Invasive group A streptococcal infection outbreaks of typeemm118 in a long-term care facility, and of type emm74 in the homeless population, Montréal, Quebec.

BACKGROUND: Two invasive group A streptococcus (iGAS) infection outbreaks occurred in Montreal in 2016 and 2017; one in a long-term care facility (typeemm118) and one in the community, primarily involving homeless people (typeemm74). OBJECTIVE: To describe two recent iGAS outbreaks in Montréal and highlight the challenges in dealing with these outbreaks and the need to tailor the public health response to control them. METHODOLOGY: All cases of iGAS were investigated and the isolates were sent to the laboratory foremmtyping. In both outbreaks, cases of superficial group Astreptococcus(GAS) infection were identified, through 1) systematic case detection accompanied by screening for asymptomatic carriers among residents and employees of the long-term care facility and 2) sentinel surveillance among homeless people. Visits were made to community organizations providing homeless services (including shelters) and social networks were analyzed to establish whether there were any links among cases of GAS infection (both invasive and noninvasive) and locations frequented. In both outbreaks, recommendations were made to service providers regarding enhancement of infection prevention and control measures. RESULTS: In the long-term care facility, five cases of typeemm118 iGAS were identified over a 22-month period, one of which resulted in death. All residents were screened and no carriers were identified. Among the employees, 81 (65%) were screened and fourcarriers were identified. Of those, one was a carrier of typeemm118 GAS. All carriers were treated, and subsequent follow-up sampling on three carriers (including the one withemm118) was negative.In the community, 23 cases of typeemm74 iGAS were detected over a 16-month period, four of which resulted in death. Half of the cases (n=12) were described as homeless, and six others were users of services for the homeless. Sentinel surveillance of superficial infections yielded 64 cultures with GAS, chiefly on the skin, including 51 (80%) of typeemm74. An analysis of the social networks revealed the large number and variety of resources for the homeless used by the cases. Visits to the community organizations providing homeless services revealed the heterogeneity and precariousness of some of these services, the difficulties encountered in applying adequate health and hygiene measures, and the high degree of mobility amongst those who use these services. CONCLUSION: The detection and control of iGAS outbreaks in both long-term care establishments and among community organizations providing homeless services are very complex. An outbreak of iGAS can develop in the background over a long time and be easily overlooked despite cases being admitted to the hospital.Emmtyping and systematic research of previous cases of iGAS are essential tools for the detection and characterization of outbreaks. Close cooperation among public health agencies, clinical teams, community organizations and laboratories is essential for proper monitoring and the reduction of GAS transmission in the community and health care settings.

Salmonella Thompson outbreak associated with consumption of chicken shawarma and the usefulness of genome sequencing in the investigation.

BACKGROUND: A sudden increase in Salmonella Thompson (S. Thompson) cases distributed throughout three border regions in the province of Quebec in November 2016 triggered a provincial investigation to identify a common source of contamination and to put the appropriate control measures into place. OBJECTIVE: To report on the outbreak and to describe the use of genomic sequencing to identify the salmonella serotype responsible. METHODS: A descriptive survey of all reported cases of Salmonella serogroup C1 that had occurred between October 1, 2016 and February 15, 2017 was conducted. A case definition was developed. Pulsed field gel electrophoresis supplemented by analyses of genome sequences using the single nucleotide variant phylogenomics method were used to demarcate and manage the outbreak. RESULTS: Eighteen cases of S. Thompson were identified through whole genome sequencing. The onset dates of symptoms for the 16 cases that presented enteric symptoms were November 21-December 2, 2016. Two cases that presented with atypical symptoms were not reported until February 2017. Among the 18 cases, 16 had eaten or probably eaten chicken shawarma at the same restaurant chain and nine of these cases ate it at the same restaurant. In total, five restaurants from this chain, spread throughout three border regions of Quebec, were identified. CONCLUSION: Outbreaks associated with chicken shawarma have been identified in the past. Efforts must be made to ensure that the owners of this type of restaurant know the contamination risk associated with this type of cooking and take the necessary steps to reduce this risk. The use of the genome sequencing method was very useful in defining the outbreak.

Sensilla coeloconica ringed by microtrichia in host-seeking biting midges.

The distribution and morphology of antennal sensilla coeloconica in parasitic and predaceous biting midges were studied in females of Forcipomyia (feeding on the blood of frogs), Atrichopogon (feeding on haemolymph), Austroconops, Culicoides (feeding on the blood of birds and mammals) and Brachypogon (feeding on haemolymph and dissolved tissues of insects) (all: Diptera: Ceratopogonidae). A Lower Cretaceous female of Archiculicoides (Diptera: Ceratopogonidae) from Lebanese amber, which fed on the blood of unknown vertebrates, was also examined. In sensilla coeloconica ringed by microtrichia, the peg is grooved longitudinally and protrudes distinctly from the pit. We suggest that the microtrichia encircling the protruding peg form a structure resembling a picket fence in order to maintain a higher level of humidity, which facilitates the capture and transport of odour molecules through the channels in the peg wall. Sensilla coeloconica ringed by microtrichia function as very effective chemoreceptors in host- and prey-seeking activity. During the evolution of Ceratopogonidae, sensilla coeloconica with a fence of microtrichia have evolved twice in groups feeding on the blood of vertebrates (i.e. in the basal lineage: Lower Cretaceous or earlier) and in the subgenus Lasiohelea of Forcipomyia (Palaeogene). Sensilla coeloconica ringed by microtrichia are described for the first time in the relict genus Austroconops.

Antimicrobial activity of untypical lipid compounds in the cuticular and internal lipids of four fly species.

AIMS: This article describes the qualitative and quantitative analyses of untypical compounds in the cuticular and internal lipids of four dipteran species. For isolated compounds, antimicrobial activity against 18 reference strains of bacteria and fungi was determined. METHODS AND RESULTS: In this study, gas chromatography (GC) combined with mass spectrometry (GC-MS) was used to analyse the surface and internal compounds of four fly species. Seven untypical compounds from both pre-imaginal and imaginal stages of examined insects were identified. Azelaic acid (AA) was the most abundant, while phenylacetic and phenylpropionic acids occurred in lower concentration. Minor quantities of sebacic acid, 2-methyl-2-hydroxybutanoic acid, tocopherol acetate and trace amounts of 2,4-decadienal were also detected. Tocopherol acetate was found only in cuticular lipids of Musca domestica larvae. Each compound was tested against several species of fungi and bacteria by determining minimal inhibitory concentration (MIC). Human pathogenic fungi were also investigated. Phenylpropionic acid showed the greatest antifungal activity. Bacterial strains were insensitive to the presence of identified compounds, apart from 2,4-decadienal which strongly inhibited bacterial growth. CONCLUSIONS: This is the first time that the chemical composition and the antimicrobial activity of untypical compounds in the cuticular and internal lipids of four fly species has been analysed. SIGNIFICANCE AND IMPACT OF THE STUDY: Determination of untypical compounds and their antimicrobial activity can effectively contribute to the knowledge concerning insect defence mechanisms.

[Organization and evolution of animal colonies]. / Organizatsiia i évoliutsiia kolonii zhivotnykh.

Based on the theory of organization and evolution of colonies in an extinct group of hemichordates graptolites (Urbanek, 1960, 1973) the relationship between the events in the late astogeny of bryozoan colonies and their somatic and reproductive cycle. The bryozoan colonies with simple organization are compared with graptoloid colonies and their structure is interpreted within the framework of the morphogen gradient theory. A morphogen produced by the founder-zooid (oozooid) diffuses along the long axis of the colonies and regulates the phenotypic expression of the size and structure of zooids. Evolutionary changes in the graptoloid colonies involve introduction of new characters and their spreading is also accompanied by gradient changes of their manifestation. Evolutionary mechanisms in bryozoan colonies are considered in terms of penetrance and expressivity of genes. In contrast to graptolites, many bryozoan colonies display multiple zones of astogeny changes and repetitions.

Knowledge and attitude assessment of Quebec daycare workers and parents regarding HIV/AIDS and hepatitis B.

ISSUES: Cases of discrimination occur in Quebec daycares towards HIV-positive children as well as HIV-negative children born to seropositive parents. OBJECTIVES: Offer three-hour information sessions on bloodborne diseases, specifically HIV and hepatitis B, universal precautions, as well as legal, ethical and psychosocial aspects of HIV/AIDS to: 1) ensure that daycare workers have basic medical information on transmission of HIV and other bloodborne infections, 2) review basic hygiene including universal precautions, 3) link daycares to HIV/AIDS resources in their communities, and 4) facilitate the development of pro-active daycare policies for the integration of HIV-positive children. RESULTS: In total, 108 information sessions were given, in which 349 daycares participated. Results show an important difference in terms of knowledge and attitudes of the participants. Of the daycares which participated in the information sessions, 37% have developed their own pro-active policy.

Outpatient percutaneous transluminal angioplasty: preconditions and results.

The present study considers whether percutaneous transluminal angioplasty (PTA) using a balloon catheter may also be performed on an outpatient basis. The prerequisites for the choice of an out-patient procedure were location of the flow obstruction above the knee joint, exclusive catheter recanalisation, absence of any complications during and after the intervention, radiological and vascular surgical standby, patient compliance and adequate social environment. In our 36 patients, 12 PTAs were performed in the pelvic region, 23 in the area of the femoral artery and one in the area of the popliteal artery. The primary success rate in the pelvic region was 100%, that in the femoropopliteal region 91.7%. The cumulative patency rate after an average follow-up period of 4 months was 89% (one early recurrence within 24 hours, 2 late recurrences after 3 and 5 months, respectively). In order to prevent early recurrence, thrombocyte aggregation inhibitors were given in combination with heparin at standard dosage. Two patients had to be hospitalized for monitoring after an aspiration embolectomy in the one case and a major haematoma in the other case. The advantages of a PTA intervention performed on an out-patient basis were the reduced time lag between diagnosis and therapy, full mobility of the patient and minimisation of hospitalization costs. Our results justify the choice of an outpatient schedule for the performance of balloon catheter recanalization in a carefully selected patient population.

Clinical use of indirect lymphography in different forms of leg edema.

Indirect lymphography by subepidermal infusion of newly developed nonionic, dimeric contrast media (e.g., Iotrolan) opacifies peripheral lymphatics of the skin. Using this method we examined 159 patients with primary and secondary lymphedema, chronic venous insufficiency, and lipedema and compared the findings to normal individuals. A variety of characteristic patterns were uncovered. The technique causes little patient discomfort and takes on the average only 30 minutes.

[Sonography of acute cholecystitis. A report on 58 cases with a correlation of pathomorphological and histological findings]. / Sonographie der akuten Cholezystitis. Bericht über 58 Fälle mit Korrelation zum pathomorphologisch-histologischen Befund.

Sonography has become the method of choice for evaluating acute diseases of the right upper quadrant. Prior to the ultrasound the diagnosis of acute cholecystitis was based on clinical and laboratory data. The pathohistomorphology of 58 opertively and histologically proven cases of acute cholecystitis has been correlated with preoperative sonography. An acute cholecystitis can be diagnosed based on the following sonographic criteria: Thickening of the wall of the gallbladder to more than 4 mm, sonolucent areas in or around the wall of the gallbladder, an increased ap. diameter of more than 4 cm as well as gallstones. A hyperechoic content of the gallbladder correlating to an empyema of the gallbladder was found in 31% and a perforation in 27.6% of the cases.

[Endoscopic incision of the pancreatic duct]. / Die endoskopische Spaltung des Ductus pancreaticus.

Concrements in the prepapillary portion of the Wirsungian duct result in secretion with simultaneous obstruction and, thus, represent a potential cause of pancreatitis. The removal of these concrements is indicated and rendered possible by endoscopic incision of the pancreatic duct. This procedure has been performed only very rarely up to the present. Its efficacy is demonstrated by a case report.

The dermal lymphatics in lymphoedema visualized by indirect lymphography.

Iotasul, a new water-soluble contrast medium, is very suitable for subepidermal infusion (indirect lymphography) for the demonstration of small (initial) dermal lymphatics in the macro-range (precollectors). By this method normal lymph vessels can be demonstrated in the healthy skin of hands and feet which are so fine that they cannot be punctured for direct lymphography. We studied thirty-eight patients with various forms of lymphoedema by indirect lymphography. In patients with congenital lymphoedema (particularly Milroy's disease) the initial dermal lymphatics in the lymphoedematous region were absent but large lymph collectors were present. Hyperplasia of dermal lymphatics in the form of an extremely fine net was seen in most patients with lymphoedema praecox and tardum. In some forms of primary lymphoedema the defect may be in the initial dermal lymphatics. In secondary lymphoedema, the changes in the peripheral lymphatics (mainly distension and congestion) are apparently a consequence of the primary lesion in the lymph nodes and large collectors. Indirect lymphography might be useful for the early diagnosis of mild lymphoedema and for excluding patients with hypoplasia of initial lymph vessels from surgery.

Differential diagnosis of lymphedema after indirect lymphography with Iotasul.

Indirect lymphography with Iotasul (interdigital, intradermal infusion) was performed in 32 patients with lymphedema. No side effects were observed. Opacification of the peripheral lymph vessels reveals two distinct patterns: 1. No, few, or only very small-calibre lymph vessels ("hypoplasia"): 17 patients (primary lymphedema in 14 cases, secondary in 3). 2. Many large-calibre (dilated) lymph vessels ("hyperplasia"): 15 patients (primary lymphedema in 2 cases, secondary in 13). An occasional finding in "hypoplasia" is drainage of the contrast material in the region of the adventitia of vessels, and a network of extremely fine lymph vessels apparently corresponding to the dermal plexus is sometimes observed. Because it leads to the opacification of barely perceptible lymph vessels in the extreme periphery which were previously inaccessible to radiology, indirect lymphography offers a genuine gain in information and improves the differential diagnosis. When administered correctly, Iotasul invariably enhances the peripheral lymph vessels without making any great demands of the patient or investigator.

[Hyperparathyreoidism and chronic lymphocytic leukemia (author's transl)]. / Hyperparathyreoidismus bei chronisch lymphatischer Leukämie.

A 55 year old patient with chronic lymphocytic leukemia is reported in whom hypercalcemia occurred associated with hypophosphatemia and elevated parathyroid hormone levels (C-terminal assay). Bone histology gave further evidence for hyperparathyroidism. During neck and mediastinal exploration numerous lymph nodes were exstirpated. Although pathologic parathyroid tissue could not be identified it is concluded from postoperative normalisation of calcium levels that hyperparathyroidism had been cured by surgery. The patient died the seventh postoperative day on bronchopulmonary infection. Early differential diagnostic evaluation of the rare symptom hypercalcemia in chronic lymphocytic leukemia is postulated.

[New aspects on diagnosis and therapy of primary hyperparathyroidism (author's transl)]. / Neuere Gesichtspunkte in Diagnostik und Therapie des primären Hyperparathyreoidismus.

26, out of them 20 surgically proven cases of primary hyperparathyroidism are presented. The value of different laboratory, radiographic and scintigraphic analysis is examined. The estimation of calcium and phosphate in serum, the iPTH-determination and fine detail hands radiographs were found to be sufficient to establish diagnosis and indication for surgery. The chloride/phosphate-ratio proved valuable in comparative statistical analysis between pHPT and two control groups. Venous sampling at present seems to be the superior method for preoperative localization of parathyroid disease. It should be performed before second surgical intervention in the cervical region, in elderly (more than 60 years old) and risk patients. Early diagnosis and therapy of pHPT is important as pHPT is a chronic disease with many organ complications. The value of calcium-screening in an age group between 40 and 60 years is discussed.

[Application of vasopressin in diagnostic radiology (author's transl)]. / Uber die Anwendung von Vasopressin in der Röntgendiagnostik.

Vasopressin is demonstrated in 100 selected patients as a suitable drug to remove intestinal gas in diagnostic radiology. After subcutaneous injection of 10 IU Vasopressin only slight side-effects occurred in 35% of the patients. Under strict attention of the contraindications the use of Vasopressin is nearly without risk and leads to partially excellent results.

[Use and effectiveness of scintigraphy, sonography and angiography in circumscribed disease of the liver (author's transl)]. / Einstaz und Leistungbreite von szintigraphie, Sonographie und Angiographie bei umschriebenen Leberprozessen

The effectiveness of scintigraphy, sonography and angiography is compared in a material of 140 cases of circumscribed disease of the liver. Typical clinical starting points are defined as points of reference of the diagnostic techniques. Clinical diagnosis is very safe in cases of secondary blastoma and hepatocellular carcinoma of the liver. Since the great majority of these conditions cause space-occupying lesions of the liver, problems of radiologic diagnosis are confined to the smaller number of clinically ill-defined lesions. For the diagnosis of secondary blastomas and cystic process of all kinds, scintigraphy and sonography are not improved by angiography. Solid space-occupying lesions of unknown origin, however, can only be recognized with angiography. Histology of both benign and malignant processes will be correct in more than 90% of cases.