February 23, 2001

Invasive Meningococcal Disease (IMD): Manitoba
Over the last several years, the incidence of invasive meningococcal disease (IMD) in Manitoba has remained at < 1 case per 100,000 population. On average, approximately 8 cases per year are reported in the province. In January 2001, 4 cases of meningococcal meningitis were reported: 3 cases were serogroup C; 1 case, serogroup B. Of the group C cases, 2 occurred among individuals 15-19 years living in the Winnipeg Health Region; 1 case was reported in an individual in the 50-54 year old age group from the Central Regional Health Authority. In February 2001, a fifth case of IMD was reported in a male in the 20-29 year old age group living in the Winnipeg Health Region. Serogroup C was confirmed for this case. At the present time, there are no known links among cases. For the most current case, Public Health investigation is ongoing. Pulsed field gel electropheresis for all cases is underway. Health care professionals have been advised of the unusual occurrence of cases and encouraged to report suspected cases as soon as possible. At this time, an outbreak has not been declared in the province and an immunization program has not been initiated. However, an Outbreak Response Team has been established for the purpose of ongoing assessment and planning.
Source: Communicable Disease Control Unit, Manitoba Health

Abiotrophia Species: United States
Recently there have been reports of unexplained sepsis and deaths among intravenous drug abusers (IDA) in Scotland, Ireland, and England. Approximately 25% of these cases have been associated with Clostridium species, of which half were identified as Clostridium novyi. A case of bacteremia in an IDA who developed a mycotic aneurysm due to another unusual, fastidious organism has been reported. A 42-year-old IDA presented with a 3-day history of fever and soft-tissue swelling in his right upper arm. Four days earlier he had crushed a lorazepam tablet, mixed it with tap water, and injected it into his right arm. Over the next 72 hours, fever developed, with swelling and erythema around the site of injection, which he incised and drained himself. Blood cultures grew abiotrophia species (formerly known as nutritionally variant streptococcus). In a recent review of abscesses and cellulitis among IDA, researchers reported a high rate of abscesses in this population (68 %), and 27 % of those with abscesses reported that they had incised and drained their own abscesses. Most soft-tissue abscesses and associated bacteremia in IDA are caused by Staphylococcus aureus or Streptococcus viridans or group A streptococci. In a large review of cases of bacteremia in IDA, mycotic aneurysms, pseudoaneurysms that develop when an extravascular hematoma communicates with the intravascular space, occurred in 9 % of the cases. Bacteremia involving abiotrophia species in IDA appears to be unusual, but given the fastidious nature of this organism, the incidence may be underreported.
Source: New England Journal of Medicine, Vol 344, No 3, January 18, 2001

Methicillin-resistant Staphylococcus aureus Infection: Switzerland
An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) among injection drug users (IDUs) occurred in Zurich, Switzerland, from August 1994 through December 1999. Thirty-one IDUs with MRSA infections were identified:12 with soft-tissue infection, 7 with pneumonia [1 death], 7 with endocarditis [1 death], 2 with osteomyelitis, 2 with septic arthritis, and 1 with ulcerative tonsillitis. Of 31 patients, 15 (48%) were infected with HIV. A point-prevalence study among IDUs who frequented outpatient facilities in Zurich revealed an MRSA carriage rate of 10.3% in various facilities. In all but 1 case, pulsed-field gel electrophoresis banding patterns of isolates obtained from these patients were indistinguishable from isolates of the initial 31 IDUs registered. Risk factors for MRSA carriage were disability and prior hospitalization in a hospice. In summary, MRSA became endemic in IDUs in Zurich as a result of the spread of a single clone. This clone caused major morbidity and was responsible for a lethal outcome in 2 cases.
Source: Clinical Infectious Diseases, Vol 32, No 4, February 14, 2001

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.