Anthrax
Illness with acute onset characterised by several distinct clinical forms including:

• a skin lesion that has evolved over 2–6 days from a papule, through a vesicular stage to a depressed black eschar, with considerable swelling around the lesion
• a respiratory illness of abrupt onset followed by the development of dyspnoea progressing to hypoxia, with X-ray evidence of mediastinal widening
• abdominal distress followed by fever and signs of septicaemia (rare).

Ninety percent of cases are cutaneous anthrax.

Chemical Poisoning from the Environment
Chemical Poisoning from the Environment must be notified to the Massey University HSDIRT system (see Massey’s Resources for health professionals page).

Congenital Rubella Syndrome
In general, the younger the foetus when infected, the more severe the illness. Severe cases may spontaneously abort, or have multiple manifestations in infancy; mild cases may have only a single manifestation. The most common anomalies are deafness, cataract or glaucoma, congenital heart disease and mental retardation. In addition, infants with congenital rubella syndrome are often growth retarded and may have radiolucent bone disease, hepatosplenomegaly, thrombocytopenia and purpuric skin lesions.

Cronobacter Species Invasive Disease
Severe illness, usually in neonates and occasionally in elderly and immunocompromised, frequently presenting with hypo- or hyperthermia, lethargy, tachycardia, periods of apnoea and one or more of the following:

• meningitis including seizures
• encephalitis
• necrotising enterocolitis
• severe diarrhoea
• severe sepsis
• respiratory distress.

Only disease in infants less than 1 year old is notifiable.

Cysticercosis
Cysticerci can cause symptoms by compression or inflammation. Outside the central nervous system, they are generally asymptomatic and, when calcified, present only as an incidental radiological finding. In the brain and spinal cord, however, cysticerci can be associated with mass effects (for example, sensorimotor or cognitive deficits), seizures, hydrocephalus, chronic meningitis and spinal cord compression. Cysticercosis can cause serious disability but has a low case-fatality rate. The clinical diagnosis of neurocysticercosis can be made by computed tomography (CT) or magnetic resonance imaging (MRI) of the brain or spinal cord.

Diphtheria
Respiratory diphtheria is characterised by infection primarily involving the tonsil(s), pharynx and/or larynx, low-grade fever, with or without an asymmetrical greyish-white adherent membrane of the tonsil(s), pharynx and/or nose. In moderate to severe cases there can be marked neck swelling (enlarged anterior cervical lymph nodes and oedema of the surrounding tissues), resulting in a ‘bull neck’ appearance. Toxic effects can arise, including cardiac and neurological symptoms (for example, myocarditis and neuropathies).

Cutaneous diphtheria is characterised by secondary infection of other skin conditions or chronic ulcers with a grey membrane. Cutaneous diphtheria can act as a reservoir of bacteria capable of causing pharyngeal disease. Toxic sequelae in cutaneous cases are uncommon. Other extra-respiratory presentations have also been described, including septic arthritis, conjunctivitis, and vaginal and external auditory canal infections.

Hydatid Disease
Cysts usually develop in the liver or lung (occasionally the spleen, brain, heart, kidney or bones) and slowly grow to 5–10 cm in length. They may persist for years or decades without symptoms and often are detected incidentally. Local pressure effects in a confined space may lead to symptoms. Rarely, cysts rupture into the biliary tree or a bronchus causing obstruction, secondary bacterial infection, an allergic reaction or secondary spread. Even asymptomatic cysts should be notified. Radiologically, hydatid cysts are single or multiple and may have a rim of calcification. There may be peripheral blood eosinophilia.

Leprosy
A chronic bacterial disease characterised mainly by the involvement of skin and peripheral nerves. Clinical forms represent a spectrum reflecting the cellular immune response to Mycobacterium leprae. Anaesthetic skin lesions and nerve enlargements are characteristic of the disease. The disease includes:

• tuberculoid leprosy (TT): a few anaesthetic skin lesions and peripheral nerve abnormalities
• borderline leprosy (BB): skin lesions characteristic of both TT and LL forms
• lepromatous leprosy (LL): widespread erythematous papules and nodules with facial and aural infiltration, often accompanied by both individual peripheral nerve abnormalities and a symmetrical peripheral neuropathy.

Note: The World Health Organization classifies leprosy as multibacillary or paucibacillary based on the number of skin lesions and the presence or absence of bacteria found in skin smears. This classification determines the duration of multi-drug chemotherapy.

Murine Typhus
Murine typhus is caused by R. typhi (formerly called R. mooseri endemic or ‘shop’ typhus) and is one of the Rickettsial diseases. See Rickettsial disease below, for clinical criteria.

Novel Coronavirus
The Novel Coronavirus form is no longer in use. If notifying COVID-19, please use the COVID-19 case report form in EpiSurv.

Plague
A disease characterised by fever and leucocytosis presenting in one of the following ways:

• regional lymphadenitis (bubonic plague)
• septicaemia (septicaemic plague)
• pneumonia (pneumonic plague).

Poliomyelitis
Poliomyelitis is caused by wild poliovirus types 1, or 3 or by live vaccine-derived poliovirus. Wild poliovirus type 2 was declared globally eradicated in 2015. Infection is established in the gastrointestinal tract. A minor illness (fever, malaise, headache, vomiting) occurs in about 10 percent of infections. Over 90 percent of infections are asymptomatic or involve non-specific fever. In a minority of cases (less than 1 percent), infection spreads to the central nervous system and is characterised by:

• having no other apparent cause
• acute flaccid paralysis (AFP) of one or more limbs with decreased or absent deep tendon reflexes in affected limbs
• no sensory or cognitive loss
• a possible effect on bulbar muscles.

In children who develop paralysis the illness may be biphasic, with the initial phase of a mild febrile illness of one to three days’ duration indistinguishable from that of many other viral infections. The child appears to recover, only to be struck down abruptly two to five days later with meningism, followed by paralysis. In adults and adolescents, the illness usually presents with a gradual onset of paralysis and muscular pain without the early symptoms.

Primary Amoebic Meningoencephalitis
Symptoms may begin with a change in taste or smell, followed by headache, nausea, vomiting, confusion, fever, stiff neck and mental status changes. The infection typically affects the olfactory bulb and grey matter of the frontal, temporal and cerebellar lobes and usually runs a rapid course with death within 6 days of onset of symptoms.

Especially consider if not responding to treatment for bacterial causes of infection and there is a history of exposure to geothermal water.

Q Fever
Q fever causes a variety of clinical syndromes. Asymptomatic infection may occur, but the onset of infection is usually acute and characterised by fever, rigors, sweats, severe headache, weakness and myalgia. Pneumonia may be a feature, and abnormal liver function tests are common. Features of chronic infection include non-specific febrile illness, pneumonia, subacute endocarditis, hepatitis and, less commonly, granulomatous lesions in bone, soft tissues or body organs. A post-Q fever fatigue syndrome has been described.

Rabies
An acute encephalomyelitis that progresses to coma and death within 10 days of the onset.

Rickettsial Disease
Rickettsial disease characteristically presents with fever, headache and malaise; there is often lymphadenopathy, myalgia and a rash, either macular or haemorrhagic. Some cases may form an inoculation eschar (ulcer or papule often with a black crust). Neutropenia, thrombocytopenia and moderate increases in transaminases are common laboratory abnormalities. There is great variation in the severity of illness, depending on the organism involved, but continuing fever, cough and signs of bronchitis or pneumonia, photophobia, conjunctivitis, delirium, deafness and hepatosplenomegaly may be present.

Severe acute respiratory syndrome (SARS)
Relatively insidious onset with fever, myalgia, malaise and headache, followed a few days to 1 week later by dry cough and dyspnoea. About 25 percent of cases have diarrhoea. Symptoms of upper respiratory tract infection (rhinorrhea and sore throat) are uncommon. Chest X-rays typically show scattered peripheral and lower zone opacification. About 25 percent of cases develop severe pulmonary disease that may lead to death from respiratory failure.

The illness is similar but a little milder in children.

Taeniasis
Gastrointestinal infestation with Taenia spp. is usually asymptomatic. Cases occasionally suffer nervousness, insomnia, anorexia, weight loss, abdominal pain and digestive disturbances. Long motile proglottids can migrate out of the anus and be seen on the perineum, on clothing or in the faeces.

Tetanus
Most commonly presents with gradual onset of muscular rigidity and painful spasms, starting in the jaw (lockjaw, trismus) then spreading to the neck, trunk and extremities. Tetanus may cause laryngeal spasms, respiratory failure and autonomic dysfunction (fluctuations in pulse and blood pressure), leading to death, even with modern intensive care.

In less than 20 percent of cases, muscle rigidity and spasms are limited to a confined area close to the site of injury.

Trichinellosis
A disease caused by ingestion of Trichinella larvae, and invasion of the larvae into muscle tissues. The disease has variable clinical manifestations. Common signs and symptoms among symptomatic people include fever, myalgia and periorbital oedema. Eosinophilia is also common.

MERS-CoV
Most confirmed cases have presented with, or later developed, acute, serious respiratory illness. Typical symptoms have included fever, coughing and breathing difficulties. Some cases have also presented with gastro-intestinal symptoms (vomiting or diarrhoea). Asymptomatic cases and cases with only mild flu-like symptoms have also been reported.

Most of the severe cases have occurred in people with underlying co-morbidities, particularly type II diabetes. Reported cases have also been more common in the middle-aged and elderly populations. The case fatality rate is higher in patients who are immunocompromised and elderly or who demonstrate significant co-morbidities.