TABLE OF CONTENTS Spring  2013Volume 24Issue 1  

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Outpatient parenteral antimicrobial therapy
KB Laupland, L Valiquette

Re: AMMI Canada Position Paper. 2012 Mandatory influenza immunization of health care workers. Can J Infect Dis Med Microbiol 2012;23:e93-e95.
AMMI Canada

Emergence of non-serotype b encapsulated Haemophilus influenzae as a cause of pediatric meningitis in northwestern Ontario
P Sadeghi-Aval, RS Tsang, FB Jamieson, M Ulanova

Bacterial meningitis continues to be a major cause of morbidity and mortality in infants and children, with Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae serotype b (Hib) being the primary pathogens that cause this disease in children younger than five years of age. However, due to the introduction of Hib conjugate vaccines in the late 1980s cases of Hib meningitis have significantly decreased. Previously, the authors reported 38 cases of non-Hib invasive disease in northwestern Ontario between 2002 and 2008, and during continued surveillance of the same region they have identified 12 new cases of invasive H influenzae disease due to non-Hib strains, including three cases of pediatric meningitis with serious complications. This study reports observations of these 12 cases of invasive H influenzae disease, as well as addressing the question of whether specific genetic or phenotypic characteristics of the isolates could be responsible for their high virulence.

Antibiotic resistance and expression of resistance-nodulation-division pumps and outer membrane porins in Acinetobacter species isolated from Canadian hospitals
D Fernando, GG Zhanel, A Kumar

The Acinetobacter calcoaceticusAcinetobacter baumannii complex, consisting of A calcoaceticus, A baumannii, Acinetobacter pittii and Acinetobacter nosocomialis species, cause serious infections in immunocompromised individuals, which are very difficult to treat due to their high antibiotic resistance. The two most important mechanisms in these Acinetobacter species that contribute to their intrinsic antibiotic resistance are multidrug efflux systems (particularly those belonging to the resistance-nodulation-division family) and the loss of outer membrane permeability. However, little is known about the mechanisms of antibiotic resistance in the Acinetobacter species found in Canadian hospitals.

A model of the costs of community and nosocomial pediatric respiratory syncytial virus infections in Canadian hospitals
P Jacobs, D Lier, KL Gooch, K Buesch, M Lorimer, I Mitchell

The respiratory syncytial virus (RSV) is a significant causitive agent in viral lower respiratory tract infection in infants and children, and is associated with substantial morbidity and mortality. Furthermore, respiratory viruses, such as RSV, have been estimated to account for 71% of all nosocmial infections that occur after admission to hospital. Despite the high costs associatd with nosocomial infections, studies describing its specific economic costs are lacking. To address this important gap in the literature, the authors created an evidence-based model to estimate the full cost associated with pediatric community-aquired RSV hospital admissions, including the costs of the original community-aquired cases, and the additional costs to prevent and treat nosocomial RSV cases.

Feasibility and success of HIV point-of-care testing in an emergency department in an urban Canadian setting
ML Becker, LH Thompson, C Pindera, N Bridger, C Lopez, Y Keynan, J Bullard, P Van Caseele, K Kasper

The number of Canadians living with HIV continues to increase every year; yet, it has been estimated that 26% of Canadians living with HIV are unaware of their status. In particular, the prairie provinces of Canada are witnessing growing numbers of HIV-positive persons in care, with the Manitoba HIV Program having reported 102 new cases to care in 2010, and, of these, 35% presented late to care with CD4 counts <200 cells/mL, which significantly increases the risk of opportunistic infections. In addition to these individual consequences of late presentation and delayed access to care, the longer patients remain unaware of their HIV infection the more opportunities there are for transmission. In an attempt to increase the rates of HIV testing and access to timely care, simplified point-of-care rapid HIV tests have begun to be introduced. This article describes the results of a study conducted in the emergency department of the Health Sciences Centre Hospital in Winnipeg, Manitoba.

A case of vertical transmission of Chagas disease contracted via blood transfusion in Canada
MA Fearon, V Scalia, M Huang, I Dines, M Ndao, P Legacé-Wiens

Chagas disease, endemic to Central and South America and Mexico, is caused by the protozoan parasite Trypanosoma cruzi and is spread by Triatominea or Reduviidae (hematophagus insects) vectors. Approximately 20% to 30% of infected individuals progress to develop chronic infection, which results when the parasite invades the smooth muscle. This may result in cardiomegaly (with associated conduction anamolies), megacolon or megaesophagus. Chagas disease can also be spread by blood transfusion, organ transplantation and through vertical transmission from mother to fetus. This report describes a Canadian female blood donor who was involved in a seroprevalence study who tested positive for Chagas disease.

Bats, fever and adenopathy - what is the link?
JJ Manolakos, M Cooray, A Patel, S Haider

Histoplasma capsulatum, the causative agent of histoplasmosis, is a dimorphic fungi commonly found in bird and bat fecal material that is prevelant in areas endemic for histoplasmosis, including most of Latin America, eastern Asia, Africa, Australia and the eastern half of the United States. This report describes a case of travel-related histoplasmosis involving a 20-year-old woman who had recently travelled to Costa Rica.

Necrotizing fasciitis in an immunocompromised elderly woman
A Ghosh, J Johnstone

Group A rotaviruses in children with gastroenteritis in a Canadian pediatric hospital: The prevaccine era
E Chetrit, Y L'Homme, J Singh Sohal, C Quach

Group A rotavirus (RVA) infection is the leading cause of severe gastroenteritis in young children, with health care-associated RVA infections adding to the already significant burden of community-acquired illness. Immunization against RVA has been shown to be effective for both preventing RVA infection and decreasing RVA-associated health care demands. The recent widespread introduction of human RVA vaccines could drive the selection of rare or atypical strains, including animal-human reassortant viruses. The objectives of this study were to examine the trends in RVA infections from 2006 to 2011 and to determine which RVA genotypes were present in Montreal, Quebec, before the publicly funded vaccination program was introduced.

Low seroconversion after one dose of AS03-adjuvanted H1N1 pandemic influenza vaccine in solid organ transplant patients
MR Resende, S Husain, J Gubbay, L Singer, E Cole, EL Renner, C Rotstein

The complications associated with influenza present a real health risk to solid-organ transplant (SOT) recipients. As a result, SOT recipients were targeted as a priority for vaccination with the AS03-adjuvanted pandemic H1N1 (pH1N1) vaccine during the epidemic situation that arose in Canada in 2009. In adult SOT recipients, seasonal influenza vaccine has been shown to be safe and studies measuring the immunogenicity of a single dose of pH1N1 vaccine in the general population have shown seroconversion rates >95%; however, few studies have assessed the immunogenicity of the adjuvanted pH1N1 vaccine in SOT recipients. To address the lack of data on this vulnerable group of patients, the authors of this study evaluated seroconversion in SOT recipients after a single dose of adjuvanted pH1N1 vaccine.

Risk of cytomegalovirus infection and disease after umbilical cord blood transplantation in children
PA Crisinel, M Duval, D Thuillard Crisinel, B Malette, N Bellier, M-F Vachon, L Dedeken, C Rousseau, B Tapiero, P Ovetchkine

Cytomegalovirus (CMV) infection and disease pose a serious threat in the first few months following hematopoietic stem cell transplantation. Besides the direct effect of the virus, CMV infection can also increase the possibility of rejection or graft-versus-host disease. Umbilical cord blood (UCB), as a source of stem cells, increases the accessibility of grafting; however, the immaturity of these cells may increase the risk of infection by certain microorganisms such as CMV. The risk of CMV infection after UCB transplantation has been assessed in adults, but there are currently no data on the risk of CMV infection and disease in purely pediatric populations transplanted with UCB. To address this important lack of pediatric data, the aim of this study was to assess the risk of CMV infection and disease in a pediatric population transplanted with UCB compared with other sources of stem cells at a pediatric tertiary care centre.

Antimicrobial resistance and antimicrobial use associated with laboratory–confirmed cases of Campylobacter in two health units in Ontario
AE Deckert, RJ Reid-Smith, SE Tamblyn, L Morrell, P Seliske, FB Jamieson, R Irwin, CE Dewey, P Boerlin, SA McEwen

Campylobacteriosis, due to infection by Campylobacter species, is characterized by bloody diarrhea, fever and abdominal pain. Although campylobacteriosis is usually a self-limiting infection, studies have found that a substantial percentage of patients are prescribed antimicrobials, which could lead to increased antimicrobial resistance in Campylobacter species. However, there is currently no information available regarding the types and prevalence of antimicrobials used to treat campylobacteriosis in Canada. To address the lack of data on this important topic, the authors conducted a population-based study to document antimicrobial resistance and antimicrobial use associated with clinical cases of campylobacteriosis in the Perth District and Wellington-Dufferin-Guelph health unit areas of Ontario.

Discordant diagnosis of malaria in a family of child refugees from Sierra Leone
SK Yanow, D Gregson, R Chawla

There are multiple methods of testing available for suspected cases of malaria, including microscopy, rapid molecular diagnostic tests and polymerase chain reaction analysis, with polymearse chain reaction analysis being able to detect an approximately 10-fold lower concentration of parasites. This report describes the diagnosis of four cases of malaria in a family who were refugees from Sierra Leone, an area known to be endemic for malaria.

Infected pseudoaneurysm of the superficial femoral artery in a patient with Salmonella enteritidis bacteremia
MA Hussain, G Roche-Nagle

Infected aneurysms are rare, comprising only 0.9% of total aneurysms, but are a serious clinical condition that requires early diagnosis and treatment to prevent rupture or distal embolization. Also known as mycotic aneurysms, they are defined as a localized, irreversible dilation of an artery due to destruction of the vessel wall by infection. Before the antibiotic era, endocarditis was the most common cause of infected aneurysms; however, in the postantibiotic era, arterial trauma has become more prevalent. This report describes a case of superficial femoral artery mycotic aneurysm involving a 52-year-old man.

Acute interstitial nephritis due to Leptospira grippotyphosa in the absence of Weil’s disease
T Schmidhauser, S Curioni, E Bernasconi

Leptospira interrogans, which is divided into more than 200 serovars, is the causative agent of leptospirosis, a zoonosis that occurs worldwide, but is far more prevalent in tropical climates. Leptospiral infections occur as two distinct clinical syndromes: anicteric leptospirosis and icteric leptospirosis. Humans become infected from direct contact with the urine of an infected animal or other contaminated materials such as soil or water. This report describes an unusual case of anicteric leptospirosis, due to Leptospira grippotyphosa, involving a 26-year-old man who had recently travelled to Thailand and Indonesia.

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