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Annualized incidence and spectrum of illness from an outbreak investigation of Bell's palsy.

https://arctichealth.org/en/permalink/ahliterature188646
Source
Neuroepidemiology. 2002 Sep-Oct;21(5):255-61
Publication Type
Article
Author
A M Morris
S L Deeks
M D Hill
G. Midroni
W C Goldstein
T. Mazzulli
R. Davidson
S G Squires
T. Marrie
A. McGeer
D E Low
Author Affiliation
Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ont., Canada.
Source
Neuroepidemiology. 2002 Sep-Oct;21(5):255-61
Language
English
Publication Type
Article
Keywords
Bell Palsy - epidemiology - etiology - microbiology
Diagnostic Errors
Health Surveys
Humans
Incidence
Infection - complications
Nova Scotia - epidemiology
Ontario - epidemiology
Risk factors
Abstract
There are limited clinical and epidemiological data on patients diagnosed with Bell's palsy. While investigating an apparent clustering of Bell's palsy, we sought to characterize the spectrum of illness in patients with this diagnosis.
A telephone survey of persons with idiopathic facial (Bell's) palsy in the Greater Toronto Area (GTA, population = 4.99 million) and Nova Scotia (population = 0.93 million) from August 1 to November 15, 1997 collected information on subject demographics, neurological symptoms, constitutional symptoms, medical investigation and management. Information regarding potential risks for exposure to infectious agents, past medical history, and family history of Bell's palsy was also collected. Subjects with other secondary causes of facial palsy were excluded.
In the GTA and Nova Scotia, 222 and 36 patients were diagnosed with idiopathic facial (Bell's) palsy, respectively. The crude annualized incidence of Bell's palsy was 15.2 and 13.1 per 100,000 population in the GTA and Nova Scotia, respectively. There was no temporal or geographical clustering, and symptomatology did not differ significantly between the two samples. The mean age was 45 years, with 55% of subjects being female. The most common symptoms accompanying Bell's palsy were increased tearing (63%), pain in or around the ear (63%), and taste abnormalities (52%). A significant number of patients reported neurological symptoms not attributable to the facial nerve.
No clustering of cases of Bell's palsy was observed to support an infectious etiology for the condition. Misdiagnosis of the etiology of facial weakness is common. Patients diagnosed with Bell's palsy have a variety of neurological symptoms, many of which cannot be attributed to a facial nerve disorder.
PubMed ID
12207155 View in PubMed
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Apparent lower rates of streptococcal toxic shock syndrome and lower mortality in children with invasive group A streptococcal infections compared with adults.

https://arctichealth.org/en/permalink/ahliterature219192
Source
Pediatr Infect Dis J. 1994 Jan;13(1):49-56
Publication Type
Article
Date
Jan-1994
Author
H D Davies
A. Matlow
S R Scriver
P. Schlievert
M. Lovgren
J A Talbot
D E Low
Author Affiliation
Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada.
Source
Pediatr Infect Dis J. 1994 Jan;13(1):49-56
Date
Jan-1994
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Male
Ontario - epidemiology
Shock, Septic - epidemiology - etiology
Streptococcal Infections - complications - epidemiology - genetics - mortality
Streptococcus pyogenes
Abstract
Since 1985 there have been worldwide reports of increases in severe invasive Group A streptococcal (IGAS) infections. We reviewed the charts of all children with IGAS infections (defined as isolation of Group A streptococcus from a normally sterile site) presenting to our institution over a 7-year period (January, 1985, to December, 1991) and the literature. Streptococcal toxic shock syndrome required hypotension and multisystem organ involvement. Twenty-four patients (mean age, 4.96 +/- 4.4 years) were identified with IGAS infection. One patient (presenting in 1989) met the criteria for probable streptococcal toxic shock syndrome and none died. Eight of 19 Group A streptococcal isolates tested were streptococcal pyrogenic exotoxin (SPE) A producers, most (90%) had the speC gene and all had the speB gene and produced the toxin. No M or T type predominated. The low rates of streptococcal toxic shock syndrome and fatalities among children with IGAS infection are consistent with other pediatric but not with adult series. The apparent differences in outcome of IGAS between children and adults were not explained by the virulence factors we examined and may warrant further investigation.
PubMed ID
8170732 View in PubMed
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Broth microdilution testing of Haemophilus influenzae with haemophilus test medium versus lysed horse blood broth. Canadian Haemophilus Study Group.

https://arctichealth.org/en/permalink/ahliterature223213
Source
J Clin Microbiol. 1992 Sep;30(9):2284-9
Publication Type
Article
Date
Sep-1992
Author
S R Scriver
D E Low
A E Simor
B. Toye
A. McGeer
R. Jaeger
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Source
J Clin Microbiol. 1992 Sep;30(9):2284-9
Date
Sep-1992
Language
English
Publication Type
Article
Keywords
Amoxicillin - chemistry
Bacteriological Techniques
Blood
Canada - epidemiology
Clavulanic Acids - chemistry
Culture Media - metabolism - standards
Drug Stability
Evaluation Studies as Topic
Haemophilus Infections - diagnosis
Haemophilus influenzae - enzymology - growth & development - isolation & purification
Humans
Microbial Sensitivity Tests - methods
Observer Variation
Reproducibility of Results
beta-Lactamases - analysis
Abstract
Broth microdilution testing of 702 community-acquired isolates of Haemophilus influenzae from across Canada was performed with both Mueller-Hinton broth supplemented with 3% lysed horse blood broth (LHB) (BBL Microbiology Systems, Cockeysville, Md.) and haemophilus test medium (HTM). The prevalence of beta-lactamase production was found to be 26% with no regional variation. MICs determined with LHB tended to be higher than those with HTM, but interpretive errors due to these differences were observed only rarely with trimethoprim-sulfamethoxazole (n = 5), cefaclor (n = 8), and cefamandole (n = 3). The interobserver variability in MIC determinations was found to be greater when LHB was used than when HTM was used. There was no difference in intraobserver variability between the two medium formulations. beta-Lactamase-positive isolates developed false resistance to amoxicillin-clavulanate 2 weeks after microdilution panels of both types of medium were stored at -20 degrees C but not when panels were stored at -70 degrees C. In conclusion, this study supports the use of HTM rather than LHB for sensitivity testing of H. influenzae because of its lower rate of interobserver variability and its ability to support the growth of these organisms, which is comparable to that of LHB.
Notes
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PubMed ID
1400992 View in PubMed
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Changing epidemiology of invasive Haemophilus influenzae in Ontario, Canada: evidence for herd effects and strain replacement due to Hib vaccination.

https://arctichealth.org/en/permalink/ahliterature144168
Source
Vaccine. 2010 May 28;28(24):4073-8
Publication Type
Article
Date
May-28-2010
Author
H J Adam
S E Richardson
F B Jamieson
P. Rawte
D E Low
D N Fisman
Author Affiliation
Department of Microbiology, Health Sciences Centre, Winnipeg, Manitoba, Canada. hadam@hsc.mb.ca
Source
Vaccine. 2010 May 28;28(24):4073-8
Date
May-28-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Bacterial Capsules - administration & dosage
Child
Child, Preschool
Haemophilus Infections - epidemiology
Haemophilus Vaccines - administration & dosage
Haemophilus influenzae type b - classification - isolation & purification
Humans
Immunity, Herd
Immunization Programs
Incidence
Middle Aged
Ontario - epidemiology
Serotyping
Young Adult
Abstract
The epidemiology of invasive Haemophilus influenzae infections was evaluated in Ontario between 1989 and 2007 to assess the impact of the introduction of the conjugate H. influenzae serotype b (Hib) vaccine in the early 1990 s on Hib and non-Hib serotypes in both vaccinated and unvaccinated cohorts as well as the possibility of "strain replacement" with non-vaccine H. influenzae strains. Data were collected by the provincial Public Health Laboratories-Toronto, Ontario Agency for Health Protection and Promotion, which performed almost all serotyping on invasive (blood, CSF, other sterile sites) H. influenzae strains isolated in the province during the study period. Temporal trends for Hib, other typeable strains, and non-typeable H. influenzae were evaluated by Poisson regression, controlling for the specimen submissions. Prior to infant Hib vaccination, the most commonly observed serotype was serotype b (64.9%). Subsequently, 70.3%, 13.6%, and 9.4% of isolates were non-typeable, serotype f, and serotype b, respectively. Infant Hib vaccination resulted in a decrease in Hib incidence in all age groups (pooled IRR 0.432) and marked increases of non-typeable and serotype f H. influenzae in children aged
PubMed ID
20398617 View in PubMed
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Characterization of Clostridium difficile strains isolated from patients in Ontario, Canada, from 2004 to 2006.

https://arctichealth.org/en/permalink/ahliterature156000
Source
J Clin Microbiol. 2008 Sep;46(9):2999-3004
Publication Type
Article
Date
Sep-2008
Author
H. Martin
B. Willey
D E Low
H R Staempfli
A. McGeer
P. Boerlin
M. Mulvey
J S Weese
Author Affiliation
Department of Clinical Studies, University of Guelph, Guelph, Ontario, Canada.
Source
J Clin Microbiol. 2008 Sep;46(9):2999-3004
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Clostridium difficile - genetics
Drug Resistance, Bacterial
Enterocolitis, Pseudomembranous - microbiology
Enterotoxins
Female
Genotype
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Ontario
Polymerase Chain Reaction
Ribotyping
Young Adult
Abstract
Clostridium difficile is the bacterium most commonly surmised to cause antimicrobial- and hospital-associated diarrhea in developed countries worldwide, and such infections are thought to be increasing in frequency and severity. A laboratory-based study was carried out to characterize C. difficile strains isolated from persons in Ontario, Canada, during 2004 to 2006 according to toxin type (enterotoxin A, cytotoxin B, and binary toxin [CDT]), tcdC gene characterization, ribotyping, pulsed-field gel electrophoresis, and toxinotyping. Clostridium difficile was isolated from 1,080/1,152 (94%) samples from 21 diagnostic laboratories. Isolates with toxin profiles A(+) B(+) CDT(-), A(+) B(+) CDT(+), A(-) B(+) CDT(-), and A(-) B(+) CDT(+) accounted for 63%, 34%, 2.4%, and 0.6% of isolates, respectively. Alterations in tcdC were detected in six different ribotypes, including ribotype 027. A total of 39 different ribotypes were identified, with ribotype 027/North American pulsotype 1 (NAP1), an internationally recognized outbreak strain associated with severe disease, being the second most common ribotype (19% of isolates). Transient resistance to metronidazole was identified in 19 (1.8%) isolates. While a large number of ribotypes were found, a few predominated across the province. The high prevalence and wide distribution of ribotype 027/NAP1 are disconcerting in view of the severity of disease associated with it.
Notes
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PubMed ID
18650360 View in PubMed
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A cluster of surgical wound infections due to unrelated strains of group A streptococci.

https://arctichealth.org/en/permalink/ahliterature221095
Source
Infect Control Hosp Epidemiol. 1993 May;14(5):265-7
Publication Type
Article
Date
May-1993
Author
F B Jamieson
K. Green
D E Low
A E Simor
C. Goldman
J. Ng
A. McGeer
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 1993 May;14(5):265-7
Date
May-1993
Language
English
Publication Type
Article
Keywords
Cluster analysis
Cross Infection - epidemiology - microbiology
Diagnosis, Differential
Hospitals
Humans
Ontario - epidemiology
Restriction Mapping
Shock, Septic - diagnosis
Streptococcal Infections - epidemiology - microbiology
Streptococcus pyogenes - isolation & purification
Surgical Wound Infection - epidemiology - microbiology
Abstract
Group A streptococci account for less than 1% of all surgical wound infections but are an important cause of nosocomial outbreaks. We report here a cluster of four group A streptococcal infections that occurred within an 11-day period on a single surgical service. The index case presented with toxic shock-like syndrome. Epidemiologic investigation did not identify any relationship between infections. Restriction endonuclease analysis and M and T typing found the four isolates to be unrelated. Restriction endonuclease analysis is a useful tool for determining relatedness of nosocomial isolates of group A streptococci.
PubMed ID
8496580 View in PubMed
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Control of transmission of vancomycin-resistant Enterococcus faecium in a long-term-care facility.

https://arctichealth.org/en/permalink/ahliterature201971
Source
Infect Control Hosp Epidemiol. 1999 May;20(5):312-7
Publication Type
Article
Date
May-1999
Author
M. Armstrong-Evans
M. Litt
M A McArthur
B. Willey
D. Cann
S. Liska
S. Nusinowitz
R. Gould
A. Blacklock
D E Low
A. McGeer
Author Affiliation
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 1999 May;20(5):312-7
Date
May-1999
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anti-Bacterial Agents - pharmacology
Costs and Cost Analysis
Cross Infection - epidemiology - prevention & control - transmission
Disease Outbreaks - prevention & control
Disease Reservoirs
Drug Resistance, Microbial
Enterococcus faecium - drug effects - isolation & purification
Female
Gram-Positive Bacterial Infections - epidemiology - prevention & control - transmission
Homes for the Aged
Humans
Infection Control - economics - methods
Long-Term Care - methods
Male
Nursing Homes
Ontario - epidemiology
Vancomycin - pharmacology
Abstract
To describe the investigation and control of transmission of vancomycin-resistant enterococci (VRE) in a residential long-term-care (LTC) setting. OUTBREAK INVESTIGATION: A strain of vancomycin-resistant Enterococcus faecium not previously isolated in Ontario colonized five residents of a 254-bed LTC facility in Toronto. The index case was identified when VRE was isolated from a urine culture taken after admission to a local hospital. Screening of rectal swabs from all 235 residents identified four others who were colonized with the same strain of E faecium.
Colonized residents were cohorted. VRE precautions were established as follows: gown and gloves for resident contact, restriction of contact between colonized and noncolonized residents, no sharing of personal equipment, and daily double-cleaning of residents' rooms and wheelchairs.
Two colonized residents died of causes unrelated to VRE. Although bacitracin therapy (75,000 units four times a day x 14 days) failed to eradicate carriage in two of three surviving residents, both cleared their carriage within 7 weeks. Repeat rectal swabs from 224 residents (91%) 2 months after isolation precautions were discontinued and from 125 residents (51%) 9 months later identified no new cases. Total cost of investigation and control was $12,061 (Canadian).
VRE may be transmitted in LTC facilities, and colonized LTC residents could become important VRE reservoirs. Control of VRE transmission in LTC facilities can be achieved even with limited resources.
PubMed ID
10349946 View in PubMed
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Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. Canadian Bacterial Surveillance Network.

https://arctichealth.org/en/permalink/ahliterature201396
Source
N Engl J Med. 1999 Jul 22;341(4):233-9
Publication Type
Article
Date
Jul-22-1999
Author
D K Chen
A. McGeer
J C de Azavedo
D E Low
Author Affiliation
Department of Medicine, University of Toronto, Canada.
Source
N Engl J Med. 1999 Jul 22;341(4):233-9
Date
Jul-22-1999
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anti-Bacterial Agents - therapeutic use
Anti-Infective Agents - pharmacology - therapeutic use
Canada
Drug Resistance, Microbial
Drug Utilization
Fluoroquinolones
Humans
Microbial Sensitivity Tests
Middle Aged
Pneumococcal Infections - drug therapy - microbiology
Serotyping
Streptococcus pneumoniae - classification - drug effects
Abstract
Fluoroquinolones are now recommended for the treatment of respiratory tract infections due to Streptococcus pneumoniae, particularly when the isolates are resistant to beta-lactam antibiotics. Although pneumococci with reduced susceptibility to fluoroquinolones have been identified, their prevalence has not been determined in a defined population.
We performed susceptibility testing on 7551 isolates of S. pneumoniae obtained from surveillance in Canada in 1988 and from 1993 to 1998. Pneumococci with reduced susceptibility to fluoroquinolones (defined as a minimal inhibitory concentration of ciprofloxacin of at least 4 microg per milliliter) were further characterized. We also examined antibiotic prescriptions dispensed in Canadian retail pharmacies.
Between 1988 and 1997, fluoroquinolone prescriptions increased from 0.8 to 5.5 per 100 persons per year. The prevalence of pneumococci with reduced susceptibility to fluoroquinolones increased from 0 percent in 1993 to 1.7 percent in 1997 and 1998 (P=0.01). Among adults, the prevalence increased from 1.5 percent in 1993 and 1994 combined to 2.9 percent in 1997 and 1998 combined. The prevalence was higher in isolates from older patients (2.6 percent among those 65 years of age or older vs. 1.0 percent among those 15 to 64 years of age, P
Notes
Comment In: N Engl J Med. 1999 Nov 11;341(20):1547; author reply 1547-810577110
Comment In: N Engl J Med. 1999 Nov 11;341(20):1546-7; author reply 1547-810577109
PubMed ID
10413735 View in PubMed
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