Public Health Follow-up of Suspected Exposure to Echinococcus multilocularis in Southwestern Ontario.

In the 3 years since the first report of canine alveolar echinococcosis (AE) in Ontario, three additional cases have been diagnosed in the province. Of the four cases reported to date, three have had no known history of travel outside the province. It is possible that this development is an indication of previously unrecognized environmental contamination with Echinococcus multilocularis eggs in some areas of the province. If so, there is the potential for an emerging threat to human health. This article describes a local public health department's investigation of the possible exposure to E. multilocularis of a number of individuals who had had contact with the latest of the four cases of canine AE, and summarizes a comprehensive decision process that can be used by public health departments to assist in the follow-up of such exposures.

CATMAT statement on disseminated strongyloidiasis: Prevention, assessment and management guidelines.

BACKGROUND: Strongyloides stercoralis is a parasitic nematode found in humans, with a higher prevalence in tropical and sub-tropical regions worldwide. If untreated, the infection can progress to disseminated strongyloidiasis, a critical illness which may be fatal. OBJECTIVE: To provide clinical guidance on the prevention, assessment and management of disseminated strongyloidiasis. METHODS: A literature review was conducted to evaluate the current evidence and to identify any systematic reviews, case reports, guidelines and peer reviewed and non-peer reviewed medical literature. The Committee to Advise on Tropical Medicine and Travel (CATMAT) assembled a working group to develop this statement, which was then critically reviewed and approved by all CATMAT members. RECOMMENDATIONS: CATMAT recommends that screening for strongyloidiasis should be considered for individuals with epidemiologic risk and/or co-morbidities that place them at risk for Strongyloides hyperinfection and dissemination. Those at highest risk of hyperinfection and dissemination are individuals born in a Strongyloides-endemic area who undergo iatrogenic immunosuppression or have intercurrent human T-lymphotropic virus (HTLV-1) infection. Diagnosis of strongyloidiasis is based on serologic testing and/or examination of stools and other clinical specimens for larvae. Referral to a tropical medicine specialist with expertise in the management of strongyloidiasis is recommended for suspected and confirmed cases. A diagnosis and treatment algorithm for strongyloidiasis has been developed as a reference tool. CONCLUSION: Strongyloidiasis is relatively widespread in the global migrant population and screening for the disease should be based on an individual risk assessment. A practical tool for the clinician to use in the prevention, assessment and management of disseminated strongyloidiasis in Canada is now available.

Illness in Canadian travellers and migrants from Brazil: CanTravNet surveillance data, 2013-2016.

BACKGROUND: In light of the 2016 summer Olympic games it is anticipated that Canadian practitioners will require information about common illnesses that may affect travellers returning from Brazil. OBJECTIVE: To identify the demographic and travel correlates of illness among recent Canadian travellers and migrants from Brazil attending a network of travel health clinics across Canada. METHODS: Data was analyzed on returned Canadian travellers and migrants presenting to a CanTravNet site for care of an illness between June 2013 and June 2016. RESULTS: During the study period, 7,707 ill travellers and migrants presented to a CanTravNet site and 89 (0.01%) acquired their illness in Brazil. Tourists were most well represented (n=45, 50.6%), followed by those travelling to "visit friends and relatives" (n=14, 15.7%). The median age was 37 years (range <1-78 years), 49 travellers were men (55.1%) and 40 were women (44.9%). Of the 40 women, 26 (65%) were of childbearing age. Nine percent (n=8) of travellers were diagnosed with arboviruses including dengue (n=6), chikungunya (n=1) and Zika virus (n=1), while another 14.6% (n=13) presented for care of non-specific viral syndrome (n=7), non-specific febrile illness (n=1), peripheral neuropathy (n=1) and non-specific rash (n=4), which are four syndromes that may be indicative of Zika virus infection. Ill returned travellers to Brazil were more likely to present for care of arboviral or Zika-like illness than other ill returned travellers to South America (23.6 per 100 travellers versus 10.5 per 100 travellers, respectively [p=0.0024]). INTERPRETATION: An epidemiologic approach to illness among returned Canadian travellers to Brazil can inform Canadian practitioners encountering both prospective and returned travellers to the Olympic games. Analysis showed that vector-borne illnesses such as dengue are common and even in this small group of travellers, both chikungunya and Zika virus were represented. It is extremely important to educate travellers about mosquito-avoidance measures in advance of travel to Brazil.

Diagnostic challenges in chikungunya infection: Report of an atypical presentation.

Due in part to increasing global travel, chikungunya fever has emerged as a significant public health concern. With recent outbreaks in Caribbean nations and the first report of locally acquired infection in the United States, there is concern that we may see an increasing number of cases in Canada. As chikungunya fever shares many clinical similarities to other arthropod-borne illnesses such as dengue fever, clinical diagnosis is challenging. We report an atypical presentation of acute chikungunya fever in a man returning from travel to Haiti. Microbiologic diagnosis, treatment, prognosis, and public health implications will aid clinician preparedness for this emerging pathogen.

Travel-acquired infections in Canada: CanTravNet 2011-2012.

BACKGROUND: Important gaps remain in our knowledge of the infectious diseases people acquire while travelling and the impact of pathogens imported by Canadian travellers. OBJECTIVE: To provide a surveillance update of illness in a cohort of returned Canadian travellers and new immigrants. METHODS: Data on returning Canadian travellers and new immigrants presenting to a CanTravNet site between September 2011 and September 2012 were extracted and analyzed by destination, presenting symptoms, common and emerging infectious diseases and disease severity. RESULTS: During the study period, 2283 travellers and immigrants presented to a CanTravNet site, 88% (N=2004) of whom were assigned a travel-related diagnosis. Top three destinations for non-immigrant travellers were India (N=132), Mexico (N=103) and Cuba (N=89). Fifty-one cases of malaria were imported by ill returned travellers during the study period, 60% (N=30) of which were Plasmodium falciparum infections. Individuals travelling to visit friends and relatives accounted for 83% of enteric fever cases (15/18) and 41% of malaria cases (21/51). The requirement for inpatient management was over-represented among those with malaria compared to those without malaria (25% versus 2.8%; p<0.0001) and those travelling to visit friends and relatives versus those travelling for other reasons (12.1% versus 2.4%; p<0.0001). Nine new cases of HIV were diagnosed among the cohort, as well as one case of acute hepatitis B. Emerging infections among travellers included hepatitis E virus (N=6), chikungunya fever (N=4) and cutaneous leishmaniasis (N=16). Common chief complaints included gastrointestinal (N=804), dermatologic (N=440) and fever (N=287). Common specific causes of chief complaint of fever in the cohort were malaria (N=47/51 total cases), dengue fever (14/18 total cases), enteric fever (14/17 total cases) and influenza and influenza-like illness (15/21 total cases). Animal bites were the tenth most common diagnosis among tourist travellers. INTERPRETATION: Our analysis of surveillance data on ill returned Canadian travellers provides a recent update to the spectrum of imported illness among travelling Canadians. Preventable travel-acquired illnesses and injuries in the cohort include malaria, enteric fever, HIV, hepatitis B, hepatitis A, influenza and animal bites. Strategies to improve uptake of preventive interventions such as malaria chemoprophylaxis, immunizations and arthropod/animal avoidance may be warranted.

Post-translational glutamylation and tyrosination in tubulin of tritrichomonads and the diplomonad Giardia intestinalis.

Glutamylated and tyrosinated tubulin were localized in Giardia intestinalis and selected trichomonads of the Tritrichomonadinae subfamily, using specific monoclonal antibodies directed at each of the post-translational modifications. Analysis was carried out using indirect immunofluorescence microscopy. Although trichomonad tubulins remained unlabeled by anti-tyrosine tubulin (TUB-1A2), the presence of the glutamylation motif (GT 335) was confirmed and found to differ in distribution among tritrichomonads. Tritrichomonas muris was most heavily labeled with GT 335, while T. foetus was the least so. Like trichomonads, Giardia was unreactive to anti-tyrosine tubulin; however, the GT 335 antibody produced marked fluorescence in Giardia trophozoites. This study is the first to report immunofluorescent localization of tubulin glutamylation in Giardia and confirms previously reported mass spectrometry data.