[Infectious Diseases News Brief]

Cryptosporidiosis: Vancouver Vicinity
Public health officials have issued an advisory following the identification of four cases of cryptosporidiosis since mid-October. The source of infection has not been identified; however, the four cases had each visited a municipal aquatic centre in Coquitlam prior to becoming ill. The pool has temporarily closed for testing and remediation.
Source: News Release, Fraser Health Authority, 5 December 2003

Syphilis: United States
The syphilis rate in the United States rose in 2002 for the second consecutive year, following a decade-long decline that led to an all-time low in 2000. The increase was due in large part to increases in reported syphilis cases among men, particularly gay and bisexual men. At the same time, continued declines in syphilis among African Americans and women point to the success of STD prevention efforts in some areas and populations. Between 2001 and 2002, the overall rate of syphilis increased 9.1%, from 2.2 cases to 2.4 cases per 100,000 population – the highest rate since 1999. The total number of reported cases increased 12.4%, from 6,103 to 6,862 cases. Syphilis cases among men increased 27.4% between 2001-2002 (from 4,134 to 5,267 cases). CDC does not collect syphilis data by sexual orientation; however, it is estimated that more than 40% of all syphilis cases reported in 2002 occurred among gay and bisexual men, accounting for much of the reported overall increase in the disease. Recent research has highlighted increases in unprotected sex among some groups of men who have sex with men (MSM), as well as high rates of HIV co-infection among men diagnosed with syphilis (averaging about 50%). These findings, plus HIV surveillance data from a recent CDC 25-state study showing a 17.7% increase in HIV diagnoses among men who have sex with men between 1999-2002, have raised concerns about a resurgence of HIV in this population.
Source: Morbidity and Mortality Weekly Report, Volume 52, Number 46, 21 November 2003

Clostridial Endophthalmitis After Cornea Transplantation: Florida
In February 2003, two patients received corneal transplant on the same day in the same facility. The corneas used for both patients were recovered from one donor. The first patient experienced severe eye pain, nausea, and vomiting within 12 hours after surgery. Eye examination was consistent with endophthalmitis. Cultures of fluid inside the eye yielded C. perfringens. The second patient was determined on routine evaluation 1 day after surgery to have probable early endophthalmitis in the eye in which the cornea was transplanted. Intraocular cultures yielded C. perfringens. Cultures of both donor corneas, collected immediately before transplantation, subsequently grew C. perfringens. Review of data from the eye bank indicated that the donor body was refrigerated within 3 hours after death; eyes were recovered approximately 8 hours after death. The corneal tissues had undergone tissue processing. The donor tissue had been maintained in a solution of gentamicin and streptomycin, and transplantation was completed within 48 hours of tissue recovery. The eye bank and the surgeon had evaluated the donor tissue by slit lamp examination and found no abnormalities. Clostridium perfringens, an anaerobic gram-positive bacillus found in soil and bowel flora, is an infrequent cause of endophthalmitis. Although the majority of cases are caused by penetrating injury with soil-contaminated foreign bodies, C. perfringens endophthalmitis has been reported in patients after cataract surgery.
Source: Morbidity and Mortality Weekly Report, Volume 52, Number 48, 5 December 2003

Tetanus in Injecting Drug Users (IDUs): England (Update)
Eight cases of clinical tetanus, including one death, have now been reported in IDUs in England since July 2003, six of which occurred since October. The cases are in five women and three men aged between 20-47 years, and the latest reported onset date was 17 November. Two of the cases are known to be unimmunized and one case is known to have received a dose of tetanus toxoid 9 years ago. These cases so far has ranged from mild trismus to full blown tetanus and respiratory arrest in the emergency department. The source of infection in this incident is not known. The close clustering of recent cases suggests contamination of drugs, either the drug itself or an adulterant. If this incident has been caused by a single contaminated batch of drugs, then the outbreak could be almost over, as the incubation period for tetanus is between 4 to 14 days. Further cases are, however, expected if there is a continuing source of contamination.
Source: Eurosurveillance Weekly, Volume 7, Issue 49, 4 December 2003

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.

[Infectious Diseases News Brief]