Infection In Australia Research Articles

Chlamydia screening interventions from community pharmacies: a systematic review

Chlamydia (Chlamydia trachomatis) is the most commonly notified sexually transmissible infection in Australia. Increasing the number of people aged 16-25 years being tested for chlamydia has become a key objective. The strategy recommends that chlamydia screening sites should be easy to access. Community pharmacies are conveniently located and easily accessible. This review aimed to determine the different types of pharmacy-based chlamydia screening interventions, describe their uptake rates, and understand issues around the acceptability of and barriers to testing. Seven electronic databases were searched for peer-reviewed articles published up to 30 October 2011 for studies that reported chlamydia screening interventions from community pharmacies, or had qualitative evidence on acceptability or barriers linked with interventions. Of the 163 publications identified, 12 met the inclusion criteria. Nine reported chlamydia screening interventions in a pharmacy setting, whereas three focussed on perspectives on chlamydia screening. Pharmacists could offer a chlamydia test to consumers attending the pharmacy for a sexual health-related consultation, or consumers could request a chlamydia test as part of a population-based intervention. Participating consumers said pharmacies were accessible and convenient, and pharmacists were competent when offering a chlamydia test. Pharmacists reported selectively offering tests to women they thought would be most at risk, undermining the principles of opportunistic interventions. Chlamydia screening from community pharmacies is feasible, and can provide an accessible, convenient venue to get a test. Professional implementation support, alongside resources, education and training programs, and incentives may overcome the issue of pharmacists selectively offering the test.

Reducing barriers to testing for Chlamydia trachomatis by mailed self-collected samples

Chlamydia trachomatis (chlamydia) is the most commonly notified sexually transmissible bacterial infection in Australia, where distance to health services can be a barrier. This study investigated the acceptability of a self-collection kit for chlamydia testing (sent by mail) and assessed the risk profiles of participants with respect to locality. In total, 2587 self-collection kits were distributed opportunistically or sent directly to participants upon request, as was a self-administered questionnaire. The return rate was 13.2% (n=341) for samples and questionnaires. The return rate did not differ with location (P=0.522) but with mode of distribution (opportunistic: 9.7%; by request: 27.4%; P<0.001). Although 37% of participants had previously been tested for chlamydia, 77.5% said that they would not have sought testing otherwise. The median age of participants was 22.6 years, 33.8% were male and 9.1% were of Aboriginal descent. Overall, 9.0% (95% confidence interval (CI)=6.1-12.5) of participants were chlamydia-positive. Prevalence of chlamydia and Aboriginal participation increased with remoteness (P<0.001), and self-reported condom use was significantly reduced for remote and very remote locations (P=0.008). Within remote and very remote locations, 30.8% (95% CI=9.1-61.4) of Aboriginal participants and 38.9% of non-Indigenous participants were chlamydia-positive (P=0.718; 95% CI=17.3-64.3). Testing for chlamydia using a mailed self-collection kit opened access to a predominantly test-naïve population. The proposed model was able to reach remote populations. Actively requested kits were more likely to be returned.

The Australian experiment: general practitioner care of HIV

Over 20,000 people are living with HIV infection in Australia. From the early days of the epidemic general practitioners (GPs) have been closely involved in providing HIV care including antiretroviral therapy (ART). Training programs began in 1990 with about 200 GPs currently trained to provide ART. However there are limited data available on uptake and outcomes of GP HIV care. This review will present data on current GP involvement in providing HIV care as well as treatment outcomes. A Medline search was conducted using the terms general practice, HIV and Australia. Abstracts from local conferences were also reviewed. The major identified study of treatment uptake is HIV Futures [1], a national survey of approximately 1000 HIV+ve people performed every 2 years. Over the last 10 years this study consistently reports that about 50% of all HIV specific care is provided by GPs. One study describes an audit of 500 HIV+ve patients starting treatment in primary and hospital sites [2]. This found that there were comparable and high levels of adherence to guidelines on ART initiation in both general and specialist practice. A cohort of 168 patients followed for over 10 years in an Australian GP reported that 24% had been lost to follow‐up, 7% died and 68% continued in care with 98% receiving ART with 96% having an undetectable viral load (&lt;400) [3]. These outcomes were similar to those reported in the long‐running national Australian HIV Observational Database (AHOD). Robust data show that about half of all HIV care in Australia is provided by GPs. Limited published data on adherence to guideline and treatment outcomes suggest comparable result in general practice versus specialist settings. GP care appears to be an acceptable and effective approach to HIV management although more research on treatment outcomes is needed.

First reported case of imported human Babesia microti infection in Australia

First reported case of imported human Babesia microti infection in Australia

Hendra virus: an emerging paramyxovirus in Australia

Hendra virus, first identified in 1994 in Queensland, is an emerging zoonotic pathogen gaining importance in Australia because a growing number of infections are reported in horses and people. The virus, a member of the family Paramyxoviridae (genus Henipavirus), is transmitted to horses by pteropid bats (fruit bats or flying foxes), with human infection a result of direct contact with infected horses. Case-fatality rate is high in both horses and people, and so far, more than 60 horses and four people have died from Hendra virus infection in Australia. Human infection is characterised by an acute encephalitic syndrome or relapsing encephalitis, for which no effective treatment is currently available. Recent identification of Hendra virus infection in a domestic animal outside the laboratory setting, and the large range of pteropid bats in Australia, underpins the potential of this virus to cause greater morbidity and mortality in both rural and urban populations and its importance to both veterinary and human health. Attempts at treatment with ribavirin and chloroquine have been unsuccessful. Education, hygiene, and infection control measures have hitherto been the mainstay of prevention, while access to monoclonal antibody treatment and development of an animal vaccine offer further opportunities for disease prevention and control.

Public disclosure of health care‐associated infections in Australia: quality improvement or parody?

Public disclosure of health care‐associated infections in Australia: quality improvement or parody?

Investigation of Borrelia burgdorferi genotypes in Australia obtained from erythema migrans tissue

BackgroundLyme disease (LD) is an emerging infectious disease in Australia. There has been controversy regarding endemic lyme disease in the country for over 20 years. Borrelia burgdorferi sensu stricto (Bbss) and sensu lato (Bbsl) are closely related spirochetal species that are the causative agents of LD in humans. Clinical transmission of this tick-borne disease is marked by a characteristic rash known as erythema migrans (EM). This study employed molecular techniques to demonstrate the spirochetal agent of Lyme disease isolated from EM biopsies of patients in Australia and then investigate their genetic diversity.MethodsFour patients who presented to the author’s practice over a one-year period from mid 2010 to mid 2011 returned positive results on central tissue biopsy of EM lesions using polymerase chain reaction (PCR) analysis. The findings were confirmed by DNA sequencing, and basic local alignment search tool (BLAST) analysis was then used to genetically characterize the causative organisms.ResultsThree isolates were identified as Bbss that lay genotypically between strains B31 and ZS7 and were then characterized as strain 64b. One of the three isolates though may have similarity to B. bissettii a Bbsl. The fourth isolate was more appropriately placed in the sensu lato group and appeared to be similar, but not identical to, a B. valaisiana-type isolate. In this study, a central biopsy taken within 6 days of infection was used instead of conventional sampling at the leading edge, and the merits of this are discussed.ConclusionThese patients acquired infection in Australia, further proving endemic LD on the continent. Central biopsy site of EM is a useful tool for PCR evaluation. BLAST searches suggest a genetic diversity of B. burgdorferi, which has implications concerning the diagnosis, clinical severity, and testing of LD in Australia.

Harmonised epidemiological indicators for poultry slaughter: case studies for Salmonella and Campylobacter

EFSA Supporting PublicationsVolume 9, Issue 6 294E External scientific reportOpen Access Harmonised epidemiological indicators for poultry slaughter: case studies for Salmonella and Campylobacter A. R. Cameron, A. R. Cameron AusVet Animal Health ServicesSearch for more papers by this author A. R. Cameron, A. R. Cameron AusVet Animal Health ServicesSearch for more papers by this author First published: 29 June 2012 https://doi.org/10.2903/sp.efsa.2012.EN-294Citations: 3 This external report is not produced by EFSA. It is published to help keep the public informed of developments related to EFSA's scientific work. EFSA reserves its rights, view and position as regards the issues addressed and conclusions reached in the present document, without prejudice to the rights of the authors. Published date: 29 June 2012 Question number: EFSA-Q-2011-00433 AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References Arnold ME, Mueller-Doblies D, Carrique-Mas JJ and Davies RH, 2009. The estimation of pooled-sample sensitivity for detection of Salmonella in turkey flocks Journal of Applied Microbiology 107, 936– 943. EFSA (European Food Safety Authority), 2010 Analysis of the baseline survey on the prevalence of Campylobacter in broiler batches and of Campylobacter and Salmonella on broiler carcasses in the EU, 2008. Part A: Campylobacter and Salmonella prevalence estimates. EFSA Journal, 8(03):1503, [ 100 pp.]. Gradel KO, Andersen J and Madsen M, 2002. Comparisons of Sampling Procedures and Time of Sampling for the Detection of Salmonella in Danish Infected Chicken Flocks Raised in Floor Systems. Acta Veterinaria Scandinavica, 43, 21– 30. Hofshagen M and Kruse H, 2005. Reduction in flock prevalence of Campylobacter spp. in broilers in Norway after implementation of an action plan. Journal of Food Protection, 68, 2220– 23. Hofshagen M, Opheim M, Johannessen GS, Lyngstad T, Jonsson M and Hauge K, 2008. Plan of action against Campylobacter in poultry for slaughter. Norsk Veterinartidsskrift, 120, 154– 56. Hue O, Le Bouquin S, Laisney MJ, Allain V, Lalande F, Petetin I, Rouxel S, Quesne S, Gloaguen PY, Picherot M, Santolini J, Salvat G, Bougeard S, Chemaly M, 2010. Prevalence of and risk factors for Campylobacter spp. contamination of broiler chicken carcasses at the slaughterhouse. Food Microbiology 27(8), 992– 9. Epub 2010 Jun 23. Martin PAJ, 2008. Current value of historical and ongoing surveillance for disease freedom: Surveillance for bovine Johne's disease in Western Australia. Preventive Veterinary Medicine, 84, (3–4), 291– 309. Rogan WJ and Gladen B, 1978. Estimating prevalence from the results of a screening test. American Journal of Epidemiology 107, 71– 76. Watkins RE, Martin P A, Kelly H, Madin B and Watson C, 2009. An evaluation of the sensibility of acute flaccid paralysis surveillance for poliovirus infection in Australia. BMC Infectious Diseases, 9: 162. Citing Literature Volume9, Issue6June 2012294E ReferencesRelatedInformation

Implementation of standardised surveillance for Clostridium difficile infections in Australia: initial report from the Victorian Healthcare Associated Infection Surveillance System

Detection of a hypervirulent strain of Clostridium difficile in Victoria led to commencement of targeted surveillance for C. difficile infection in 2010. Cases were reported through the Victorian Healthcare Associated Infection Surveillance System. Between 1 October 2010 and 31 March 2011, 477 cases of C. difficile infection were identified; 11 (2.3%) secondary to a hypervirulent strain. Three hundred and seventy (1.7 per 10,000 occupied bed days) were healthcare associated. Data reflect successful implementation of continuous surveillance for C. difficile infection. With hypervirulent C. difficile infection now reported in other Australian states, development of a national data repository for C. difficile infection is necessary.

The prevalence of Chlamydia trachomatis infection in Australia: a systematic review and meta-analysis.

BackgroundChlamydia trachomatis is a common sexually transmitted infection in Australia. This report aims to measure the burden of chlamydia infection by systematically reviewing reports on prevalence in Australian populations.MethodsElectronic databases and conference websites were searched from 1997–2011 using the terms ‘Chlamydia trachomatis’ OR ‘chlamydia’ AND ‘prevalence’ OR ‘epidemiology’ AND ‘Australia’. Reference lists were checked and researchers contacted for additional literature. Studies were categorised by setting and participants, and meta-analysis conducted to determine pooled prevalence estimates for each category.ResultsSeventy-six studies met the inclusion criteria for the review. There was a high level of heterogeneity between studies; however, there was a trend towards higher chlamydia prevalence in younger populations, Indigenous Australians, and those attending sexual health centres. In community or general practice settings, pooled prevalence for women <25 years in studies conducted post-2005 was 5.0% (95% CI: 3.1, 6.9; five studies), and for men <30 years over the entire review period was 3.9% (95% CI: 2.7, 5.1; six studies). For young Australians aged <25 years attending sexual health, family planning or youth clinics, estimated prevalence was 6.2% (95% CI: 5.1, 7.4; 10 studies) for women and 10.2% (95% CI: 9.5, 10.9; five studies) for men. Other key findings include pooled prevalence estimates of 22.1% (95% CI: 19.0, 25.3; three studies) for Indigenous women <25 years, 14.6% (95% CI: 11.5, 17.8; three studies) for Indigenous men <25 years, and 5.6% (95% CI: 4.8, 6.3; 11 studies) for rectal infection in men who have sex with men. Several studies failed to report basic demographic details such as sex and age, and were therefore excluded from the analysis.ConclusionsChlamydia trachomatis infections are a significant health burden in Australia; however, accurate estimation of chlamydia prevalence in Australian sub-populations is limited by heterogeneity within surveyed populations, and variations in sampling methodologies and data reporting. There is a need for more large, population-based studies and prospective cohort studies to compliment mandatory notification data.

Projected burden of disease for Salmonella infection due to increased temperature in Australian temperate and subtropical regions

ObjectiveThis study aimed to project the future disability burden of Salmonella infection associated with increased temperature in future in temperate and subtropical regions of Australia in order to provide recommendations for public health policy to respond to climate change. MethodsYears Lost due to Disabilities (YLDs) were used as the measure of the burden of disease in this study. Regions in temperate and subtropical Australia were selected for this study. Future temperature change scenarios in the study were based on Australian projections, developed by the Commonwealth Scientific and Industrial Research Organization (CSIRO). YLDs for Salmonella infection in 2000 were calculated as the baseline data. YLDs for Salmonella infection in 2030 and 2050 under future temperature change scenarios were projected based on the quantitative relationship between temperature and disease examined in previously published regression models. Future demographic change was also considered in this analysis. ResultsCompared with the YLDs in 2000, increasing temperature and demographic changes may lead to a 9%–48% increase in the YLDs for Salmonella infection by 2030 and a 31%–87% increase by 2050 in the temperate region, and a 51%–100% increase by 2030 and an 87%–143% increase by 2050 in the subtropical region, if other factors remain constant. ConclusionTemperature-related health burden of Salmonella infection in Australia may increase in the future due to change in climate and demography in the absence of effective public health interventions. Relevant public health strategies should be developed at an early stage to prevent and reduce the health burden of climate change.

Epidemiology of Shiga toxin producing Escherichia coli in Australia, 2000-2010.

BackgroundShiga toxin-producing Escherichia coli (STEC) are an important cause of gastroenteritis in Australia and worldwide and can also result in serious sequelae such as haemolytic uraemic syndrome (HUS). In this paper we describe the epidemiology of STEC in Australia using the latest available data.MethodsNational and state notifications data, as well as data on serotypes, hospitalizations, mortality and outbreaks were examined.ResultsFor the 11 year period 2000 to 2010, the overall annual Australian rate of all notified STEC illness was 0.4 cases per 100,000 per year. In total, there were 822 STEC infections notified in Australia over this period, with a low of 1 notification in the Australian Capital Territory (corresponding to a rate of 0.03 cases per 100,000/year) and a high of 413 notifications in South Australia (corresponding to a rate of 2.4 cases per 100,000/year), the state with the most comprehensive surveillance for STEC infection in the country. Nationally, 71.2% (504/708) of STEC infections underwent serotype testing between 2001 and 2009, and of these, 58.0% (225/388) were found to be O157 strains, with O111 (13.7%) and O26 (11.1%) strains also commonly associated with STEC infections. The notification rate for STEC O157 infections Australia wide between 2001-2009 was 0.12 cases per 100,000 per year. Over the same 9 year period there were 11 outbreaks caused by STEC, with these outbreaks generally being small in size and caused by a variety of serogroups. The overall annual rate of notified HUS in Australia between 2000 and 2010 was 0.07 cases per 100,000 per year. Both STEC infections and HUS cases showed a similar seasonal distribution, with a larger proportion of reported cases occurring in the summer months of December to February.ConclusionsSTEC infections in Australia have remained fairly steady over the past 11 years. Overall, the incidence and burden of disease due to STEC and HUS in Australia appears comparable or lower than similar developed countries.

High Rates of Late HIV Diagnosis Among People Who Inject Drugs Compared to Men Who Have Sex with Men and Heterosexual Men and Women in Australia

We aimed to estimate temporal trends in the proportion of HIV diagnoses which could be characterized as recent infections in Australia for men who have sex with men (MSM), people who inject drugs (PWID), and heterosexual men and women using modified back-projection methodology based on data sources from HIV/AIDS Surveillance database. The proportion of HIV diagnoses among MSM that can be classified as recent infections increased in MSM, heterosexual men and women consistently. However, after initial increases during 1996-2000, the proportion of overall recent infections estimated among PWID declined by 50% in 2007 compared to 2000 (from 23 to 11%). These data suggest that late HIV diagnoses were more common among PWID compared to other groups. Ongoing prevention efforts need to be coupled with targeted testing and treatment efforts to increase the diagnosis of recent infection in PWID and reduce apparent inequities in access to screening.

Epstein-Barr Virus Genotypes and Strains in Central Nervous System Demyelinating Disease and Epstein-Barr Virus-Related Illnesses in Australia

Objectives: To identify Epstein-Barr virus (EBV) genotypes and strains in samples from individuals with and without a first diagnosis of central nervous system (CNS) demyelinating disease (a possible precursor to multiple sclerosis) and patients with EBV-associated diseases in Australia. Methods: Samples from 55 EBV DNA and serology positive subjects including individuals with (n = 17) and without (n = 21) a first clinical diagnosis of CNS demyelination and patients with EBV-related diseases (n = 17) were examined. EBV genotype and strain were identified by sequence mutations within the Epstein-Barr nuclear antigen-2 region (EBNA-2) using DNA sequence analysis. Results: Both EBV genotypes, A and B, were detected (genotype A, 54/55, 98.2%; genotype B, 1/55, 1.8%). Within genotype A, GD1 was the most commonly detected strain (42/54, 77.7%), followed by B95-8 (9/54, 16.7%) and M-ABA (3/54, 5.6%). Genotype B, strain AG876, was found in one individual with CNS demyelinating disease. Conclusions: EBV genotype A and the GD1 strain were the common EBV genotypes isolated from individuals with and without CNS demyelinating disease, and in subjects with various EBV-related diseases. Although disease-specific genotypes or strains were not identified, this study provides useful insights into the molecular epidemiology of EBV infection in Australia.

Karen Brown and Daniel Gilfoyle (eds), Healing the Herds: Disease Livestock Economies, and the Globalization of Veterinary Medicine, Ecology and History Series (Athens, OH: Ohio University Press, 2010), pp. x + 299, £22.50, paperback, ISBN: 978-0-8214-1885-7.

Karen Brown and Daniel Gilfoyle (eds), Healing the Herds: Disease Livestock Economies, and the Globalization of Veterinary Medicine, Ecology and History Series (Athens, OH: Ohio University Press, 2010), pp. x + 299, £22.50, paperback, ISBN: 978-0-8214-1885-7.

Correlates of Chlamydia trachomatis infection in a primary care sentinel surveillance network

Chlamydia is the most commonly notified infection in Australia. Prevention strategies should be informed by routine data on at-risk populations. We calculated chlamydia positivity and correlates of infection using multivariable logistic regression for data collected between April 2006 and June 2009. Chlamydia positivity was 5.6% in 12233 females, 7.7% in 10316 heterosexual males and 6.2% in 7872 men who have sex with men (MSM). Correlates of chlamydia positivity among females included younger age (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.92-2.69), being born overseas (OR 1.50, 95% CI 1.25-1.82), multiple sex partners in the past year (OR 1.72, 95% CI 1.40-2.11) and inconsistent condom use with regular sex partners (OR 3.44 ,95% CI 1.65-7.20). Sex work was protective for females (OR 0.68, 95% CI 0.53-0.86). Among heterosexual males, correlates of positivity were younger age (OR 1.87, 95% CI 1.62-2.17), being born overseas (OR 1.35, 95% CI 1.16-1.58), symptoms at the time of testing (OR 1.64, 95% CI 1.40-1.92) and multiple sex partners in the past year (OR 1.83, 95% CI 1.46-2.30). Correlates of positivity among MSM were being born overseas (OR 1.23, 95% CI 1.00-1.51), being HIV-positive (OR 1.80, 95%CI 1.32-2.47), and reporting six or more anal sex partners in the past 6 months (OR 4.45, 95% CI 1.37-14.5). Our analysis identified subgroups at the highest risk of chlamydia in Victoria. These estimates will provide important baseline information to measure the impact of chlamydia control strategies.

Young people's views on the potential use of telemedicine consultations for sexual health: results of a national survey

BackgroundYoung people are disproportionately affected by sexually transmissible infections in Australia but face barriers to accessing sexual health services, including concerns over confidentiality and, for some, geographic remoteness. A possible innovation to increase access to services is the use of telemedicine.MethodsYoung people's (aged 16-24) pre-use views on telephone and webcam consultations for sexual health were investigated through a widely-advertised national online survey in Australia. Descriptive statistics were used to describe the study sample and chi-square, Mann-Whitney U test, or t-tests were used to assess associations. Multinomial logistic regression was used to explore the association between the three-level outcome variable (first preference in person, telephone or webcam, and demographic and behavioural variables); odds ratios and 95%CI were calculated using in person as the reference category. Free text responses were analysed thematically.ResultsA total of 662 people completed the questionnaire. Overall, 85% of the sample indicated they would be willing to have an in-person consultation with a doctor, 63% a telephone consultation, and 29% a webcam consultation. Men, respondents with same-sex partners, and respondents reporting three or more partners in the previous year were more willing to have a webcam consultation. Imagining they lived 20 minutes from a doctor, 83% of respondents reported that their first preference would be an in-person consultation with a doctor; if imagining they lived two hours from a doctor, 51% preferred a telephone consultation. The main objections to webcam consultations in the free text responses were privacy and security concerns relating to the possibility of the webcam consultation being recorded, saved, and potentially searchable and retrievable online.ConclusionsThis study is the first we are aware of that seeks the views of young people on telemedicine and access to sexual health services. Although only 29% of respondents were willing to have a webcam consultation, such a service may benefit youth who may not otherwise access a sexual health service. The acceptability of webcam consultations may be increased if medical clinics provide clear and accessible privacy policies ensuring that consultations will not be recorded or saved.

Neurological diseases of ruminant livestock in Australia. III: bacterial and protozoal infections

Bacteria (including chlamydia) and protozoa can produce neurological disease in Australian ruminant livestock and the nature of the inflammatory and neuroparenchymal response is often suggestive of a particular aetiological agent. An overview of the clinicopathological features of infectious disease affecting the central nervous system (CNS) is followed by a discussion of important bacterial and protozoal infections in Australia. Each infectious disease is discussed in terms of classification and pathogenesis linked to clinical signs and gross and microscopic findings. The literature review is restricted to infectious conditions causing CNS disease in Australia. Sources include the Australian Veterinary Journal (over 50 years of articles), the quarterly newsletter of the National Animal Health Surveillance System and the Animal Health Surveillance Quarterly.

Proof of freedom from equine influenza infection in Australia in 2007–08

The challenges faced in demonstrating Australia's freedom from equine influenza following the outbreak in 2007-08 and the responding strategy developed by the Proof of Freedom Working Group are presented.

Evidence incriminating midges (Diptera: Ceratopogonidae) as potential vectors of Leishmania in Australia

The first autochthonous Leishmania infection in Australia was reported by Rose et al. (2004) and the parasite was characterised as a unique species. The host was the red kangaroo (Macropus rufus) but the transmitting vector was unknown. To incriminate the biological vector, insect trapping by a variety of methods was undertaken at two field sites of known Leishmania transmission. Collected sand flies were identified to species level and were screened for Leishmania DNA using a semi-quantitative real-time PCR. Collections revealed four species of sand fly, with a predominance of the reptile biter Sergentomyia queenslandi (Hill). However, no Leishmania-positive flies were detected. Therefore, alternative vectors were investigated for infection, giving startling results. Screening revealed that an undescribed species of day-feeding midge, subgenus Forcipomyia (Lasiohelea) Kieffer, had a prevalence of up to 15% for Leishmania DNA, with high parasitemia in some individuals. Manual gut dissections confirmed the presence of promastigotes and in some midges material similar to promastigote secretory gel, including parasites with metacyclic-like morphology. Parasites were cultured from infected midges and sequence analysis of the Leishmania RNA polymerase subunit II gene confirmed infections were identical to the original isolated Leishmania sp. Phylogenetic analysis revealed the closest known species to be Leishmania enriettii, with this and the Australian species confirmed as members of Leishmania sensu stricto. Collectively the results strongly suggest that the day-feeding midge (F. (Lasiohelea) sp. 1) is a potential biological vector of Leishmania in northern Australia, which is to our knowledge the first evidence of a vector other than a phlebotomine sand fly anywhere in the world. These findings have considerable implications in the understanding of the Leishmania life cycle worldwide.