Filling the Gaps in the Healthy Skin Program

Project: Filling the Gaps in the Healthy Skin Program

CRCAH Project No. HS164 Administering organisation Menzies School of Health Research Program Manager Arwen Pratt Project Leaders Ross Andrews (Menzies School of Health Research), Shelley Walton (Menzies School of Health Research) Team members Christine Connors, Jonathan Carapetis, Bart Currie, Deborah Holt, Kate Mounsey, Yvette Emmanuel, Rachael Lillebridge, Rebecca Towers, Malcolm McDonald, Sophie LaVincente, Kylie Carville, Dave Kemp, K. S. Sriprakash, James McCarthy, David McMillian, Michael Good, Michael Batzloff, Katja Fischer, Cielo Pasay, Charlene Willis, Mei-Fong Ho, Melina Georgousakis Contact details Dr Ross Andrews Tel: 08 8922 8668 Fax: 08 8927 5187 Email:  ross.andrews@menzies.edu.au Funding sources CRC for Aboriginal Health In kind contributors: Queensland Institute of Medical Research Partners involved The University of Melbourne Queensland Institute of Medical Research Menzies School of Health Research Murdoch Children’s Research Institute Aboriginal communities of Galiwin’ku, Gapuwiyak, Ramingining, Marngarr, Milingimbi, Yirrkala and WuChopperen

Project summary
The Filling the Gaps (FTG) project is a collaboration between three CRC for Aboriginal Health partners utilising laboratory, clinical and epidemiological methods and building on work currently being undertaken by the East Arnhem Healthy Skin project and on previous work conducted over the past decade. The four themes of the FTG project are:

• Theme 1: Scabies resistance and the immunology of infection.

• Theme 2: Determinants of persistent/recurrent scabies.

• Theme 3: Treatment of skin sores and the role of antibiotic resistance.

• Theme 4: Epidemiology of group A streptococcus (GAS) isolates in East Arnhem and Queensland Indigenous communities.

The emergence of antibiotic resistance among skin bacteria and drug resistance among scabies mites are two issues likely to be major obstacles to the sustainability of community-based programs. Also of serious concern is the emergence in Australia of community-acquired methicillin resistant Staphylococcus aureus (CAMRSA), which has increasingly been found to involve remote Indigenous communities. The FTG proposal will supplement activities aimed at ensuring effectiveness of a potential GAS vaccine that may eventually prevent skin disease from progressing to the more serious illnesses of rheumatic fever, rheumatic heart disease and streptococcal kidney disease.

Summary of projected outcomes
The primary objectives of the FTG project are:

1. Better understanding of the types of bacteria that cause skin infections in Aboriginal communities in the Northern Territory and Queensland and whether these will be preventable by a vaccine currently under development at Queensland Institute of Medical Research.
2. Better understanding of how bacteria and scabies mites develop resistance to treatments and identification of alternative therapies.
3. Consolidation of evidence about the causes and associated risk factors for persistent and recurrent scabies infestations.
4. Identification of the mechanism of the allergic reaction responsible for many of the manifestations of scabies infestation.

Summary of project implementation
Over three years the FTG researchers are utilising laboratory, clinical and epidemiological methods to evaluate drug resistance levels and to evaluate alternative drugs for scabies, GAS and CAMRSA. All scabies and bacterial samples used come from the seven communities already being studied as part of other Healthy Skin program projects.

Timeline

The original project milestones are as follows:

Nov 2005	Commence analysis of scabies mites, skin sore and throat swabs collected from the East Arnhem Project. Commence cross-sectional skin swabbing surveys in Queensland.
Feb 2006	Subject to results of community consultation, submit funding application for a Randomised Control Trial or observational study of various treatment protocols.
Dec 2006	Construction of S. scabiei genomic and 5’ cDNA libraries at Menzies School of Health Research. Generation of mdx -/- mice as mouse model for scabies at Queensland Institute of Medical Research. Complete follow-up of subjects recruited for case-control study. Summary report on progress of GAS collection and typing. Summary report of types of bacteria and their antibiotic resistance profiles from the first year of swabbing studies in East Arnhem and Queensland.
March 2007	Complete follow up of subjects recruited for case-control study.
Jul 2007	Complete final report for case-control study.
Dec 2007	Characterise the genes associated with scabies resistance. Begin development of a diagnostic test for resistance in scabies mite populations. Evaluation of drug resistance levels and evaluation of alternative drugs for both scabies and GAS and CAMRSA. Report of epidemiology of GAS and staph isolates, and their antibiotic resistance profiles from the swabbing studies in East Arnhem and Queensland.

Publications:

Clucas DB, Carville KS, Connors C, Currie BJ, Carapetis JR, Andrews RM. 2008.  Disease Burden and Health-Care Clinic Attendances for Young Children in Remote Aboriginal Communities of Northern Australia. Bulletin of the World Health Organization; 86 (4): 275-280.

Kearns T. 2008 Treating skin infections in NT Indigenous communities. Every Child Magazine;14 (2):14.

Mounsey KE, Holt D, McCarhty J, Currie B, Walton S. (2008) Scabies: molecular perspectives and therapeutic implications in the face of emerging drug resistance. Future Microbiol 3 (1). 57-66.

Pasay C, Arlian L, Morgan M, Uyszenski-Mohor D, Rose A, Holt D, Walton S, McCarthy J. (2008) High-resolution melt analysis for the detection of a mutation associated with permethrin resistance in – population of scabies mites. Medical and Veterinary Entomology 22, 82-88.

Mounsey KE, Dent JA, Holt DC, McCarthy J, Currie BJ and Walton SF, 2007. Molecular characterisation of a pH-gated Chloride Channel from Sarcoptes scabiei. Invertebrate Neuroscience, In press 31/5/07.

Fischer K, Holt DC,  Currie BJ, Walton SF,  Kemp DJ, (2006) Scabies mite inactivated protease paralogues. ICS 1289, Streptococci and Streptococcal Disease International Congress Series Vol 1289: 85-88.

Mounsey KE, Holt DC, McCarthy J, Walton SF, 2006. Identification of ABC Transporters in Sarcoptes scabiei. Parasitology 132(2):1-10.

Pasay C, Walton S, Fischer K, Holt D, McCarthy J (2006) PCR-based assay to survey for knockdown resistance to pyrethroid acaricides in human scabies mites (Sarcoptes  scabiei var hominis) Am J Trop Med Hyg 74: 649-657. (IF 2.0)

Willis C, Fischer K, Walton S, Currie BJ and Kemp DJ. (2006) Scabies Mite Inactivated Serine Protease Paralogues are present both internally in the mite gut and externally in faeces. Am J Trop Med Hyg 75(4):683-7.

See also publications on the Healthy Skin Program page.

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