Osteomyelitis of the Jaw: A 10-Year Retrospective Analysis at a Tertiary Health Care Centre in Canada.

BACKGROUND: Osteomyelitis (OM) of the jaw is a rare medical condition. In this review, we provide a descriptive analysis of the experience with this condition at a single tertiary health care centre in Canada over 10 years. MATERIALS AND METHODS: We conducted a retrospective chart review of adult patients aged ≥ 18 years presenting with OM of the jaw at the University of Manitoba Health Sciences Centre between January 2009 and May 2019. We included cases with consistent clinical symptoms and radiographic and/or microbiologic evidence of OM of the jaw. Excluded were cases with a previous history of head and neck cancer, radiation therapy in the head and neck regions and use of anti-resorptive medications. RESULTS: Of the 37 patients who met our criteria, the mean age was 44 years (standard deviation [SD] ± 16 years), 21 (56.8%) were male, 16 (43.2%) were diagnosed with acute OM and 21 (57.8%) with chronic OM. Underlying comorbidities, such as diabetes mellitus and chronic kidney diseases, were reported in 6 (16.2%) and 3 patients (8.1%), respectively. Traumatic injuries to the facial skeleton were the most common predisposing factor (11 patients [29.7%]). The most commonly isolated infective organisms were viridans group streptococci (VGS; 75.8%), followed by Prevotella spp. (45.4%). Results showed a higher level of resistance to penicillin of the isolated organisms in chronic OM compared with acute OM. CONCLUSIONS: This description of acute and chronic forms of OM of the jaw will enable clinicians to better understand OM patient profiles, leading to early diagnosis, improved patient care and better outcomes.

Beyond urinalysis: evaluation of various clinical and laboratory reflex criteria to warrant urine culture collection in the emergency department.

BACKGROUND: Clinical criteria are essential for diagnosing urinary tract infections (UTIs) followed by urine testing, including urinalysis (UA). No study has evaluated the potential related factors that may guide the appropriate collection of urine cultures. Therefore, we aimed to assess the factors that may guide the appropriate collection of urine cultures. METHODS: This was a case-control study of patients for whom a urine culture and a UA were ordered in the emergency department (ED) between February 2018 and December 2022. The cases included patients with positive cultures, whereas the controls included patients without growth. Patients were excluded if they were pregnant, underwent any urological procedure, received antibiotics within 3 days before ED presentation, or before culture collection. RESULTS: Of the 263 patients, 123 had growth and 140 did not have growth in urine cultures. In the univariate analysis, female gender, urinary symptoms, urinary white blood cell (WBC) count > 5 cells/hpf, and nitrite in urine were significantly associated with growth (P < 0.05). However, only female gender (aOR, 1.86; 95% CI, 1.06-3.24), urinary WBC count > 5 cells/hpf (aOR, 4.60; 95% CI, 2.21-9.59), and positive nitrite in urine (aOR, 21.90; 95% CI, 2.80-171.00) remained significant in the multivariable analysis. These factors also remained significant in the subgroup of patients with urinary symptoms, except for the female gender. CONCLUSION: A high urinary WBC count and positive nitrite in UA should be utilized as a guide to collect urine culture, particularly in female patients, to limit the unnecessary ordering of urine culture in the ED. These factors can be used as evidence-based UA reflex criteria as an antimicrobial stewardship intervention.

Trimethoprim-Sulfamethoxazole-Induced Aseptic Meningitis: A Rare Presentation of Commonly Used Antibiotic.

Drug-induced aseptic meningitis is a rare medical condition with trimethoprim-sulfamethoxazole being one of the most common antimicrobial agents associated with it. Here, I report a case of a 56-year-old male who presented to a health care facility with shock and meningitis-like syndrome in two occasions, one year apart following an exposure to trimethoprim-sulfamethoxazole for treatment of skin/soft tissue infection. Investigations did not reveal an infectious etiology in the two presentations. The patient improved with supportive care and withdrawal of the offending agent. In the two admissions, the patient improved following stopping the offending drug in addition to supportive care. The diagnosis of trimethoprim-sulfamethoxazole-induced aseptic meningitis was the most likely explanation for this case. Trimethoprim-sulfamethoxazole-induced aseptic meningitis is rare although it is a life-threatening side effect of TMP/SMX; therefore, the clinicians should keep the diagnosis of drug-induced aseptic meningitis in the differential diagnosis of aseptic meningitis in the appropriate clinical setting as early withdrawal of the culprit drug and supportive measurements will lead to early recovery.

Echinococcus granulosus hydatid cyst in rural Manitoba, Canada: Case report and review of the literature.

Echinococcal infections are a rare but important disease in Canada. The parasite's traditional endemic area includes rural, northern communities with wild canines and ungulates. There is evidence that the endemic area is enlarging. Echinococcus can cause significant morbidity, and rarely death. An 18-year-old female presented with right upper quadrant abdominal pain. Computed Tomography (CT) of the abdomen showed a 5.4 × 4 cm cyst with the presence of "water lily sign". She showed signs of cyst leak including eosinophilia and fever. Therefore, she underwent surgical resection of her cyst with Albendazole cover and was continued post-operatively for three months. CT head, chest, and pelvis failed to identify further sites of cyst formation. She has recovered well from surgery and is no longer followed by Infectious Diseases. The annual incidence and prevalence of Echinococcus disease are very low among the Canadian population. Therefore, there is a paucity of experience with new interventional techniques. Traditional management with surgery and anti-helminthic drugs is a reasonable alternative to percutaneous drainage. Screening communities has previously been determined not to be cost effective. Screening family members with similar risk factors has not been previously documented, and treatment has historically been reserved for symptomatic individuals with the disease.

Gonococcal meningitis: An unusual presentation of disseminated gonococcal infection.

Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae. The rate of N. gonorrhoeae infections in Canada has increased from 2010 to 2015. Disseminated gonococcal infection typically results from bacteremic spread of N. gonorrhoeae from a preceding mucosal site of disease (e.g., urogenital). Common clinical manifestations of disseminated gonococcal infection include skin lesions, tenosynovitis, and septic arthritis. Bacterial meningitis as a manifestation of disseminated gonococcal infection has been rarely described. A case of bacterial meningitis due to N. gonorrheae, complicated by an ischemic stroke, is reported here. Clinical features that may point to N. gonorrhoeae as the pathogen in a patient with bacterial meningitis include a concomitant active urogenital infection, skin rash, arthritis, and/or tenosynovitis. Parenteral ceftriaxone for 10 to 14 days combined with a single oral dose of azithromycin is currently recommended as the treatment for gonococcal meningitis in recent guidelines. This case is presented to highlight a potential, albeit rare, complication of a preventable disease that has resurged in the last decade in our community.

La gonorrhée est une infection transmise sexuellement causée par la Neisseria gonorrhoeae. Le taux d'infection par la N. gonorrhoeae a augmenté au Canada entre 2010 et 2015. L'infection gonococcique disséminée est généralement causée par la transmission bactériémique de la N. gonorrhoeae à partir d'un autre siège d'infection muqueux (p. ex., système urogénital). Les lésions cutanées, la ténosynovite et l'arthrite septique sont des manifestations cliniques courantes de l'infection gonococcique disséminée, mais la méningite bactérienne est rarement décrite. Les auteurs rendent compte d'un cas de méningite bactérienne attribuable à la N. gonorrheae, compliqué par un accident ischémique cérébral. Plusieurs caractéristiques cliniques peuvent laisser présager que la N. gonorrhoeae en est l'agent pathogène, telles qu'une infection urogénitale active simultanée, une éruption cutanée, l'arthrite et une ténosynovite. Selon les directives récentes, l'administration de ceftriaxone par voie parentérale pendant dix à 14 jours, combinée à une monodose d'azithromycine par voie orale, est actuellement recommandée pour traiter la méningite gonococcique. Le présent cas est présenté pour faire ressortir une complication potentielle, mais rare, d'une maladie évitable qui a refait surface dans la collectivité depuis dix ans.