In Canada, Hansen disease (leprosy) is rare and not considered in diagnoses for nonimmigrant patients. We report Mycobacterium leprae infection in a Canadian man whose sole travel was to Florida, USA. The M. leprae isolate was identified as armadillo-associated genotype 3I-2-v1. Travelers to the southern United States should avoid contact with armadillos.
Tick born zoonotic infections spread by Ixodes scapularis are on the rise in Canada. Tick-borne illnesses have a large constellation of symptoms associated with them which can often overlap and cloud diagnostic certainty. Human granulocytic anaplasmosis (HGA) is an emerging infectious disease in Canada, with tick carriage rates as high as 15% in some parts of the country. The majority of cases are associated with fever, headache, myalgia and malaise, thrombocytopenia, and transaminitis. The diagnosis is made through indirect fluorescent antibody titres, examination of peripheral smear, or polymerase chain reaction. Here we present the case of an otherwise health 71-year-old male presenting with fevers, thrombocytopenia, leukopenia, and a mixed transaminitis following a tick bite. He was subsequently diagnosed as the first case of HGA in Nova Scotia confirmed by indirect fluorescent antibody titre.
Genital herpes is a widespread sexually transmitted infection caused by the herpes simplex viruses (HSV). Suppressive valacyclovir therapy has been shown to significantly reduce HSV transmission. The benefits and costs of using valacyclovir to reduce transmission in couples discordant for genital herpes will be analyzed in order to better inform decision-making. By reducing transmission, the physical and psychological harms of living with symptomatic genital herpes will be prevented while saving on certain healthcare costs. However, the large number needed to treat and the low symptomatic rate among infected individuals may outweigh these benefits. The costs of trying to achieve a significant reduction in incidence include the psychological harms of identifying asymptomatic individuals through a large screening program and the economic costs of the antiviral agent and screening. When these issues are weighed, the high economic costs render a program to reduce incidence unfeasible. Nevertheless, it is clinically important to consider the consequences of transmission at an individual level. The specific circumstances that influence the decision to use suppressive therapy are identified.
Mycobacterium fortuitum is a rapidly growing mycobacterium, ubiquitous in soil and water, but it is an uncommon cause of infections in immunocompetent hosts. Cardiac device infections and bloodstream infections due to non-tuberculous mycobacteria are rare. We present the case of an 85-year-old patient with infective endocarditis and pacemaker lead infection secondary to M. fortuitum.
BackgroundSurgical site infections are common causes of healthcare-associated infections. Using surgical antimicrobial prophylaxis (SAP) is a complex process that can reduce these rates if performed correctly. While antimicrobial stewardship programs have developed guidelines for SAP, there has been less focus on understanding and modifying the behavioral and contextual factors required to optimize prophylaxis use. We performed chart reviews and workflow analyses to develop interventions based on a theoretical framework to improve SAP use in two academic hospitals.MethodsSAP use during a one month period (October 2016) was analyzed for orthopedic and general surgery procedures by chart review. The primary outcomes of interest included SAP choice, preoperative timing, intraoperative re-dosing, and postoperative continuation. Structured workflow analyses were performed to understand the processes involved in SAP ordering and administration. These findings were applied to the Theoretical Domains Framework (TDF) to develop theory-based interventions.ResultsWe reviewed 88 orthopedic and 63 general surgery procedures. Adherence to institutional guidelines for prophylaxis choice was low in both orthopedic (55%) and general surgery (70%). For general surgery, preoperative timing was incorrect in 25% of cases, re-dosing for procedure duration was incorrect in 59% of cases, and re-dosing for blood loss was not routinely performed. Alternatively, for orthopedic surgery cefazolin was re-dosed too early, at a median of 93 minutes (n = 42), and postop antibiotic use was continued for 10 days in all 14 aseptic hip revisions. There was variation in practice patterns among orthopedic surgeons. Using TDF, we identified barriers among numerous theoretical domains for re-dosing (knowledge; memory, attention, and decision processes; environmental context and resources), choice of antibiotic and postoperative duration (knowledge; beliefs about consequences; emotion; social influences).ConclusionWe identified suboptimal SAP use in two surgical services, each with distinct deficiencies. Performing in-depth chart reviews and workflow analyses characterized the specific behavioural and contextual barriers that require intervention.Disclosures
All authors: No reported disclosures.
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