Epidemiology of bloodstream infections in children with sickle cell disease.

The incidence of invasive Streptococcus pneumoniae and Haemophilus influenzae type b infections in the sickle cell disease population has declined. In this report, we determine the predominant organisms responsible for bloodstream infections in a pediatric sickle cell disease population during the postheptavalent conjugate vaccine era. Central venous access device associated infections are a new burden to efforts aimed at preventing bloodstream infections in this population.

Medical treatment failure and complete left pneumonectomy after Legionella pneumophila pneumonia in a bone marrow transplant recipient.

Legionnaire disease (LD) is infrequently considered in the differential diagnoses for hospital- and community-acquired pneumonia in pediatrics. We report a case of Legionnaire disease in a 19-year-old male with aplastic anemia after bone marrow transplant, who was being treated in a children's hospital. Severe, refractory pulmonary disease necessitated pneumonectomy to control the infection.

Clostridium difficile testing algorithms using glutamate dehydrogenase antigen and C. difficile toxin enzyme immunoassays with C. difficile nucleic acid amplification testing increase diagnostic yield in a tertiary pediatric population.

We evaluated the performance of the rapid C. diff Quik Chek Complete's glutamate dehydrogenase antigen (GDH) and toxin A/B (CDT) tests in two algorithmic approaches for a tertiary pediatric population: algorithm 1 entailed initial testing with GDH/CDT followed by loop-mediated isothermal amplification (LAMP), and algorithm 2 entailed GDH/CDT followed by cytotoxicity neutralization assay (CCNA) for adjudication of discrepant GDH-positive/CDT-negative results. A true positive (TP) was defined as positivity by CCNA or positivity by LAMP plus another test (GDH, CDT, or the Premier C.

Pneumococcal bacteremia in a vaccinated pediatric sickle cell disease population.

The incidence of pneumococcal disease in sickle cell disease declined significantly with penicillin prophylaxis as well as with the pneumococcal polysaccharide and heptavalent conjugate vaccines. In this report, we describe our experience with pneumococcal bacteremia in pediatric patients with sickle cell disease in the post-heptavalent pneumococcal conjugate vaccine era. Despite established prophylactic strategies, pneumococcal bacteremia continues to occur in patients with sickle cell disease.

Declining incidence of candidemia in a tertiary inpatient pediatric population.

We examined the incidence of candidemia, Candida species distribution, and antifungal susceptibility patterns in a pediatric institution. We identified 301 episodes of candidemia from 2001 to 2010 inclusive. Annual incidence decreased from 0.

Identification of sexual networks through molecular typing of quinolone-resistant Neisseria gonorrhoeae in Ontario, Canada.

Neisseria gonorrhoeae multi-antigen sequence typing technique demonstrated multiple sexual transmission networks in Ontario, Canada. Isolates with novel sequences had higher odds of originating in Toronto but had no association with heightened population-level quinolone exposure. Neisseria gonorrhoeae multi-antigen sequence typing technique can be a useful tool for investigation of multidrug-resistant N.

Incidence and treatment outcomes of pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections in men who have sex with men: a 13-year retrospective cohort study.

Background: This study investigated the incidence and treatment outcomes of pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis cases at a Canadian clinic that mainly serves men who have sex with men.

Methods: All patients with pharyngeal N. gonorrhoeae and C.

Toxocariasis mimicking liver, lung, and spinal cord metastases from retinoblastoma.

A boy with bilateral retinoblastoma underwent metastatic surveillance for increased risk of systemic and central nervous system metastasis because of the extensive choroid and optic nerve invasion in his enucleated eye. Two years after finishing chemotherapy, surveillance MRI showed multiple new liver, lung and spinal cord lesions. High Toxocara antibody titers, eosinophilia, and elevated IgE levels supported a diagnosis of toxocariasis, rather than retinoblastoma metastasis.

Prevalence of and risk factors for quinolone-resistant Neisseria gonorrhoeae infection in Ontario.

Background: Quinolone-resistant Neisseria gonorrhoeae has swiftly emerged in Canada. We sought to determine its prevalence in the province of Ontario and to investigate risk factors for quinolone-resistant N. gonorrhoeae infection in a Canadian setting.

Vaccine-strain varicella zoster virus causing recurrent herpes zoster in an immunocompetent 2-year-old.

Varivax III is a live attenuated vaccine against varicella zoster virus (VZV). We report a case of recurrent vaccine-strain herpes zoster in an immunocompetent 2-year-old child. Vaccine-strain VZV was identified through polymerase chain reaction.

Identification badges: a potential fomite?

Background: Staff identification badges are mandatory in all hospitals. The purpose of this study was to assess microbial contamination of identification badges at a Canadian tertiary centre. Risk factors for badge contamination were also investigated.

Influence of decision aids on patient preferences for anticoagulant therapy: a randomized trial.

Background: Decision aids have been shown to be useful in selected situations to assist patients in making treatment decisions. Important features such as the format of decision aids and their graphic presentation of data on benefits and harms of treatment options have not been well studied.

Methods: In a randomized trial with a 3 x 2 factorial design, we investigated the effects of decision aid format (decision board, decision booklet with audiotape, or interactive computer program) and graphic presentation of data (pie graph or pictogram) on patients' comprehension and choices of 3 treatments for anticoagulation, identified initially as "treatment A" (warfarin), "treatment B" (acetylsalicylic acid) and "treatment C" (no treatment).