Wuchopperen skin study

Skin infections are highly prevalent in many Australian Aboriginal communities. The study aimed to determine the prevalence of group A streptococcus (GAS) and Staphylococcus aureus (S.aureus) in skin sores of Indigenous people living in an urban setting.

The project involved a cross-sectional study of 173 children and youths attending the Wuchopperen Clinic (Cairns) for treatment of skin infections. Participants were interviewed using a structured questionnaire, and a skin lesion swab obtained. The median age was 5.3 years, with 42% identifying themselves as Torres Strait Islanders and 34% as Aboriginal.

Key Findings

• impetigo (65%) was the most frequent diagnosis reported followed by scabies (19%); 79% of the lesions had erythema and 70% had exudate.
• of 118 lesions, 114 were positive for pathogenic bacteria, with GAS isolated in 84 cases and ‘S. aureus’ in 92; both these species were recovered from 63 lesions.
• significant diversity of emm-types of GAS was associated with skin lesions in Indigenous patients (22 emm-types identified).
• fifteen of the 92 ‘S.aureus’ isolates were suggestive of being community-acquired on the basis of antimicrobial susceptibility profile and nine of these strains were co-cultured from nine legions.

The project results will inform:

• future changes of antibiotic policies for the treatment of skin infections in this population
• health promotion programs used in the primary healthcare service 
• the development of a GAS vaccine.

The results of the study suggest a significant diversity of emm-types of GAS associated with skin lesions in Indigenous patients living in an urban setting. This would be consistent with findings in remote communities in Northern Territory. Given that the majority of the Indigenous population of Queensland live in cities, further investigation of the prevalence and antibiotic susceptibility patterns of ‘S. aureus’ isolates to guide selection of antibiotic therapy is warranted.

Related resources

• Valery, P. C., Wenitong, M., Clements, V., Sheel, M., McMillan, D., Stirling, J., Sriprakash, K. S., Batzloff, M., Vohra, R. & McCarthy, J. S. 2008, ‘Skin Infections among Indigenous Australians in an Urban Setting in Far North Queensland’, Epidemiology and Infection, vol. 136, issue 8, pp. 1103–08.