ABSTRACT
A 21-year-old, previously healthy male presented to hospital following 1 week of bilateral asymmetric ascending paralysis, odynophagia, and dysphagia. Initial magnetic resonance imaging (MRI) of the spine revealed an abnormal increased T2 signal with predominant dorsal column involvement and sparing of white matter throughout the cervical cord and extending to T5. The initial presumptive diagnosis was an acute infectious, versus inflammatory, myelitis. On reviewing the history, family members recalled a bat scratch on the left hand, sustained months prior, for which the patient did not seek or receive post-exposure prophylaxis (PEP). Rabies virus (RABV) RNA was detected by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in two saliva samples, while nuchal skin biopsy and cerebrospinal fluid (CSF) were negative. Serum was negative for RABV neutralizing antibody. Sequencing and phylogenetic analyses identified the infecting RABV as a variant associated with silver-haired bats. Following risk assessment of exposure, 67 health care workers and several family members were offered PEP.
Un homme de 21 ans auparavant en santé a consulté à l'hôpital parce qu'il souffrait de paralysie ascendante, asymétrique et bilatérale, d'odynophagie et de dysphagie depuis une semaine. Une première imagerie par résonance magnétique (IRM) du rachis a révélé une augmentation anormale du signal T2 avec atteinte prédominante de la colonne dorsale et épargne de la matière blanche dans toute la colonne cervicale jusqu'à la vertèbre T5. Le diagnostic provisoire en était un de myélite infectieuse, et non inflammatoire. À la prise de l'histoire, les membres de la famille se sont souvenus d'une égratignure de chauve-souris sur la main gauche du patient plusieurs mois auparavant, qui n'a pas été suivie d'une prophylaxie postexposition (PPE). Les chercheurs ont décelé l'ARN du virus de la rage (RABV) par amplification en chaîne par polymérase quantitative de transcription inverse (RT-qPCR) dans deux échantillons de salive, mais constaté un résultat négatif de la biopsie de la peau nucale et du liquide céphalorachidien. Le sérum était négatif à l'anticorps neutralisant du RABV. Les analyses de séquençage et de phylogénétique ont confirmé une contamination par une variante du RABV associée aux chauves-souris argentées. Après une évaluation du risque d'exposition, 67 travailleurs de la santé et plusieurs membres de la famille se sont fait offrir une PPE.
ABSTRACT
BACKGROUND: The prevalence of adult chronic kidney disease and cardiovascular comorbidities in Canadian Indigenous communities is largely unknown. We conducted a study to document the prevalence of chronic kidney disease and concurrent diabetes mellitus, hypertension and dyslipidemia in a First Nations population in northwest Ontario. METHODS: In this observational study, we used retrospective data collected from regional electronic medical records of 16 170 adults (age ≥ 18 yr) from 26 First Nations communities in northwest Ontario from May 2014 to May 2017. Demographic and laboratory data included age, gender, prescribed medications, estimated glomerular filtration rate, urine albumin:creatinine ratio, low-density lipoprotein cholesterol (LDL-C) level and glycated hemoglobin (HbA1c) concentration. We identified patients with diabetes by an HbA1c concentration of 6.5% or higher, or the use of a diabetic medication, those with dyslipidemia by an elevated LDL-C level (≥ 2.0 mmol/L) or use of lipid-lowering medication, and those with hypertension by use of antihypertensive medication. RESULTS: Of the 16 170 adults residing in the communities, 5224 unique patients (32.3%) had renal testing (albumin:creatinine ratio and/or estimated glomerular filtration rate). The age-adjusted prevalence of chronic kidney disease was 14.5%, and the prevalence of stage 3-5 chronic kidney disease (estimated glomerular filtration rate < 60 mL/min) was 7.0%. Most patients with chronic kidney disease (1487 [80.0%]) had at least 1 cardiovascular comorbidity. A total of 1332 patients (71.6%) had diabetes, 1313 (70.6%) had dyslipidemia, and 1098 (59.1%) had hypertension; all 3 comorbidities were present in 716 patients (38.5%). INTERPRETATION: We document a high prevalence of advanced chronic kidney disease in this First Nations population, 7.0%, double the rate in the general population. High rates of cardiovascular comorbidities were also common in these patients with chronic kidney disease, which places them at increased risk for cardiovascular disease.
