Case report: a metabolic disorder presenting as pediatric manganism.

CONTEXT: Manganese is a trace element, essential for physiologic functioning but neurotoxic at high doses. Common exposure sources include dietary intake as well as drinking water in some regions; toxicity is most often associated with inhalation exposures in occupational settings. In this article we describe the investigation of a pediatric case of manganism using both clinical and environmental assessment methods. CASE PRESENTATION: A previously healthy 6-year-old child presented with severe Mn neurotoxicity, iron deficiency, and elevated cobalt levels. Immediate and selected extended family members had elevated plasma Mn but remained asymptomatic. An exposure assessment identified seasonal ingestion exposures to Mn at the family's summer cottage; these were common to the four immediate family members. Well water used for drinking and cooking exceeded recommended guidelines, and foods high in Mn predominated in their diet. No inhalation exposures were identified. Only pica was unique to the patient. DISCUSSION: The combined evidence of the environmental assessment and biomonitoring of blood Mn levels supported a seasonal ingestion exposure source; this alone was insufficient to explain the toxicity because the patient's 7-year-old sibling was asymptomatic with almost identical exposures (except pica). A metabolic disorder involving divalent metals (Mn, Fe, and Co) interacting with environmental exposures is the most likely explanation. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE: This case report adds to the emerging body of evidence linking neurologic effects to ingestion Mn exposure.

A nosocomial outbreak of community-associated methicillin-resistant Staphylococcus aureus among healthy newborns and postpartum mothers.

BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has increasingly been isolated from individuals with no predisposing risk factors; however, such strains have rarely been linked to outbreaks in the hospital setting. The present study describes the investigation of an outbreak of CA-MRSA that occurred in the maternal-newborn unit of a large community teaching hospital in Toronto, Ontario. METHODS: Screening and clinical specimens collected from mothers and newborns delivered during the outbreak period, as well as from staff on the affected unit, were submitted for microbiological testing. Computerized delivery logs and nursing notes were reviewed, and a case control study was conducted. RESULTS: Analysis by pulsed-field gel electrophoresis revealed 38 babies and seven mothers with MRSA colonization and/or infection by the same unique strain (Canadian MRSA-10-related) from September to December 2004. Isolates were characterized as having the staphylococcal chromosome cassette mec type IVa and were positive for the Panton-Valentine leukocidin gene. No one health care worker was associated with all cases; however, mothers and newborns exposed to one particular nurse (Nurse A) were almost 23 times (odds ratio 22.7, 95% CI 3.3 to 195.9) more likely to acquire MRSA than those with no such contact. MRSA was successfully isolated from Nurse A and from an environmental swab of a telephone recently used by Nurse A; both isolates matched the pulsed-field gel electrophoresis pattern of the outbreak strain. CONCLUSION: The first nosocomial outbreak of CA-MRSA among healthy newborns and postpartum mothers in Canada is described. Effective control of sustained MRSA transmission within an institution may require prompt identification, treatment and monitoring of colonized and/or infected staff.

HIV Testing among Canadian Tuberculosis Cases from 1997 to 1998.

BACKGROUND: Recent evidence suggests a global rise in adult tuberculosis (TB) cases associated with HIV/AIDS. The World Health Organization, the United States Centers for Disease Control and Prevention, and the Public Health Agency of Canada advocate universal screening of all TB cases for HIV. The contribution of HIV to the TB burden in Canada remains unclear. METHODS: A retrospective cohort study was conducted of all TB cases reported in Canada from 1997 to 1998. The aim was to determine the proportion of patients that had an HIV test on record, and of these, the number of patients infected with HIV. RESULTS: From 1997 to 1998, 3767 TB cases were reported to the national TB surveillance system. In the present study, 3416 case records (90.7%) were included. The number of cases with a record of an HIV test was 736 (21.5%), and of these, 41.2% were tested within one month of TB diagnosis. Among the 703 cases with known HIV test results, the prevalence of HIV infection was 14.7%. Cases with an HIV test on record were more likely to have one or more risk factors for HIV, and also were more likely to be male, aged 15 to 49 years, of Aboriginal ethnicity, and to have smear-positive TB and both pulmonary and extrapulmonary disease at the time of diagnosis. DISCUSSION: These results suggest that HIV testing of TB patients is not universal, but rather selective, and is likely based on perceived risk factors for HIV as opposed to TB diagnosis alone.

Chronic health conditions reported by male inmates newly admitted to Canadian federal penitentiaries.

BACKGROUND: International health studies have shown that inmates have higher rates of infectious diseases, chronic diseases and psychiatric disorders relative to the general population. We conducted a systematic collection of data on chronic physical health conditions reported by newly admitted inmates in Canadian federal penitentiaries. METHODS: Over a 6-month period from April to September 2012, we collected and analyzed data from a standardized health interview routinely conducted with consenting incoming male inmates (n = 2273). Prevalence rates of health conditions were determined and disaggregated by age (< 50 yr and ≥ 50 yr) and by Aboriginal status. RESULTS: The most common health conditions reported by respondents were head injury (34.1%), back pain (19.3%), asthma (14.7%) and hepatitis C virus (HCV) infection (9.4%). Rates of many health conditions were higher among inmates 50 years of age or older than among younger inmates. Compared with their non-Aboriginal counterparts, Aboriginal inmates had higher rates of head injury and HCV infection. INTERPRETATION: Our study provides a benchmark that can be used to examine health trends within Canada's federal penitentiaries over time and points to subgroups of newly admitted inmates for whom health services may need to be concentrated.