Incidence of poststreptococcal glomerulonephritis in northwestern Ontario: Cross-sectional study at a tertiary care centre.

OBJECTIVE: To measure the incidence of poststreptococcal glomerulonephritis (PSGN) and resulting complications in northwestern Ontario, including among Indigenous and rural populations. DESIGN: Cross-sectional study. SETTING: As the only tertiary care hospital in northwestern Ontario, Thunder Bay Regional Health Sciences Centre (TBRHSC) functions as the primary referral centre for most of the region. The catchment population has substantial Indigenous (21.5%) and rural (34.2%) populations. PARTICIPANTS: All cases of PSGN managed at TBRHSC over an 8-year period from January 1, 2010, to December 31, 2017. MAIN OUTCOME MEASURES: Cases were classified as confirmed, probable, or possible based on the type of evidence available. Patients' rurality and Indigenous status were recorded. Incidence rates and incidence rate ratios of all, pediatric (<18 years), and adult PSGN cases were calculated, as were incidence rates and incidence rate ratios of those requiring dialysis. Linear interpolation and extrapolation were used to estimate the population in non-census years. RESULTS: Over the 8-year study period, 33 cases of PSGN were observed with annual incidence rates of 0.0 to 4.8 per 100,000 person-years and a mean annual incidence rate of 1.8 (95% CI 1.2 to 2.5) per 100,000 person-years. Of these 33 cases, 28 were confirmed with renal biopsy or clinical and laboratory data. Indigenous patients accounted for 61% (n=17) of confirmed cases and were 6.0 (95% CI 2.8 to 13, P<.001) times as likely to have PSGN and 9.6 (95% CI 3.0 to 31, P<.001) times as likely to require dialysis compared with non-Indigenous patients. Patients living in rural areas accounted for 71% (n=20) of confirmed cases and were 3.2 (95% CI 1.4 to 7.3, P=.006) times as likely to have PSGN and 3.9 (95% CI 1.0 to 10, P=.02) times as likely to require dialysis compared with patients in urban areas. CONCLUSION: The main burden of PSGN in northwestern Ontario occurs among Indigenous and rural populations. Additional research is required to investigate the true overall burden of PSGN in the region. In collaboration with regional Indigenous groups, advocacy is needed for PSGN to be made reportable and public health action must be taken to address these pronounced disparities.

Epidemiology of invasive pneumococcal disease in indigenous and non-indigenous adults in northwestern Ontario, Canada, 2006-2015.

BACKGROUND: Despite the use of pneumococcal vaccines, indigenous populations are consistently disproportionately affected by invasive pneumococcal disease (IPD). With recent changes in Ontario's provincial pneumococcal vaccination program, we sought to evaluate the epidemiology and burden of IPD in northwestern Ontario (NWO) Canada - a region that contains a substantial (19.2%) indigenous population. METHODS: We retrospectively reviewed all adult cases of IPD that were reported to the Thunder Bay District Health Unit, in Thunder Bay, Ontario, Canada, over a 10-year period (2006-2015). Patients admitted to the Thunder Bay Regional Health Sciences Centre with IPD had their charts reviewed to abstract clinical data. Statistical analysis, including incidence rates of IPD, was performed. RESULTS: Two hundred sixty-two cases of IPD occurred over the 10-year observation period and clinical data was available for 182 cases. Fifty-three of 182 (29.1%) patients were indigenous. 73 of 182 (40.1%) of patients were immunocompromised. Indigenous patients with IPD were more likely to be immunocompromised than non-indigenous patients (p < 0.001). Serotype data was available for 159 cases of IPD; PCV7, PCV13, and PPV23 covered 5.7%, 28.3%, and 79.2% of isolates, respectively, while 29 (20.8%) were non-vaccine serotypes. The annual incidence rate of IPD ranged from 8.9 to 25.9 per 100,000 among adults 18-64 years old; among adults 65 years of age and older the annual incidence of IPD ranged from 18.5 to 60.7 per 100,000. CONCLUSION: Among adults in NWO, Canada, there is a high incidence of IPD. Immunocompromised indigenous adults in NWO may benefit from pneumococcal vaccination coverage. Emerging non-vaccine serotypes of Streptococcus pneumoniae warrant the consideration of the provincial pneumococcal vaccination program.

Trichinella Nativa Outbreak With Rare Thrombotic Complications Associated With Meat From a Black Bear Hunted in Northern Ontario.

BACKGROUND: Although trichinellosis is known to cause thrombotic disease, serious thrombotic events are rare and have not been previously associated with Trichinella nativa infection. METHODS: Patient interviews and medical chart reviews were conducted on 10 men who became ill following consumption of a common source of black bear meat. Trichinella serology on patient sera as well as polymerase chain reaction (PCR) and larval identification of the meat samples was conducted. RESULTS: All 10 exposed individuals developed an acute illness clinically compatible with trichinellosis, characterized by fever, abdominal pain, and diarrhea, along with eosinophilia ranging from 0.9 × 109/L to 6.1 × 109/L. Within 2 weeks of the diarrheal illness, systemic symptoms developed in all exposed individuals characterized by fever, myalgia, periorbital edema, and fatigue. ST-elevation myocardial infarction and sinus venous tract thrombosis occurred as a complication of trichinellosis in 2 patients. Acute serology was nonreactive in all patients, though convalescent serology was reactive in 6 of 8 (75%) patients for whom sera was available. Multiplex PCR identified T. nativa from the bear meat, and was corroborated by microscopic larval identification. CONCLUSIONS: We report a 100% attack rate of T. nativa from bear meat among those who were exposed, and demonstrate that this species can cause serious thrombotic complications of trichinellosis in humans. Education of hunters and the public regarding the importance of proper preparation of wild game prior to ingestion is warranted.

Blastomyces gilchristii as Cause of Fatal Acute Respiratory Distress Syndrome.

Since the 2013 description of Blastomyces gilchristii, research describing the virulence or clinical outcome of B. gilchristii infection has been lacking. We report molecular evidence of B. gilchristii as an etiologic agent of fatal acute respiratory distress syndrome. B. gilchristii infection was confirmed by PCR and sequence analysis.

Blastomycosis in northwestern Ontario, 2004 to 2014.

Blastomycosis is an invasive fungal disease caused by Blastomyces dermatitidis and the recently discovered Blastomyces gilchristii. The medical charts of 64 patients with confirmed cases of blastomycosis in northwestern Ontario during a 10-year period (2004 to 2014) were retrospectively reviewed. The number of patients diagnosed with blastomycosis in Ontario was observed to have increased substantially compared with before 1990, when blastomycosis was removed from the list of reportable diseases. Aboriginals were observed to be disproportionately represented in the patient population. Of the patients whose smoking status was known, 71.4% had a history of smoking. 59.4% of patients had underlying comorbidities and a higher comorbidity rate was observed among Aboriginal patients. The case-fatality rate from direct complications of blastomycosis disease was calculated to be 20.3%; this case-fatality rate is the highest ever to be reported in Canada and more than double that of previously published Canadian studies. The clinical characteristics of 64 patients diagnosed with blastomycosis are summarized.

La blastomycose est une maladie fongique invasive causée par la Blastomyces dermatitidis et le Blastomyces gilchristii, récemment découvert. Les chercheurs ont réalisé une analyse rétrospective des dossiers médicaux des 64 patients atteints d'une blastomycose confirmée au nord-ouest de l'Ontario, déclarés sur une période de dix ans (2004 à 2014). Le nombre de patients ayant un diagnostic de blastomycose en Ontario avait considérablement augmenté par rapport à celui d'avant 1990, lorsque la blastomycose a été retirée de la liste de médicaments à déclaration obligatoire. Le nombre d'Autochtones représenté au sein de la population de patients était disproportionné. Chez les patients dont on connaissait le statut de fumeur, 71,4 % avaient des antécédents de tabagisme, 59,4 % présentaient des comorbidités sousjacentes, et le taux de comorbidités était plus élevé chez les patients autochtones. Le taux de mortalité causé par les complications directes de la blastomycose s'élevait à 20,3 %. C'est le taux le plus élevé jamais déclaré au Canada, soit plus de deux fois celui signalé auparavant dans les études canadiennes. Les caractéristiques cliniques des 64 patients atteints d'une blastomycose diagnostiquée sont résumées.

Student-run clinics in Canada: an innovative method of delivering interprofessional education.

The age of siloed healthcare delivery is coming to an end. Research demonstrates that interprofessional collaboration (IPC), the provision of comprehensive services to patients by multiple health providers who collaborate within and across settings, improves the efficiency of the healthcare system, work environments, and patient outcomes. However, developing IPC skills requires training, often referred to as interprofessional education (IPE). This report aims to describe an innovation in IPE: student-run clinics (SRCs). SRCs are organizations composed of students from various disciplines who collaboratively plan and deliver healthcare and health promotion. Recent trends in Canadian SRCs are contrasted with those in the United States. The literature supporting SRCs as a method of delivering IPE, as well as the benefits conferred to patients, students, and communities at large is explored. It is clear that SRCs in Canada are an evolving approach to IPE and are filling a previously undiscovered healthcare niche.

Malignant Down: Hypertrichosis Lanuginosa Acquisita Associated With Endometrial Adenocarcinoma.

BACKGROUND: Skin changes often signal systemic disease. Hypertrichosis lanuginosa acquisita (HLA) is a well-recognized symptom of internal malignancy defined as the adult onset of colourless, fine, lanugo-type hairs. To our knowledge, only 5 cases of HLA associated with endometrial malignancy have been reported in the literature. OBJECTIVE: The objective of this report is to describe the clinical presentation of a patient with HLA associated with endometrial adenocarcinoma. METHODS: We report a patient presenting with atypical lanugo and weight loss who was diagnosed with HLA associated with endometrial adenocarcinoma. We summarize and critically review the 5 other known cases of endometrial malignancy associated with HLA reported in the literature. RESULTS: The ectopic adult development of lanugo hair led to the diagnosis of endometrial adenocarcinoma. The diagnosis was made following computed tomography imaging and was confirmed by biopsy. CONCLUSION: Continued vigilance and reporting of HLA will increase identification and understanding of this rare paraneoplastic condition. Family physicians should be aware of HLA.

The Role of Human Beta-Defensin-2 in Pseudomonas aeruginosa Pulmonary Infection in Cystic Fibrosis Patients.

Cystic fibrosis (CF) is the most common genetic disease affecting the Caucasian population. Chronic Pseudomonas aeruginosa pulmonary infection is the major cause of morbidity and mortality in CF patients. Human beta-defensin-2 (hBD-2) is an inducible pulmonary antimicrobial peptide that exerts bacteriostatic activity in a concentration-dependent manner. The decreased expression and compromised function of hBD-2 contributes to the pathogenesis of P. aeruginosa infection in the CF lung. The purpose of this review is to outline the significance of hBD-2 in P. aeruginosa chronic pulmonary infection in CF patients.