Reducing antimicrobial use is believed to be a critical intervention in an era of impending catastrophic drug resistance, with little promise in the antimicrobial pipeline (1,2). Up to one-half of human antimicrobial use is believed to be inappropriate in terms of indication, choice of agent or duration (3). After years of research, it is clear that the most important determinant of resistance development is the use of an antimicrobial (4,5). In an effort to counteract overuse, Accreditation Canada now mandates, in its Required Organizational Practices, the existence of a multidisciplinary antimicrobial steward-ship program (ASP) at most inpatient health care facilities, including long-term care facilities providing ‘complex continuing care’ (6). Successful ASPs have demonstrated benefits including reduced drug resistance, fewer Clostridium difficile infections and reduced anti-microbial-related toxicity, with no demonstrated adverse clinical outcomes .
{"title":"When it comes to stewardship, it’s time to get with the programmers","authors":"E. Parfitt, L. Valiquette, K. Laupland","doi":"10.1155/2015/707348","DOIUrl":"https://doi.org/10.1155/2015/707348","url":null,"abstract":"Reducing antimicrobial use is believed to be a critical intervention in an era of impending catastrophic drug resistance, with little promise in the antimicrobial pipeline (1,2). Up to one-half of human antimicrobial use is believed to be inappropriate in terms of indication, choice of agent or duration (3). After years of research, it is clear that the most important determinant of resistance development is the use of an antimicrobial (4,5). In an effort to counteract overuse, Accreditation Canada now mandates, in its Required Organizational Practices, the existence of a multidisciplinary antimicrobial steward-ship program (ASP) at most inpatient health care facilities, including long-term care facilities providing ‘complex continuing care’ (6). Successful ASPs have demonstrated benefits including reduced drug resistance, fewer Clostridium difficile infections and reduced anti-microbial-related toxicity, with no demonstrated adverse clinical outcomes .","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"1 1","pages":"234 - 236"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74925468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CASE PRESENTATION An 80-year-old woman of Caribbean descent with a history of type 2 diabetes mellitus, gout, osteoarthritis, gastrointestinal reflux and atrial fibrillation, presented with a 12 h history of left-sided shoulder, neck and back pain. Her temperature was 38.0°C and her white blood cell count was 15×109 cells/L. She experienced tenderness in the left sternoclavicular and sternomanubrial regions associated with warmth and erythema, but without an effusion. Her neck range of motion was restricted by pain on the left side, including neck deviation to the right, which was compatible with torticollis. She could not abduct her shoulder beyond 60 degrees. She had a III/VI systolic ejection murmur at the left upper sternal border, but no stigmata of infectious endocarditis. Her gastrointestinal, dermatological and respiratory examinations were within normal limits. On admission, she was empirically started on ceftriaxone for suspected shoulder joint septic arthritis. An unsuccessful attempt was made to aspirate the left shoulder joint. The pain progressed toward her anterior chest wall and within 72 h C-reactive protein levels had increased from 11 mg/L to 240 mg/L. Blood cultures were positive in three of three sets for penicillin-susceptible Streptococcus pneumoniae. Aspiration of the sternoclavicular joint (SCJ) was unsuccessful. Transesophageal echocardiography did not reveal evidence of endocarditis. The chest radiograph did not reveal evidence of pneumonia. Despite prolonged antibiotic therapy, the patient never experienced full recovery of function, primarily with respect to arm adduction, which was limited by pain at the SCJ. Repeat computed tomography (CT) scan after therapy revealed arthritic changes related to her treated infection. Avoidance of pain led to the patient’s torticollis, which was the most distressing clinical feature for her. This persisted for months despite regular physiotherapy sessions.
{"title":"Osteomyelitis with a twist: Streptococcus pneumoniae causing sternoclavicular septic arthritis","authors":"R. Murthy, D. Petrescu, I. Salit","doi":"10.1155/2015/426704","DOIUrl":"https://doi.org/10.1155/2015/426704","url":null,"abstract":"CASE PRESENTATION An 80-year-old woman of Caribbean descent with a history of type 2 diabetes mellitus, gout, osteoarthritis, gastrointestinal reflux and atrial fibrillation, presented with a 12 h history of left-sided shoulder, neck and back pain. Her temperature was 38.0°C and her white blood cell count was 15×109 cells/L. She experienced tenderness in the left sternoclavicular and sternomanubrial regions associated with warmth and erythema, but without an effusion. Her neck range of motion was restricted by pain on the left side, including neck deviation to the right, which was compatible with torticollis. She could not abduct her shoulder beyond 60 degrees. She had a III/VI systolic ejection murmur at the left upper sternal border, but no stigmata of infectious endocarditis. Her gastrointestinal, dermatological and respiratory examinations were within normal limits. On admission, she was empirically started on ceftriaxone for suspected shoulder joint septic arthritis. An unsuccessful attempt was made to aspirate the left shoulder joint. The pain progressed toward her anterior chest wall and within 72 h C-reactive protein levels had increased from 11 mg/L to 240 mg/L. Blood cultures were positive in three of three sets for penicillin-susceptible Streptococcus pneumoniae. Aspiration of the sternoclavicular joint (SCJ) was unsuccessful. Transesophageal echocardiography did not reveal evidence of endocarditis. The chest radiograph did not reveal evidence of pneumonia. Despite prolonged antibiotic therapy, the patient never experienced full recovery of function, primarily with respect to arm adduction, which was limited by pain at the SCJ. Repeat computed tomography (CT) scan after therapy revealed arthritic changes related to her treated infection. Avoidance of pain led to the patient’s torticollis, which was the most distressing clinical feature for her. This persisted for months despite regular physiotherapy sessions.","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"111 1","pages":"251 - 252"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80118984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vaginal colonization and symptomatic vaginitis involving Candida albicans is common during pregnancy (1,2); however, infection of the amniotic fluid in the presence of intact membranes is encountered rarely in obstetrical practice and mostly recognized retrospectively (3). C albicans is able to cross intact fetal membranes (4) and several case reports describe the isolation of the organism from amniotic fluid in amniocentesis specimens obtained before placement of emergency cervical cerclage (2,5). We present three cases in which C albicans was not isolated on culture from the precerclage amniotic fluid, but was isolated from the postcerclage amniotic fluid. The present cases were identified during a retrospective review of all cases of emergency cerclage at our institution and approval was granted through the Research Ethics Board at the University of Manitoba (Winnipeg, Manitoba).
{"title":"Intra-amniotic infection involving Candida albicans subsequent to emergency cerclage: A case series","authors":"V. Poliquin, Eman Al-Sulmi, S. Menticoglou","doi":"10.1155/2015/589078","DOIUrl":"https://doi.org/10.1155/2015/589078","url":null,"abstract":"Vaginal colonization and symptomatic vaginitis involving Candida albicans is common during pregnancy (1,2); however, infection of the amniotic fluid in the presence of intact membranes is encountered rarely in obstetrical practice and mostly recognized retrospectively (3). C albicans is able to cross intact fetal membranes (4) and several case reports describe the isolation of the organism from amniotic fluid in amniocentesis specimens obtained before placement of emergency cervical cerclage (2,5). We present three cases in which C albicans was not isolated on culture from the precerclage amniotic fluid, but was isolated from the postcerclage amniotic fluid. The present cases were identified during a retrospective review of all cases of emergency cerclage at our institution and approval was granted through the Research Ethics Board at the University of Manitoba (Winnipeg, Manitoba).","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"1 4","pages":"245 - 246"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72633134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CASE PRESENTATION A 56-year old woman presented to the emergency department with a vague history of abdominal pain that had persisted for five days. A long-standing smoker, she was otherwise healthy with no previously diagnosed chronic medical conditions, and had no recent exposure to any sick contacts; she did admit to having a short episode of an upper respiratory tract infection two weeks previously that self-resolved. There was also no recent history of travel. On examination, she was tachycardic (110 beats/min to 115 beats/min), hypertensive (169/110 mmHg) and afebrile, and had a soft but tender abdomen. White blood cell count was in the 20×109/L range. Computed tomography (CT) angiography of the abdomen and pelvis revealed a 4 cm infrarenal aortic aneurysm extending to the aortic bifurcation with an associated 6.4 cm × 10 cm periaortic hematoma suggestive of rupture (Figure 1). The renal arteries and visceral vessels displayed mild atheromatous changes; other intra-abdominal structures were unremarkable. The patient’s relatively young age and female sex, coupled with the relatively small size and inflammatory appearance of the ruptured aneurysm on CT scan, were highly suggestive of a mycotic aneurysm. Blood cultures were drawn and ciprofloxacin and cefazolin were initiated. The patient was brought to the operating room for emergent open repair through a midline transperitoneal approach. Intraoperatively, note was made of an edematous retroperitoneum and an adherent duodenum. There were significant inflammatory changes in the aorta, extending distally into the iliac arteries. The periaortic fluid was noted to be nonpurulent; a sample of this was sent for Gram stain, and was reported as “moderate polymorphs with no organisms seen”. Given these nonspecific findings, the aneurysm was repaired with an in situ aorto-bi-iliac 12 mm × 7 mm Hemashield graft. The patient was then transferred to the intensive care unit (ICU) for postoperative care and continued on ciprofloxacin and cefazolin. Recovery was complicated, however, with acute occlusion of the graft. The patient underwent a second surgery with extensive thrombectomy of both limbs of the graft, as well as a left iliofemoral bypass due to consistently poor flow. The patient continued to decline, requiring increasing pressors to maintain hemodynamics. Antibiotics were broadened to include meropenem, vancomycin and fluconazole to treat her sepsis, despite negative blood cultures drawn at the time of the initial presentation. Additional complications included the need for hemodialysis for renal failure.
{"title":"A rare case of ruptured infrarenal aortic aneurysm infected with Haemophilus influenzae type B","authors":"H. Khambati, T. Brandys","doi":"10.1155/2015/863275","DOIUrl":"https://doi.org/10.1155/2015/863275","url":null,"abstract":"CASE PRESENTATION A 56-year old woman presented to the emergency department with a vague history of abdominal pain that had persisted for five days. A long-standing smoker, she was otherwise healthy with no previously diagnosed chronic medical conditions, and had no recent exposure to any sick contacts; she did admit to having a short episode of an upper respiratory tract infection two weeks previously that self-resolved. There was also no recent history of travel. On examination, she was tachycardic (110 beats/min to 115 beats/min), hypertensive (169/110 mmHg) and afebrile, and had a soft but tender abdomen. White blood cell count was in the 20×109/L range. Computed tomography (CT) angiography of the abdomen and pelvis revealed a 4 cm infrarenal aortic aneurysm extending to the aortic bifurcation with an associated 6.4 cm × 10 cm periaortic hematoma suggestive of rupture (Figure 1). The renal arteries and visceral vessels displayed mild atheromatous changes; other intra-abdominal structures were unremarkable. The patient’s relatively young age and female sex, coupled with the relatively small size and inflammatory appearance of the ruptured aneurysm on CT scan, were highly suggestive of a mycotic aneurysm. Blood cultures were drawn and ciprofloxacin and cefazolin were initiated. The patient was brought to the operating room for emergent open repair through a midline transperitoneal approach. Intraoperatively, note was made of an edematous retroperitoneum and an adherent duodenum. There were significant inflammatory changes in the aorta, extending distally into the iliac arteries. The periaortic fluid was noted to be nonpurulent; a sample of this was sent for Gram stain, and was reported as “moderate polymorphs with no organisms seen”. Given these nonspecific findings, the aneurysm was repaired with an in situ aorto-bi-iliac 12 mm × 7 mm Hemashield graft. The patient was then transferred to the intensive care unit (ICU) for postoperative care and continued on ciprofloxacin and cefazolin. Recovery was complicated, however, with acute occlusion of the graft. The patient underwent a second surgery with extensive thrombectomy of both limbs of the graft, as well as a left iliofemoral bypass due to consistently poor flow. The patient continued to decline, requiring increasing pressors to maintain hemodynamics. Antibiotics were broadened to include meropenem, vancomycin and fluconazole to treat her sepsis, despite negative blood cultures drawn at the time of the initial presentation. Additional complications included the need for hemodialysis for renal failure.","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"4 1","pages":"249 - 250"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91532488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oral vancomycin and oral metronidazole have several limitations with regard to their use in the treatment of Clostridium difficile infections (CDIs); however, oral vancomycin has been considered the gold standard in clinical trials. In June 2012, fidaxomicin received Health Canada approval for the treatment of CDIs. Its chemistry, mechanisms of action and pharmacological properties are discussed, along with its potential role in CDI therapy.
{"title":"Fidaxomicin: A novel agent for the treatment of Clostridium difficile infection","authors":"G. Zhanel, A. Walkty, J. Karlowsky","doi":"10.1155/2015/934594","DOIUrl":"https://doi.org/10.1155/2015/934594","url":null,"abstract":"Oral vancomycin and oral metronidazole have several limitations with regard to their use in the treatment of Clostridium difficile infections (CDIs); however, oral vancomycin has been considered the gold standard in clinical trials. In June 2012, fidaxomicin received Health Canada approval for the treatment of CDIs. Its chemistry, mechanisms of action and pharmacological properties are discussed, along with its potential role in CDI therapy.","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"59 1","pages":"305 - 312"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74574208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Xiong, S. Krajden, J. Kus, P. Rawte, J. Blondal, M. Downing, Urszula Zurawska, W. Chapman
Pasteurella dagmatis, a Gram-negative coccobacillus, has been isolated from both dogs and cats as normal flora. It is also a fairly new species for many clinicians because it is a pathogen in human infections. The authors present a case of bacteremia in a 74-year-old man that was caused by P dagmatis. A comparison of other reported cases of bacteremia due to P dagmatis is provided, along with a discussion of the challenges of standard automatic identification including alternative methodologies.
{"title":"Bacteremia due to Pasteurella dagmatis acquired from a dog bite, with a review of systemic infections and challenges in laboratory identification","authors":"J. Xiong, S. Krajden, J. Kus, P. Rawte, J. Blondal, M. Downing, Urszula Zurawska, W. Chapman","doi":"10.1155/2015/946812","DOIUrl":"https://doi.org/10.1155/2015/946812","url":null,"abstract":"Pasteurella dagmatis, a Gram-negative coccobacillus, has been isolated from both dogs and cats as normal flora. It is also a fairly new species for many clinicians because it is a pathogen in human infections. The authors present a case of bacteremia in a 74-year-old man that was caused by P dagmatis. A comparison of other reported cases of bacteremia due to P dagmatis is provided, along with a discussion of the challenges of standard automatic identification including alternative methodologies.","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"98 1","pages":"273 - 276"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79267047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Tsang, M. Morshed, V. Allen, M. Chernesky, K. Fonseca, R. Garceau, G. Jayaraman, K. Kadkhoda, Bonita E. Lee, P. Levett, Sandra M Radons, B. Serhir, A. Singh, T. Wong
The development of these recommendations arose in the spring of 2009 under the support and recommendation of the Canadian Public Health Laboratory Network (CPHLN). The initial group was formed of a federal co-chair (RT), a provincial co-chair (MM) and a CPHLN secretariat lead (SR). An initial environmental scan was performed in 2009, which was published in August 2011 (R Tsang, SM Radons, M Morshed. Laboratory diagnosis of syphilis: A survey to examine the range of tests used in Canada.
这些建议是在加拿大公共卫生实验室网络(CPHLN)的支持和建议下于2009年春季提出的。最初的小组由一名联邦联合主席(RT)、一名省联合主席(MM)和一名CPHLN秘书处负责人(SR)组成。2009年进行了初步环境扫描，结果于2011年8月发表(R Tsang, SM Radons, M Morshed)。梅毒的实验室诊断:一项调查，以检查在加拿大使用的测试范围。
{"title":"Canadian Public Health Laboratory Network national syphilis laboratory testing recommendations: INTRODUCTION","authors":"R. Tsang, M. Morshed, V. Allen, M. Chernesky, K. Fonseca, R. Garceau, G. Jayaraman, K. Kadkhoda, Bonita E. Lee, P. Levett, Sandra M Radons, B. Serhir, A. Singh, T. Wong","doi":"10.1155/2015/808405","DOIUrl":"https://doi.org/10.1155/2015/808405","url":null,"abstract":"The development of these recommendations arose in the spring of 2009 under the support and recommendation of the Canadian Public Health Laboratory Network (CPHLN). The initial group was formed of a federal co-chair (RT), a provincial co-chair (MM) and a CPHLN secretariat lead (SR). An initial environmental scan was performed in 2009, which was published in August 2011 (R Tsang, SM Radons, M Morshed. Laboratory diagnosis of syphilis: A survey to examine the range of tests used in Canada.","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"20 1","pages":"4A - 5A"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87403752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CASE PRESENTATION A 54-year-old man presented to the emergency room following a scorpion sting to the right index finger. He had been unloading a shipment of mangoes from South America and noted a small scorpion in the box, which he picked up and then killed after the sting (Figure 1A). Following the envenomation, he experienced acute paresthesia localized to the right arm, up to the elbow. He reported no fasciculations, spasms, myoclonus or any other focal or generalized neurological symptoms at that time. Review of systems was otherwise unremarkable. Medical history was only remarkable for a remote smoking history. He was on no regular medications and had no known drug allergies. On initial examination, he was afebrile, with a blood pressure of 125/70 mmHg sitting, heart rate of 70 beats/min, oxygen saturation of 98% on room air and a respiratory rate of 20 breaths/min. He was in no apparent distress. The distal interphalangeal joint of his right finger was swollen and erythematous, with an obvious puncture mark present. No sensory or motor abnormalities were noted, and reflexes were normal in the right upper extremity. No lymphadenopathy was noted. Cardiovascular, respiratory and abdominal examinations were all within normal limits. Initial white blood cell count was 10.1×109/L, hemoglobin 144 g/L and platelets 317×109/L. Sodium was 139 mmol/L, potassium 3.9 mmol/L, chloride 106 mmol/L and bicarbonate 24 mmol/L. Creatinine was 66 μmol/L, aspartate transaminase 22 U/L, alanine transaminase 31 U/L, alkaline phosphatase 110 U/l, total bilirubin 3 μmol/L, creatinine kinase 155 U/L and lipase 114 U/L. In the emergency room, he was monitored for 5 h with no progression of upper extremity paresthesia. Local poison control was contacted, but believed that antitoxin was not needed. The patient was discharged home with symptomatic management, including nonsteroidal anti-inflammatory drugs. He was assessed as an outpatient 24 h later, and experienced regression of paresthesia to the wrist and had developed significant spasms in his right hand. He was prescribed benzodiazapines for symptomatic management, with resolution of his symptoms. He was assessed a few weeks following the envenomation and had some residual paresthesia localized to the bite site without any other sensory symptoms or muscular spasms.
{"title":"A venomous visitor from the tropics","authors":"Z. Chagla, A. Boggild, S. Chakrabarti","doi":"10.1155/2015/739079","DOIUrl":"https://doi.org/10.1155/2015/739079","url":null,"abstract":"CASE PRESENTATION A 54-year-old man presented to the emergency room following a scorpion sting to the right index finger. He had been unloading a shipment of mangoes from South America and noted a small scorpion in the box, which he picked up and then killed after the sting (Figure 1A). Following the envenomation, he experienced acute paresthesia localized to the right arm, up to the elbow. He reported no fasciculations, spasms, myoclonus or any other focal or generalized neurological symptoms at that time. Review of systems was otherwise unremarkable. Medical history was only remarkable for a remote smoking history. He was on no regular medications and had no known drug allergies. On initial examination, he was afebrile, with a blood pressure of 125/70 mmHg sitting, heart rate of 70 beats/min, oxygen saturation of 98% on room air and a respiratory rate of 20 breaths/min. He was in no apparent distress. The distal interphalangeal joint of his right finger was swollen and erythematous, with an obvious puncture mark present. No sensory or motor abnormalities were noted, and reflexes were normal in the right upper extremity. No lymphadenopathy was noted. Cardiovascular, respiratory and abdominal examinations were all within normal limits. Initial white blood cell count was 10.1×109/L, hemoglobin 144 g/L and platelets 317×109/L. Sodium was 139 mmol/L, potassium 3.9 mmol/L, chloride 106 mmol/L and bicarbonate 24 mmol/L. Creatinine was 66 μmol/L, aspartate transaminase 22 U/L, alanine transaminase 31 U/L, alkaline phosphatase 110 U/l, total bilirubin 3 μmol/L, creatinine kinase 155 U/L and lipase 114 U/L. In the emergency room, he was monitored for 5 h with no progression of upper extremity paresthesia. Local poison control was contacted, but believed that antitoxin was not needed. The patient was discharged home with symptomatic management, including nonsteroidal anti-inflammatory drugs. He was assessed as an outpatient 24 h later, and experienced regression of paresthesia to the wrist and had developed significant spasms in his right hand. He was prescribed benzodiazapines for symptomatic management, with resolution of his symptoms. He was assessed a few weeks following the envenomation and had some residual paresthesia localized to the bite site without any other sensory symptoms or muscular spasms.","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"51 1","pages":"243 - 244"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74733507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Church, A. Ambasta, A. Wilmer, Holly Williscroft, G. Ritchie, D. Pillai, S. Champagne, D. Gregson
Pneumocystis pneumonia is caused by Pneumocystis jirovecii, an opportunistic fungal pathogen. Presently, many clinical microbiology laboratories rely on direct microscopic detection of P jirovecii. The validation, and clinical and laboratory development of a qualitative P jirovecii real-time polymerase chain reaction assay for the rapid detection of Pneumocystis pneumonia is discussed by the authors. In addition, this new technique is compared with the existing gold-standard immunofluorescence assay.
{"title":"Development and validation of a Pneumocystis jirovecii real-time polymerase chain reaction assay for diagnosis of Pneumocystis pneumonia","authors":"D. Church, A. Ambasta, A. Wilmer, Holly Williscroft, G. Ritchie, D. Pillai, S. Champagne, D. Gregson","doi":"10.1155/2015/138787","DOIUrl":"https://doi.org/10.1155/2015/138787","url":null,"abstract":"Pneumocystis pneumonia is caused by Pneumocystis jirovecii, an opportunistic fungal pathogen. Presently, many clinical microbiology laboratories rely on direct microscopic detection of P jirovecii. The validation, and clinical and laboratory development of a qualitative P jirovecii real-time polymerase chain reaction assay for the rapid detection of Pneumocystis pneumonia is discussed by the authors. In addition, this new technique is compared with the existing gold-standard immunofluorescence assay.","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"71 1","pages":"263 - 267"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85482298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：