Fish Cod, salmon, tuna, hake

Crustaceans Shrimp, crab, lobster

Molluscs Oyster, mussel, squid, scallop

Uncertain seafood Crab, squid, lobster + seafood mix (cod, shrimp, tuna, blue mussel, salmon)

FEATURE ARTICLE

>>> CONTINUED OVERLEAF

FEATURE ARTICLE

EXTENDED SPECIFIC IGE (EXTENDED RAST) PANELS FOR ALLERGY DIAGNOSIS

For patients who are willing to pay a gap fee, QML Pathology is able to provide more extensive panels of allergen testing when needed. Certain patients may benefit from testing more than 4 allergens or allergen mixes at a time. To aid in requesting allergy tests, QML Pathology has developed the following panels:

Panel 1: Inhalant - 10

Panel 2: Childhood allergy - 15

Panel 3: Allergenic foods - 20

Panel 4: Moulds and Mites - 10

House dust miteBlomia tropicalis (mite)CockroachMould mixWeed pollen mixTree pollen mixGrass pollen mixCatDogHorse

House dust mite Grass pollen mix

Milk Egg white Soy Wheat Sesame seed Peanut Cashew Almond Hazelnut Strawberry

Banana Fish (cod) Oyster Shrimp (prawn) Rice Corn Potato Kiwi fruit Beef Mango

Dust mite (D. pteronyssinus) Dust mite (D. farinae) Blomia tropicalis Acarus siro Apergillus fumigatus Alternaria alternata Cladosporium herbarum Penicillium notatum Botrytis cinerea Mucor racemosus

CatDogHorseMould mixMilkEgg whiteWheatSoy

Fish (cod)PeanutCashewAlmondHazelnutAlmond

COMPONENT ALLERGY TESTING

QML Pathology offers a broad array of component (sometimes called molecular allergy) tests. Component-resolved diagnosis based on well-characterised individual allergen molecules is a major advance in allergy diagnosis.

Table b: Recombinant and component allergens (subject to out-of-pocket charges as per table c)

Name Common request term Name Common request term

MUXF3, CCD (bromelain) CCD, bromelain, MUXF3 Paper wasp (rPol d 5 recombinant protein antigen 5)

Pol d 5

nGal d 1, ovomucoid (egg) Ovomucoid Peach (rPru p 4 Profilin) Peach profilin

nAsp o 21 (enzyme alpha-amylase)

Alpha amylase, amylase Peanut (rAra h 2) Ara h 2

Enzyme savinase Savinase Peanut (rAra h 9, LTP) Ara h 9

rApi m 1 - phospholipase A2 (honey bee)

Api m 1; phospholipase A2 Prawn or shrimp (rPen a 1, Tropomyosin)

Tropomysin

rHev b 5 (latex) Latex Hev b 5 Wheat (rTri a 19, Omega-5 Gliadin)

Omega 5 gliadin

Gal-alpha-1,3-gal thyroglobulin bovine

Alpha-gal; Gal-alpha-1,3-Gal Wasp (rVes v 5, Vespula) Ves v 5

IMMUNOCAP ISAC® AT QML PATHOLOGY

ImmunoCAP ISAC® is a multiplex immunoassay platform based on modern biochip technology that allows for rapid, simultaneous measurement of specific IgE to over 100 allergen components in a single test. The ISAC® system tests well-characterised individual allergen molecules, either purified natural or recombinant allergen components, rather than crude whole allergen extracts. Specific IgE to allergen components correlate better with the presence and nature of clinical reactions to allergen exposure than specific IgE to whole allergen extracts.

ISAC® testing offers a broad approach to investigation of disease-associated specific IgE. Clinical scenarios where ISAC® is likely to be most beneficial include assessment of complex patients such as those with inconsistent histories, refractoriness to conventional therapy, multi-sensitised patients with symptoms due to allergen cross-reactivity or patients with anaphylaxis without a definable cause. For further information please consult the QML Pathology Immunocap ISAC brochure.

FEATURE ARTICLE

HOW TO ORDER

Specific IgE: Request 'Specific IgE (RAST)' on a QML Pathology request form, followed by the individual allergens or mixes required for testing. In the case of the lab receiving unspecified requests for Specific IgE, allergen testing will be based on the patient’s age and any clinical information supplied. In this scenario, the standard number of allergens/mixes tested is three.

A measurement of total IgE is useful in the interpretation of the significance of specific IgE and may be requested at the same time.

Extended Specific IgE (Extended RAST): Write the name of the panel from the table above e.g. ‘Extended RAST panel 1’ or ‘Extended sIgE panel 1’ in the ‘Tests Requested’ area of your QML Pathology request form.

Component Allergy Testing: Please request individual component allergens by name for specific IgE testing. For example, 'specific IgE for Ara h2' or 'RAST for Ara h2'.

ISAC Testing: Please request 'ISAC' on your QML Pathology request form. When possible, please provide brief clinical notes to assist with the interpretation of the ISAC results.

TURNAROUND TIME

RAST, Extended RAST and Component Testing: RAST testing is performed daily (Mon - Fri). Results are normally available within 48 hours from the time of collection.

ISAC Testing: Approximately 4 weeks.

COST FOR ALLERGY TESTING

Specific IgE (RAST): The Medicare benefit for specific IgE testing allows 4 testing episodes in a 12 month period. If a request contains more than 4 allergens, or allergen mixes; initial testing will be done on 4 allergens with additional allergy tests being processed at fortnightly intervals, up to a maximum of 4 episodes per 12 month period. If it is required that more than 4 allergens or mixes be tested together in a single episode, an out-of-pocket charge will apply. Charges will also apply if there are more than 4 episodes of allergy testing within 12 months, or if component allergens are included in a request. Out-of-pocket charges are summarised in Table c.

Extended Specific IgE (Extended RAST): These panels are not fully funded by Medicare and attract an out-of-pocket fee. The standard Medicare rebate for RAST testing is applicable. Please enquire through your local collection centre or medical liaison officer for costs.

Component Allergy Testing: These panels are not funded by Medicare and attract an out-of-pocket fee. In order to provide a comprehensive repertoire of these useful tests, an out-of-pocket gap fee applies to each component allergen requested– please see Table c.

ISAC Testing: Testing will incur an out-of-pocket cost of $350.00*.

Table c: Gap payment scenarios for allergy testing at QML Pathology

Scenario Gap payment Comments

> 4 allergens or mixes in a single episode $40.00 Non-specialist referrals only

> 4 episodes within 12 months $60.00 per episode All referrals

Component allergens $40.00 per component allergen All referrals

ISAC $350.00 No Medicare rebate available

FURTHER INFORMATION

For further information please call (07) 3121 4909

Dr David Heyworth-Smith FRCPA FRACP Consultant Clinical Immunologist Immunology & Microbiology Department

Dr Paul Campbell MB ChB, BSc (Hons), PhD (Oxford), FRCPAConsultant Immunologist, Immunology

Ms Marie HetheringtonChief Scientist, Immunology

To receive a copy of the QML Pathology doctor and patient brochures on allergy testing, please contact your MLO or email marketing@qml.com.au

QML PATHOLOGY UPDATES

Calprotectin is a cytoplasmic protein released by activated neutrophils. Its biological function is to sequester calcium and zinc ions, and deny them to pathogens. Calprotectin released by mucosal or luminal neutrophils may be measured in faecal specimens as an index of bowel inflammation. As such, testing is useful in the assessment of patients with suspected or known inflammatory bowel diseases.

WHEN TO ORDER

Calprotectin levels correlate with the degree of bowel inflammation and it is stable for at least 3 days at room temperature. This test permits non-invasive, inexpensive and rapid assessment of bowel inflammation. An endoscopy may be required to help determine the cause of inflammation, signs, and symptoms.

A faecal specimen is required because measurement of serum calprotectin does not correlate with mucosal inflammation. Normal levels of faecal calprotectin do not exclude the

possibility of colorectal carcinoma and coeliac disease. The validity of measurement can be negatively affected by faecal heterogeneity and therapy using Aspirin, NSAIDs and PPIs.

TESTING AT QML PATHOLOGY

A faecal specimen is required; samples can remain stable for up to 72 hours. To order the test, request faecal or stool calprotectin level on a standard QML Pathology request form. This is a self-collect for patients; please ensure patients understand the procedure required. Our collection centres can provide faeces collection kits for your patient or clinic. Results are available within 2-3 working days. There is currently no Medicare rebate for this test and as such, QML Pathology will charge an out-of-pocket fee of $75*.

For more information regarding faecal calprotectin or to receive a copy of the doctor and patient brochures please contact your MLO or email marketing@qml.com.au

Faecal Calprotectin: A Biomarker of Bowel Inflammation

The diagnosis of suspected coeliac disease (CD) involves serological testing for antibodies, and upper intestinal endoscopy with histological examination of a small bowel biopsy for confirmation in most cases. Endoscopy with biopsy findings confirms serological results and may exclude other causes of gastrointestinal pathology. CD is associated with the MHC alleles HLA-DQ2 and HLA-DQ8 and coeliac genotyping is also useful in certain circumstances.

ANTIBODY MEASUREMENT IN INVESTIGATION

Serological investigation of CD involves the detection of antibodies to gliadin (deamidated gliadin protein or DPG) and auto-antibodies to the antigen tissue transglutaminase. Thus, relevant assays are measurement of anti-gliadin antibodies and anti-tissue transglutaminase antibodies. In CD, measurement of antibodies of IgA isotype provides optimal sensitivity and specificity (in contrast to most autoimmune disorders in which the antibodies tested for are of IgM or IgG isotype). IgG antigliadin testing is useful in infants and in patients with IgA deficiency. Antibody measurement is useful both diagnostically and also to monitor compliance with a gluten-free diet.

GENOTYPING

As a negative HLA-DQ2/ DQ8 status means CD is unlikely, coeliac genotype assessment may be useful when there are

equivocal serological or biopsy results, or when a patient is on a gluten-free diet and does not wish to undergo a gluten challenge. However, a positive HLA-DQ2/DQ8 status is not diagnostic as these are permissive genetic factors only and approximately 25-30% of the Australian population are HLA-DQ2/DQ8 positive, whereas only 1-2% of the population have CD.

TESTING AT QML PATHOLOGY

Please request ‘coeliac serology’ on a standard QML Pathology request form. This generates a result for anti-tissue transglutaminase IgA antibodies and anti-gliadin IgG antibodies. Results are usually available within 2 working days. This test is bulk-billed subject to Medicare guidelines and criteria.

To request assessment of HLA DQ2/DQ8 status please request ‘coeliac genotype’. Results are usually available within 1 week. This test may be requested as a bulk-billed test, subject to Medicare guidelines and criteria.

For more information regarding laboratory investigation of coeliac disease or to receive a copy of the doctor and patient brochures please contact your MLO or email marketing@qml.com.au

*Prices, where displayed, are correct at time of printing and subject to change without notice.

Blood Tests in Investigation of Coeliac Disease

QML PATHOLOGY UPDATES

April 10, 2017

1st May - Changes to Cervical Screening

Further to the recent postponement in implementing the new National Cervical Cancer Screening Program, a new item number will be introduced for liquid based cytology commencing on Monday, 1st May. From this date, the following billing practices will be applied:

Referral May 1st to November 30th, 2017 Charges

Conventional smear only Bulkbill

Liquid based cytology only (Thinprep or Surepath) Bulkbill

Conventional smear AND liquid based cytology $35 out of pocket fee

HPV screening (non-MBS rebateable) $40 out of pocket fee

HPV testing for test of cure (MBS Item 69418) will continue to be performed according to the same Medicare criteria until the new National Cervical Cancer Screening program is introduced on 1st December this year. The postponement of the conversion to HPV screening has provided a number of challenges for our cytology teams in managing this transition. The out-of-pocket fee for referrals where both conventional smear and liquid based cytology referrals are received is to assist our efforts in providing better turnaround times for routine screening. We would like to thank you for your patience and understanding of the recent extension in turnaround times.

Providing you and your patients with reliable and accurate results in a timely and hassle-free manner is key for us, which is why we are committed to working closely with you throughout the coming months. Your local Medical Liaison Officer will be in contact with you to assist as these changes are implemented. In the meantime, please feel free to contact us directly if we can be of any assistance.

Yours sincerely,

Dr Jason Stone Gwenda LawrenceHead of Cytopathology Manager, Cytology

QML PATHOLOGY UPDATES

The influenza season of 2016 was dominated by influenza A. In Queensland, 92% of all the influenza strains typed were influenza A and 8% were influenza B. Of the 21,415 influenza A strains only 3,047 influenza A strains were subtyped, and of those 73% were subtyped as influenza A/H3N2 and 27% subtyped as influenza A (H1N1) pdm 091. In Queensland, the season reached its peak in week 35 as shown in figure 1, with highest percentage (27.7%) of positive influenza tests1.

Figure 1. Weekly influenza notifications in Queensland by type and percentage of positive tests (public laboratory system only) by week and month of testing, 1 January 2016 to 31 December 2016. Data extracted from NOCS and AUSLAB 6 March 2017.

Influenza Update

QML Pathology performs respiratory virus PCR (polymerase chain reaction) which includes influenza A, influenza B, respiratory syncytial virus (RSV), adenovirus, rhinovirus, human metapneumovirus and parainfluenza virus. The overall positivity for all the respiratory viruses at QML was 35% for 2016. The percentage positivity for influenza A and B was 35%, followed by 23% for rhinovirus, 15 % for RSV, 12% for parainfluenza virus and 6% for adenovirus.

Data from the World Health Organization Collaborating Centre for Reference and Research on influenza (WHOCC) indicates that the circulating strains were covered by the 2016 quadrivalent vaccine1.

Annual vaccination is important to prevent influenza and complications. There is recent evidence to suggest that protection against influenza may decline 3-4 months after vaccination and therefore early vaccination may need to be balanced with this evidence2.

Only quadrivalent influenza vaccine formulation is available in 2017 in Australia. Under the National Immunisation Programme (NIP) in 2017 the quadrivalent vaccine is funded for the following groups:

• Aboriginal and/or Torres Strait Islander children aged 6 months to <5 years

• Aboriginal and/or Torres Strait Islander persons aged ≥15 years

QML PATHOLOGY UPDATES

• All persons aged ≥65 years

• All persons aged ≥6 months who have certain medical conditions which increase the risk of influenza disease complications; for example, severe asthma, lung or heart disease, low immunity or diabetes

• Pregnant women (during any stage of pregnancy).

Influenza vaccination is also strongly recommended, but not funded, for other groups who are at increased risk of influenza and its complications.

The 2017 influenza vaccine contains the following strains:

• A (H1N1): an A/Michigan/45/2015 (H1N1)pdm09* like virus

• A (H3N2): an A/Hong Kong/4801/2014 (H3N2) like virus

• B: a B/Brisbane/60/2008 like virus

• B: a B/Phuket/3073/2013 like virus

*New strain (differs from strain in 2016 vaccine)

Please refer to figures 2 and 3 for seasonal influenza vaccines for use in 2017 in Australia by age, and the volume per dose and number of doses of these vaccines by age.

Figure 2: Seasonal influenza vaccines available for use in Australia in 2017, by age2

Age FluQuadri Junior 0.25 mL

(Sanofi Pasteur)

FluQuadri 0.50 mL

(Sanofi Pasteur)

Fluarix Tetra 0.50 mL

(GSK)

Afluria Quad 0.50 mL

(Seqirus)

<6 months No No No No

6 to 35 months (<3 years)

Yes No No No

≥3 years to 18 years No Yes Yes No

≥18 years No Yes Yes Yes

Please note that Seqirus Afluria Quad is NOT registered for use in children aged <18 years.

Figure 3: Number of doses and volume per dose for influenza vaccines, by age2

Age Dose volume Number of doses required in the first year of influenza

vaccination

Number of doses required if previously received any doses of influenza vaccine

6 months to <3 years 0.25 mL 2 1

≥3 years to <9 years 0.50 mL 2 1

≥9 years 0.50 mL 1† 1

†Two doses, at least 4 weeks apart, are recommended for persons with certain immunocompromising conditions (i.e. haematopoietic stem cell transplant or solid organ transplant) receiving influenza vaccine for the first time post transplant (irrespective of their age).

REFERENCES

1. Queensland Health: Statewide Weekly Influenza Surveillance Report – Reporting Period: 1 January to 31 December 2016. https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/surveillance/reports/flu/default.asp

2. Australian Technical Advisory Group on Immunisation (ATAGI) advice for immunisation providers regarding the administration of seasonal influenza vaccines in 2017. www.health.gov.au

FURTHER INFORMATION

2017 quadrivalent vaccines can be purchased though QML Pathology. Please call the Vaccines Department on (07) 3121 4523 to place an order.

QML PATHOLOGY UPDATES

2017-2019 TRIENNIUM

QML Pathology has been very active in continuing education since the beginning of 2017. We have already delivered ALMs, small group learning and Cat 2 events taking place throughout Queensland. We would like to thank all doctors and our chosen speakers for giving up their time, expertise and enthusiasm to ensure each and every event has been a success.

Due to Cyclone Debbie, plans for our Cytology “The Renewal” Roadshow for the far north of Queensland had to be postponed, we would like to thank all the doctors of Cairns and Townsville for their understanding in this unfortunate situation. Please watch out for a revised date as there are limited spots available so please RSVP early to avoid disappointment.

CYTOLOGY PAP AUDIT

Just a reminder, the QML Pathology Cytology Pap Audit will close in line with National Cervical Screening Program’s “The Renewal” implementation date.

SURGICAL SKIN AUDIT

The ever popular QML Pathology Surgical Skin Audit, had a record number of registrations this triennium and many practitioners are continuing to use this audit as part of their everyday practice. The Surgical Skin Audit has specialised request forms, to order these please use your stores request forms via your local laboratory. Please use these request forms with the reverse of the form completed to ensure your specimen is included in your count.

DYSGLYCAEMIC AND DIABETES MELLITUS AUDIT

Our recently released QML Pathology Dysglycaemic and Diabetes Mellitus Audit has gained momentum very quickly within the medical community. A quick refresher follows to assist you.

The 3 monthly reports will show the clinician

Dysglycaemic states

• Identifies the number of patients with impaired glucose within a 3 month snapshot.

• The table beside will display those patients who have recorded a raised glucose level and have been followed up.

• The Non-presenting Patients report (sent via hard copy separately) will be those patients that have been identified with a raised blood glucose which have not presented for any follow up testing at a QML Pathology collection centre. * Please note follow up of the individual patient is at doctors discretion however recommendations are for a repeat fasting glucose, HbA1c or GTT.

Diabetes Mellitus

• Monitor patients already diagnosed with diabetes type 1 or 2.

• HbA1c results indicating how well your patients are controlling their Diabetes within the defined timeframe

• See exact number of recommended tests in line with the annual cycle of care requested for your patients diagnosed with Diabetes (type 1 or 2) within the defined timeframe.

* Please note - Patient figures and statistics included in the reporting can only reflect those patients who have been referred and presented for testing at QML Pathology. Gestational diabetes is excluded from this audit.

For further information on all of our upcoming educational activities please visit our website qml.com.au, contact your local Medical Liaison Officer or contact education directly via email at education@qml.com.au

Warm regards, The QML Pathology Education team

From the Education Desk

Changes to Medicare Eligibility for QuantiFERON® Tuberculosis Testing from 1 May 2017Patients may now be eligible for a bulk-billed test, subject to the following Medicare guidelines and criteria.

MBS Item 69471 - Test of cell‘s mediated immune response in blood for the detection of latent tuberculosis by interferon gamma release assay (IGRA) in people who:

(a) Have been exposed to a confirmed case of active tuberculosis.

(b) Are infected with human immunodeficiency virus.(c) Are to commence, or have commenced, tumour necrosis

factor (TNF) inhibitor therapy.

(d) Are to commence, or have commenced, renal dialysis.(e) Have silicosis.(f ) Are, or are about to become, immunosuppressed because

of a disease, or a medical treatment, not mentioned in paragraphs (a) to (e).

Dr Terry Sheahan MBBS (Qld), FRCOG (Lond), FRANZCOG

Obstetrician and Gynaecologist Dr Terry Sheahan has recently commenced practice at the North Lakes QML Pathology Consulting Rooms. Dr Sheahan has a special interest in IVF and is one of Queensland Fertility Group’s expert specialists. His other special interests include advanced laparoscopic surgery, incontinence surgery, prolapse surgery, and the management of abnormal pap smears and menstrual disorders. His rooms are based at North West Medical Centre.

P: (07) 3353 3100 F: (07) 3353 4130 E: reception@drsheahan.com.au W: www.drsheahan.com.au

Dr Kyle Kowalewski BSc (Hons), MBBS, FRACS

Dr Kowalewski is a Queensland-trained general surgeon with post-fellowship training in breast surgery through BreastSurgANZ. After completing fellowships at Christchurch Hospital and the Peter MacCallum Cancer Centre (Melbourne), Dr Kowalewski has established a private practice on Brisbane’s Northside. Referrals are available for benign and malignant breast disease, and minor surgical, hernia, haemorroidectomy and laparoscopic cholecystectomy procedures. Consulting in Kallangur and The Gap, surgery is offered in North Lakes, Redcliffe and Gaythorne.

P: (07) 3204 4222 / E: kkowalew@hotmail.com

Dr Gillian Mahy MBchB, BSc(Hons), FRCP(Lon), FRACP

Dr Gillian Mahy is a Gastroenterologist and Endoscopist, specialising in all aspects of gastroenterology, general hepatology and upper and lower GI endoscopy, with subspecialty interests in the areas of Inflammatory Bowel disease, interventional endoscopy and ERCP. Dr Mahy’s rooms are located in Mundingburra, Townsville, North Queensland. She is also a senior staff specialist at the Townsville Hospital and consults at the Mount Isa Base Hospital and Ayr Hospital.

P: (07) 4775 4141 / E: reception@mahygastro.com

Dr Beata Peter-Przyborowska MBBS, FRANZCOG, BSc (Hons)

Consultant private practice obstetrician and gynaecologist, Dr Beata Peter-Przyborowska, has recently commenced working in Townsville. Dr Peter-Przyborowska has broad experience and training in gynaecology and obstetrics, as well as rural and regional medicine. Practicing in all age groups, Dr Peter-Przyborowska has a special interest adolescent gynaecology, vulval and cervical disorders, infertility, high risk obstetrics and pre-conceptual planning. Appointments can be made by phoning 07 4721 3713.

P: (07) 4721 3713 / (07) 4721 3019

North West Hospital Cardiology

P: (07) 3160 4331 / F: (07) 3353 0077 E: admin@northwest-cardiology.com.au

Dr Akshay Mishra MBBS, MD, DnB, FRACP, FCSANZ

Dr David Seaton MBBS, FRACP

Dr Mishra is an Interventional Cardiologist and Vascular Physician who has joined Dr David Seaton to offer cardiac services at North West Hospital Cardiology. His special interests include primary angioplasty for acute myocardial infarction, complex coronary and peripheral interventions. Trained in CTCA imaging, Dr Mishra enjoys imaging modalities to evaluate coronary and structural heart disease. He is also available for consultation at the Holy Spirit Northside Private Hospital.

Dr Seaton is an experienced Nuclear Physician and a Cardiologist. He graduated in Medicine from the University of Queensland. He underwent his specialist training in nuclear medicine and cardiology at the Royal Brisbane and Prince Charles Hospitals. He is a visiting medical officer at the Prince Charles Hospital. His sub-speciality interests are Nuclear Cardiology and Echocardiography.

Dr Matthew Warren BSc (Hons), MBBS, PhD, FACD

Specialist dermatologist Dr Matthew Warren is now taking appointments at South East Dermatology Stafford. A fellow of the Australasian College of Dermatologists, Dr Warren has published research in dermatology. He is an Associate Lecturer with the University of Queensland and has a special interest in acne treatment, surgical and non-surgical treatment of skin cancers, eczema and psoriasis.

P: (07) 3856 5007 / F: (07) 3352 6979 E: stafford@sebderm.com.au W: sebderm.com.au

Dr Brendan Louie BSc MBBS FRACS (Plast.)

Dr Louie is a Plastic and Reconstructive surgeon, available to private patients through Valley Plastic Surgery, Fortitude Valley. Aesthetic and reconstructive consultations, cosmetic medicine services, allied health assessments and treatments, and local anaesthetic procedures are available via appointment. For general anaesthetic procedures; Dr Louie holds regular lists at Brisbane Private Hospital. His specialties include head and neck reconstruction, limb and hand trauma, post mastectomy breast reconstruction, and skin cancer (particularly melanoma).

P: (07) 3488 8118 / F: (07) 3488 8119

E: info@valleyplasticsurgery.com.au

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DOCTOR NOTICEBOARD

CLINICAL DATA

This newsletter has been prepared and published by QML Pathology for the information of referring doctors. Although every effort has been made to ensure that the newsletter is free from error or omission, readers are advised that the newsletter is not a substitute for detailed professional advice. © Copyright 2016.

Infectious Diseases ReportGEOGRAPHIC DISTRIBUTION - MAR 2017

ORGANISMRegions (as per key below) TOTAL

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 MAR FEB JANAdenovirus (not typed) 16 1 7 10 18 4 1 4 61 43 58

Adenovirus (typing pending) 3 4 1 3 4 2 3 20 6 9

Barmah Forest virus 1 1 2 3 1 8 3 1

Bordetella pertussis 11 28 8 4 20 22 4 44 16 7 3 7 174 123 195

Brucella species 1 2 1 4 4 2

Campylobacter jejuni

Chlamydia pneumoniae

Chlamydia trachomatis, not typed 100 138 56 26 3 136 107 24 228 76 35 50 29 1008 487 378

Coxiella burnetii 1 1 1 1 1 2 5 12 9 8

Cryptococcus species 3 3

Cytomegalovirus (CMV) 5 8 1 2 7 7 4 11 8 1 4 58 52 47

Entamoeba histolytica

Enterovirus - not typed 1 1

Epstein-Barr virus (EBV) 8 22 13 1 34 1 23 6 58 20 6 6 3 201 151 173

Flavivirus unspecified 3 5 2 1 2 1 3 1 1 1 1 21 27 21

Hepatitis A virus 2 2 4 2 3

Hepatitis B virus 9 11 11 20 7 3 74 1 3 8 2 149 102 140

Hepatitis C virus 23 92 33 11 3 40 1 34 16 116 38 17 17 14 455 352 374

Hepatitis D virus 1 1

Hepatitis E virus 1 2

Herpes simplex Type 1 20 48 26 10 52 44 12 95 42 12 18 12 391 325 499

Herpes simplex Type 2 27 31 10 9 27 21 6 46 33 4 8 6 228 159 206

Herpes simplex virus - not typed

HIV-1 2 1 6 4 1 14 7 20

HTLV-1

Human Metapneumovirus 3 6 8 3 9 4 2 10 6 5 7 63 37 82

Influenza A virus 13 54 18 1 37 8 36 5 77 36 9 27 8 329 223 288

Influenza B virus 12 3 2 4 14 1 2 38 9 24

Legionella pneumophila (all serogroups) 1 1

Legionella species

Leptospira species 1 1 3 2 2 2 11 5 2

Measles virus 1 1 2 4

Mumps virus 1 2 1 1 5 5 7

Mycoplasma pneumoniae 5 17 6 2 1 11 6 3 16 5 3 3 78 64 85

Neisseria gonorrhoeae 7 10 5 2 18 13 29 5 2 5 1 97 67 47

Parainfluenza virus 7 16 10 18 14 1 30 14 4 5 2 121 49 103

Parvovirus 1 2 1 4 5 9

Pneumocystis carinii 1 1 2 2 1

Respiratory Syncytial virus 23 70 19 5 1 70 44 9 77 41 4 26 6 395 108 91

Rhinovirus (all types) 6 67 29 2 5 41 50 13 98 41 16 14 7 389 259 199

Rickettsia - Spotted Fever Group 1 1 1 1 4 2

Ross River virus 20 23 22 3 1 22 19 7 25 24 3 22 6 197 82 79

Rubella virus 1 1

Salmonella paratyphi A

Salmonella paratyphi B

Salmonella typhi 1 1

Streptococcus Group A 10 11 4 1 3 1 10 100 11 5 29 9 6 2 202 133 107

Toxoplasma gondii 2 1 3 2 2 10 7 5

Treponema pallidum 42 19 10 5 18 64 2 18 7 61 12 6 32 5 301 210 252

Trichomonas vaginalis 19 4 1 3 3 2 2 3 1 1 13 52 27 12

Varicella Zoster virus 12 50 20 4 55 36 7 74 52 6 9 12 337 253 308

Yersinia enterocolitica

TOTAL 389 764 313 94 41 3 716 120 541 140 1256 504 149 282 140 5452 3403 3840

FURTHER HISTORICAL CLINICAL DATA CAN BE OBTAINED BY CONTACTING MARKETING ON INFO@QML.COM.AU.

REGIONS:1 Cairns2 Gold Coast/Tweed3 Ipswich

4 Mackay5 Mount Isa6 New England7 North Brisbane

8 Northern Territory9 Redcliffe10 Rockhampton11 South Brisbane

12 Sunshine Coast13 Toowoomba14 Townsville15 Wide Bay/Burnett

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(Nov

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