Disseminated cutaneous Mycobacterium haemophilum infection in a patient on infliximab for rheumatoid arthritis.

Mycobacterium haemophilum is a rarely encountered pathogen that is difficult to identify given its unique growth requirements. It is most often seen in adult patients who are immunosuppressed due to advanced HIV or haematological malignancy. Our case highlights a typical presentation of an atypical pathogen in a patient with rheumatoid arthritis receiving anti-tumour necrosis factor therapy. This case represents an important patient population in whom this previously rare infection is increasingly common.

Metronidazole-resistant trichomoniasis: Two Canadian cases.

Metronidazole-resistant trichomoniasis is a health burden for patients, and limited access to susceptibility testing and treatment is a challenge for Canadian clinicians. These cases emphasize the burden of metronidazole resistance in our population. Herein we describe two cases of metronidazole-resistant trichomoniasis. In one case, a patient underwent five courses of therapy to treat a persistent Trichomonas vaginalis infection. International culture and susceptibility testing revealed resistance to metronidazole and susceptibility to tinidazole. The patient was subsequently lost to follow-up. In another case, a patient was treated with six courses of therapy before their infection had cleared. International culture and susceptibility testing indicated resistance to metronidazole and intermediate resistance to tinidazole. In both cases, metronidazole treatment, either alone or in addition to another therapy, was attempted an average of 3.5 times in escalating dose regimens before switching to tinidazole. Tinidazole proved to be an effective second-line therapy when tolerated by the patient. Until susceptibility testing is available in Canada, clinicians should be aware of access to international susceptibility testing of T. vaginalis to appropriately identify metronidazole-resistant cases and make timely and informed decisions regarding treatment.

La trichomonase résistante au métronidazole est un fardeau pour les patients, et l'accès limité au test de susceptibilité et au traitement représente un défi pour les cliniciens canadiens. Ces cas font ressortir le fardeau de la résistance au métronidazole dans la population. Dans le présent article, les auteurs décrivent deux cas de trichomonase résistante au métronidazole. Dans un cas, un patient a reçu cinq traitements pour soigner une infection persistante à Trichomonas vaginalis. La culture internationale et le test de susceptibilité ont révélé une résistance au métronidazole et une susceptibilité au tinidazole. Le patient a ensuite été perdu au suivi. Dans un autre cas, un patient a reçu six traitements avant que l'infection ne se résorbe. La culture internationale et le test de susceptibilité ont révélé une résistance au métronidazole et une résistance intermédiaire au tinidazole. Dans les deux cas, le traitement au métronidazole, seul ou conjointement avec un autre traitement, a été tenté en moyenne 3,5 fois en doses progressives avant le passage au tinidazole. Le tinidazole s'est révélé efficace en deuxième intention lorsqu'il était toléré par le patient. Tant que le test de susceptibilité ne sera pas offert au Canada, les cliniciens devraient savoir qu'ils peuvent avoir accès aux tests de susceptibilité internationaux au T. vaginalis pour dépister convenablement les cas résistants au métronidazole et prendre des décisions rapides et éclairées au sujet du traitement.

The First Case Report of West Nile Virus-Induced Acute Flaccid Quadriplegia in Canada.

The 1999 New York City outbreak of West Nile virus (WNV) was associated with a high incidence of West Nile virus neuroinvasive disease (WNVND) where the outcomes for these patients were very poor. We describe a case of West Nile virus neuroinvasive disease (WNVND) characterized by acute flaccid quadriplegia with a favorable outcome in Winnipeg, Manitoba, Canada.

Evaluation of the Utility of Point-of-Care HIV Testing on a Canadian Internal Medicine Inpatient Unit.

Point-of-care (POC) HIV testing has been shown to be an acceptable method for increasing HIV testing uptake. To date, no studies have examined the use of POC testing for routine HIV screening on the medicine inpatient unit. A prospective cross-sectional study was conducted over a three-month period in July, August, and October 2016 to evaluate the prevalence of undiagnosed HIV and the attitudes towards routine POC HIV testing. Patients admitted directly to medicine inpatient teaching units at a tertiary hospital in Winnipeg, Canada, were approached for participation. The POC HIV test was administered at the bedside. Reactive and indeterminate tests were confirmed with standard serological HIV testing. Participants were given a questionnaire regarding their attitudes towards POC testing on the unit. Although no cases of previously undiagnosed HIV were identified during the study period, only 35% of participants were found to have ever had HIV testing previously. The majority of participants were satisfied with the POC testing experience and would choose to have the POC testing again. Overall, the low rate of outpatient testing highlights the need for routine HIV testing on an inpatient basis.

Snowshoe Hare Virus Causing Meningoencephalitis in a Young Adult From Northern Manitoba, Canada.

We describe a dramatic presentation of meningoencephalitis, in a young Aboriginal male from Northern Manitoba, due to infection with the Snowshoe hare virus, a member of the California serogroup viruses. Snowshoe hare virus represents a rare cause of meningoencephalitis, and, to date, few Canadian cases have been described in the literature.