Campylobacteriosis outbreak associated with ingestion of mud during a mountain bike race.

One of the largest reported campylobacteriosis outbreaks in Canada occurred in June 2007 in British Columbia, associated with a mountain bike race that took place in muddy conditions. A retrospective cohort study was conducted and environmental samples were collected and tested. There were 537 racers included in the study and 225 racers (42%) reported diarrhoeal illness after the race. C. jejuni clinical isolates (n=14) were found to be identical by multi-locus sequence typing. Although univariate analysis suggested water consumption and mud exposure as significant risk factors, multivariate analysis revealed that on direct ingestion mud was significantly associated with illness (OR 4·08, 95% CI 2·03-8·21). Contaminated mud was thus the most likely source of Campylobacter infection. We identified other unpublished reports of outbreaks associated with bike races in rainy or muddy conditions; these underscore the importance of educating racers and raising public awareness of the risks of mud ingestion.

Occupational exposure to Mycobacterium bovis infection in deer and elk in Ontario.

In late 1991, two herds of deer and elk were depopulated at a slaughtering plant in Ontario, followed by processing of infected animals at a rendering plant. We conducted a questionnaire plus tuberculin skin-test survey of 104 exposed slaughtering and rendering plant workers, and government veterinarians and inspectors. Overall, 17 participants were skin-test positive, one of 51 initially skin-test negative subjects tested a second time three months later became positive, consistent with the risk associated with occupational exposure during the depopulation of tuberculous elk previously observed in Alberta. Deer farming is widespread, with 263 herds in Ontario. The likely route of transmission is through aerosols. Possible reasons for the low conversion rate include the use of respiratory protection, absence of a tanning plant, an enclosed rendering plant process, and late skin testing which may have underestimated the number of conversions. Recommendations for prevention are summarized; in particular, respiratory protection for work with infected herds should probably include high efficiency particulate face masks.

Potentially undesirable prescribing and drug use among the elderly. Measurable and remediable.

Forty-seven patients older than 65 years were randomly selected for structured chart review of all long-term medications documented during the prior year and the number of instances of potentially undesirable prescribing for each patient. A trained nurse subsequently made home visits to assess all long-term medications used regularly during the same period. Forty-five percent of elderly patients had one or more instances of potentially undesirable drug use, all of which appeared to be readily remediable. Commercial drug interaction software identified less than half of the potentially undesirable instances.