The changing landscape of travel health services in Canada.

Canadians are increasingly travelling to areas that would necessitate a pre-travel consultation. Changes in professional regulations in Canada allow greater autonomy of nurses and pharmacists, resulting in shifts in provision of travel health services. We surveyed 824 Canadian travel clinics, 270 (33%) of whom responded. Private clinics were most common, and more likely to offer extended hours and drop-in appointments. In one province, pharmacies dominated. Half the services were relatively new and a similar proportion saw fewer than 10 patients weekly; 1/3 had a single provider. The increased spectrum of services may increase convenience for travellers but the large proportion seeing low numbers of clients will challenge providers to maintain competence.

Schistosomiasis Presenting as a Case of Acute Appendicitis with Chronic Mesenteric Thrombosis.

The manifestations of schistosomiasis typically result from the host inflammatory response to parasitic eggs that are deposited in the mucosa of either the gastrointestinal tract or bladder. We present here a case of a 50-year-old gentleman with a rare gastrointestinal presentation of both schistosomal appendicitis and mesenteric thrombosis.

Leishmania in HLH: a rare finding with significant treatment implications.

Hemophagocytic lymphohistiocytosis (HLH) associated with visceral leishmaniasis (VL) is a very rare phenomenon. We report the first known North American case in a 21 month old boy. He was initially diagnosed with Epstein Barr virus (EBV) triggered HLH and treated with the international treatment protocol, HLH-2004. Stem cell transplant was planned due to repeated reactivations of disease, but his pretransplant bone marrow revealed an unexpected protozoan-Leishmania donovani. Treatment with liposomal amphotericin B led to resolution of all manifestations of HLH. We discuss how the clinical and laboratory features of both entities can closely mimic each other and are extremely difficult to differentiate. This case also raises the question of whether to screen all children with suspected HLH for Leishmania in a non endemic area.

Paediatric malaria: What do paediatricians need to know?

Although malaria is principally a disease of the tropical and subtropical regions of the world, it is an important disease to be familiar with for both local and global reasons. It remains to be one of the most important infectious diseases of the world, particularly in sub-Saharan Africa, killing more than one million people - mostly children - every year. In Canada, at least 350 to 1100 imported cases are reported annually, 25% of which are in the paediatric age group, as a result of both travel and migration. Because malaria is a potentially severe and sometimes fatal disease that is unfamiliar to many paediatricians in Canada, it is important that clinicians become familiar with its clinical presentation; understand when it should be suspected; and have an approach to prompt diagnosis, appropriate treatment and effective prevention methods.

Human case of lobomycosis.

We describe a 42-year-old woman with histologically confirmed lobomycosis, a cutaneous fungal infection rarely reported outside of Latin America. Our case represents the first published report of imported human lobomycosis in Canada and the fifth in an industrialized country.