Sarcocystis myopathy in a patient with HIV-AIDS.

Sarcocystosis is a zoonotic infection that causes intestinal and muscular illnesses in humans. Sarcocystosis was until recently considered rare in humans. To complete their life cycle, Sarcocystis species require both a definitive and an intermediate host. Humans are the definitive host when infected by one of two species: Sarcocystis hominis (from eating undercooked beef) or Sarcocystis suihominis (from eating uncooked pork). Infection with either of these species results in intestinal sarcocystosis, causing a self-limited disease characterized by nausea, abdominal pain, and diarrhea. Humans act as the intermediate host when infected by Sarcocystis nesbitti, resulting in the markedly different clinical picture of muscular sarcocystosis. Most documented cases of muscular sarcocystosis were assumed to be acquired in Malaysia, in addition to other regions of Southeast Asia and India. Published cases of muscular sarcocystosis from the Middle East, Central and South America, and Africa are all rare. Although the clinical presentation of muscular sarcocystosis remains to be fully characterized, fever, myalgia, and headache are among the most common symptoms. Here, we report a patient from sub-Saharan Africa with chronic Sarcocystis myopathy and well-controlled HIV-AIDS.

Eosinophilia: A poor predictor of Strongyloides infection in refugees.

BACKGROUND: Canada resettles 10,000 to 12,000 refugees annually. Despite this being a highly vulnerable population, there are little Canadian data on subclinical tropical diseases harboured in this population over the past 20 years. OBJECTIVES: To determine the seroprevalence and predictors of Strongyloides infection in refugees arriving in Edmonton, Alberta. METHODS: A retrospective chart review of all refugees seen at the New Canadians Clinic between March 2009 and April 2010 was performed. Demographic, symptom and physical examination data were collected from the charts. Laboratory results were obtained from the electronic laboratory records. RESULTS: A total of 350 subjects were studied. The overall seroprevalence of strongyloidiasis was 4.6%. Equivocal results were found in 6.3%. In the positive group, the majority were male (62.5%); 75% were born in Africa (P=0.004) and 81.2% lived in refugee camps in Africa (P=0.002). Eosinophilia was present in 25% of the positive subjects (P=0.05), in none of the equivocal group and in 8.7% of the negative group. DISCUSSION: Persistent asymptomatic Strongyloides infection is maintained for years through autoinfection. Traditionally, eosinophilia was used as one of the key tools to diagnose chronic but stable diseases, but it was shown to have a poor predictive value for strongyloidiasis in returning expatriates as well as in those presenting with a disseminated form of the disease. It is important to raise awareness of the severe limitations of eosinophilia as a marker for strongyloidiasis when managing patients who either are immunocompromised, or about to start immunosuppressive therapy. CONCLUSIONS: The present study indicated that eosinophilia is a poor predictor of seropositivity and, thus, Strongyloides infection. Residence in Africa (birth/refugee camps) proved to be a significantly better predictor of Strongyloides seropositivity.

HISTORIQUE: Le Canada accueille de 10 000 à 12 000 réfugiés par année. Même s'il s'agit d'une population hautement vulnérable, depuis 20 ans, peu de données canadiennes ont porté sur les maladies tropicales subcliniques, dont cette population est atteinte. OBBJECTIF: Déterminer la séroprévalence et les prédicteurs de l'infection à Strongyloides chez les réfugiés qui arrivent à Edmonton, en Alberta. MÉTHODOLOGIE: Les chercheurs ont procédé à l'examen rétrospectif des dossiers de tous les réfugiés vus à la New Canadians Clinic de mars 2009 à avril 2010. Ils ont colligé les renseignements démographiques et les données relatives aux symptômes et à l'examen physique à partir des dossiers et obtenu les résultats de laboratoire dans les dossiers électroniques de laboratoire. RÉSULTATS: Au total, les chercheurs ont étudié 350 sujets. Ils ont constaté une séroprévalence globale de strongyloïdiase de 4,6 % et ont obtenu des résultats équivoques dans 6,3 % des cas. Dans le groupe positif, la majorité était de sexe masculin (62,5 %), 75 % étaient nés en Afrique (P=0,004) et 81,2 % avaient vécu dans des camps de réfugiés d'Afrique (P=0,002). Ils ont observé la présence d'éosinophiles chez 25 % des sujets positifs (P=0,05), chez aucun des sujets du groupe aux résultats équivoques et chez 8,7 % des sujets du groupe négatif. EXPOSÉ: L'infection à Strongyloides asymptomatique persistante perdure des années à cause de l'auto-infection. On avait l'habitude d'utiliser les éosinophiles comme l'un des principaux outils diagnostiques des maladies chroniques, mais stables, mais les chercheurs ont établi qu'ils ont une mauvaise valeur prédictive de strongyloïdiase chez les expatriés et chez les personnes atteintes de la forme disséminée de la maladie. Il est important de sensibiliser les médecins aux limites importantes des éosinophiles comme marqueur de la strongyloïdias dans la prise en charge des patients qui sont soit immunodéprimés, soit sur le point d'entreprendre un traitement immunosuppressif. CONCLUSIONS: Selon la présente étude, les éosinophiles sont un mauvais prédicteur de séropositivité et, par conséquent, de l'infection à Strongyloides. Le fait d'avoir résidé en Afrique (y être né ou avoir habité dans un camp de réfugiés) constituait un prédicteur beaucoup plus fiable de séropositivité à Strongyloides.

Enterobius vermicularis infection of the fallopian tube in an infertile female.

Enterobius vermicularis (EV) is the most common nematode to infect humans. It inhabits the intestinal lumen, but rare, ectopic infections have been documented. The female genital tract is the most common ectopic site. We present a unique case of an EV infection of the fallopian tube resulting in inflammation, tubal obstruction, and infertility. A 30-year-old woman presented with infertility. Investigations included a laparoscopy with hydrotubation using methylene blue dye. This showed a left fallopian tube obstruction and extensive pelvic adhesions. A left salpingectomy was performed. Microscopic examination of the fallopian tube revealed numerous calcified and non-calcified ova associated with granulomatous reaction. The microscopic features were compatible with EV infection. Ectopic EV infections of the female genital tract result when the gravid female worm migrates from the perianal area to the vagina and ascends through the uterus and fallopian tubes to the peritoneal cavity. Microscopic examination of these ectopic sites can reveal adult worms or ova with granulomata formation, eosinophilic infiltrate, chronic inflammatory reaction, and fibrosis. The ova have a characteristic asymmetric oval configuration with flattening on one side. We postulate that our patient's salpingitis due to EV with accompanying fibrosis is a cause of her infertility.

Nontuberculous mycobacterial breast implant infections.

BACKGROUND: For reasons that are unclear, the incidence of nontuberculous mycobacterial disease is increasing worldwide. Periprosthetic nontuberculous mycobacterial infections following augmentation mammaplasty and breast reconstruction have been reported previously in the form of case reports. METHODS: This retrospective case series examines periprosthetic nontuberculous mycobacterial infections in two western Canadian cities (Edmonton, Alberta, and Vancouver, British Columbia) over a 10-year time period. RESULTS: Ten patients were identified, four of whom had bilateral infections. The most common isolate was Mycobacterium fortuitum. Clinical features were similar to nonmycobacterial periprosthetic infections. The median time to onset of symptoms was 4.5 weeks and the median time to culture an organism was 5.4 weeks. The median duration of antibiotic therapy was 22 weeks. Patients required a mean of three additional operations after diagnosis. Nine patients underwent explantation of the involved implant(s). Reimplantation was performed in six patients a median of 11.5 months after explantation. All cases of reimplantation were successful. CONCLUSIONS: Experience with this postoperative complication is limited, as nontuberculous mycobacteria represent a minority of the pathogens responsible for periprosthetic infections. In the absence of specific features with which to identify patients at risk, the surgeon must be aware of the possibility of this infection. To achieve earlier diagnosis, the clinician should have a high index of suspicion in a patient with delayed onset of symptoms, negative preliminary cultures, and a periprosthetic infection that fails to resolve following a course of conventional antimicrobial treatment. With appropriate treatment, nontuberculous mycobacterial periprosthetic infections can be managed successfully.