scholarly journals P033: Clinical and laboratory characteristics of patients presenting to a tertiary care centre emergency department with invasive Group A Streptococcus infections

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S74-S75
Author(s):  
K. Dudar ◽  
S. Littlefield ◽  
M. Garnett
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Emergency Department ◽  
Group A Streptococcus ◽  
Vital Signs ◽  
National Average ◽  
Risk Indicator ◽  
Invasive Group ◽  
Laboratory Values ◽  
Group A

Introduction: According to the Public Health Agency of Canada, the rate of invasive Group A Streptococcus (iGAS) has more than doubled since it first became a notifiable disease in 2000. Our objectives were to describe the clinical and laboratory characteristics of iGAS in a geographic area that sees a relatively high volume of cases annually. Methods: We conducted a retrospective chart review of all adult and pediatric patients presenting to the Thunder Bay Regional Health Sciences Centre Emergency Department from January 2016 to December 2017 with a hospital discharge diagnosis of iGAS infection using ICD-10 codes. Patient demographics, host characteristics, triage vital signs, laboratory values, culture sites, and disposition were analyzed using univariate and bivariate statistics. Results: Forty-five cases of iGAS were identified over 2 years, with a mean age of 45 years (SD 18). The most prevalent associations were male sex (69%), diabetes mellitus (44%), current or previous alcohol abuse (38%), and current or previous intravenous drug use (33%). Prevalence of iGAS was roughly two times the national average in 2016 (11.5 per 100,000) and four times the national average in 2017 (25.5 per 100,000). Mean triage vital signs included a systolic blood pressure of 126 mmHg (SD 24), diastolic blood pressure of 73 mmHg (SD 16), temperature of 37.3°C (SD 1.4), oxygen saturation of 97% (SD 2), heart rate of 113 beats per minute (SD 22), and respiratory rate of 22 breaths per minute (SD 7). Mean laboratory values revealed a white blood cell count of 17,500 cells/μL (SD 9,800) and C-reactive protein of 243 mg/L (SD 144). A higher Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was positively correlated with longer hospital length of stay (r = 0.46, p < 0.01). Conclusion: Despite its morbidity and mortality, iGAS infections often present insidiously with only mild abnormalities in triage vital signs, and require a high index of suspicion by the emergency physician for a prompt diagnosis, particularly in at-risk populations such as patients with diabetes mellitus or those who misuse alcohol or drugs.

scholarly journals Paediatric Active Enhanced Disease Surveillance (PAEDS) annual report 2016: Prospective hospital-based surveillance for serious paediatric conditions

2019 ◽  
Vol 43 ◽  
Author(s):  
Jocelynne.E McRae ◽  
Helen.E Quinn ◽  
Gemma.L Saravanos ◽  
Alissa McMinn ◽  
Philip N Britton ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Herpes Zoster ◽  
Disease Surveillance ◽  
Acute Flaccid Paralysis ◽  
Group A Streptococcus ◽  
Invasive Group ◽  
Varicella Zoster ◽  
Vaccine Preventable Diseases ◽  
Group A

Introduction The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is a hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine preventable diseases and potential adverse events following immunisation (AEFI). PAEDS data is used to better understand these conditions, inform policy and practice under the National Immunisation Program, and enable rapid public health responses for certain conditions of public health importance. PAEDS enhances data available from other Australian surveillance systems by providing prospective, detailed clinical and laboratory information on children with selected conditions. This is the third annual PAEDS report, and presents surveillance data for 2016. Methods Specialist nurses screened hospital admissions, emergency department records, laboratory and other data, on a daily basis in 5 paediatric tertiary referral hospitals in New South Wales, Victoria, South Australia, Western Australia and Queensland to identify children with the conditions under surveillance. Retrospective data on some conditions was also captured by an additional hospital in the Northern Territory. Standardised protocols and case definitions were used across all sites. Conditions under surveillance in 2016 included acute flaccid paralysis (AFP) (a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal and invasive Group A streptococcus diseases. Most protocols restrict eligibility to hospitalisations; Emergency Department (ED) only presentations are also included for some conditions. Results In 2016, there were 673 cases identified across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach World Health Organization (WHO) reporting targets; identification of the leading infectious causes of acute encephalitis which included human parechovirus, influenza, enteroviruses, Mycoplasma pneumoniae, and bacterial meningo-encephalitis; demonstration of high influenza activity with vaccine effectiveness (VE) analysis demonstrating some protection offered through vaccination. All IS cases associated with vaccine receipt were reported to the relevant state health department. Varicella and herpes zoster case numbers increased from previous years associated with suboptimal vaccination in up to 40% of cases identified. Pertussis surveillance continued in 2016 with the addition of test negative controls captured for estimating vaccine effectiveness. Surveillance for invasive meningococcal disease showed predominance for serotype B in absence of immunisation, and new invasive group A streptococcus surveillance captured severe disease in children.   Conclusions PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using hospital-based sentinel surveillance. Keywords: paediatric, surveillance, child, hospital, vaccine preventable diseases, adverse event following immunisation, acute flaccid paralysis, encephalitis, influenza, intussusception, pertussis, varicella zoster virus, meningococcal, group A streptococcus.

Clinical and laboratory characteristics of patients presenting to a tertiary care center emergency department with invasive group A streptococcal infections

CJEM ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 368-374
Author(s):  
Karly Dudar ◽  
Shalyn Littlefield ◽  
Meghan Garnett
Keyword(s):  
Emergency Department ◽  
Care Center ◽  
Tertiary Care ◽  
Vital Signs ◽  
High Volume ◽  
Geographic Area ◽  
Streptococcal Infections ◽  
Invasive Group ◽  
Icd 10 ◽  
Group A

ABSTRACTObjectivesThe aim of this study was to describe the clinical and laboratory characteristics of invasive group A streptococcal infections in a geographic area that sees a high volume of cases.MethodsWe conducted a health records review of consecutive patients presenting to the Thunder Bay Regional Health Sciences Centre Emergency Department (ED) in 2016–2017 with a diagnosis of invasive group A streptococcal infection using ICD-10 codes. Patient demographics, host characteristics, triage vital signs, laboratory values, culture sites, and disposition were described using univariate and bivariate statistics.ResultsForty-four adult cases were identified over 2 years, with a median age of 44 years (interquartile range, 35–52). The most prevalent risk factors were diabetes mellitus (45%), current or previous alcohol abuse (39%), and current or previous intravenous drug use (34%). The two most abnormal triage vitals signs were a heart rate ≥ 100 beats per minute in 32 (73%) cases and a respiratory rate ≥ 20 breaths per minute in 27 (63%) cases. The temperature was ≥ 38°C in only 14 (32%) of cases. The C-reactive protein (CRP) was always elevated when measured, and greater than 150 mg/L in 20 (71%) of cases. One-third of patients had an ED visit in the preceding 7 days before the diagnosis of invasive group A Streptococcus.ConclusionsInvasive group A streptococcal infections often present insidiously in adult patients with mild tachycardia and tachypnea at triage. The CRP was the most consistently abnormal laboratory investigation.

Bilateral periorbital necrotising fasciitis associated with invasive group: a Streptococcus infection

2020 ◽  
Vol 13 (12) ◽  
pp. e236800
Author(s):  
Grace Anne McCabe ◽  
Thomas Hardy ◽  
Thomas Gordon Campbell
Keyword(s):  
Group A Streptococcus ◽  
Early Recognition ◽  
Skin Grafting ◽  
Final Diagnosis ◽  
Necrotising Fasciitis ◽  
Invasive Group ◽  
Group A ◽  
Tissue Microscopy ◽  
Periorbital Swelling ◽  
Multidisciplinary Teamwork

A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A Streptococcus (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.

scholarly journals Sequential Quadriplex Real-Time PCR for Identifying 20 Common emm Types of Group A Streptococcus

2020 ◽  
Vol 59 (1) ◽  
pp. e01764-20
Author(s):  
Srinivasan Velusamy ◽  
Katherine Jordak ◽  
Madeline Kupor ◽  
Sopio Chochua ◽  
Lesley McGee ◽  
...  
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Group A Streptococcus ◽  
High Specificity ◽  
The United States ◽  
Rapid Identification ◽  
Invasive Group ◽  
Outbreak Investigations ◽  
Group A ◽  
Culture Negative

ABSTRACTWe developed a sequential quadriplex real-time PCR-based method for rapid identification of 20 emm types commonly found in invasive group A Streptococcus (iGAS) strains recovered through the Centers for Disease Control and Prevention’s Active Bacterial Core surveillance. Each emm real-time PCR assay showed high specificity and accurately identified the respective target emm type, including emm subtypes in the United States. Furthermore, this method is useful for rapid typing of GAS isolates and culture-negative specimens during outbreak investigations.

scholarly journals Management of patients with type 2 diabetes mellitus in the Grand-Aides Program

2019 ◽  
Vol 10 (3) ◽  
pp. 1
Author(s):  
Rebekah M. Compton ◽  
Kimberly S. Bednar ◽  
Peggie E. Donowitz ◽  
M. Norman Oliver
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Emergency Department ◽  
Type 2 Diabetes Mellitus ◽  
Medication Adherence ◽  
Diastolic Blood Pressure ◽  
Home Visit ◽  
Ed Visits

Objective: To evaluate the Grand-Aides Program for patients with type 2 diabetes mellitus (T2DM) according to the variables of body weight, blood pressure, medication adherence, and hospital consultation and readmissions.Methods: Patients ages 18 years or older with a past medical history of T2DM, hypertension (HTN), and/or obesity and who were recently seen in the emergency department (ED) or recently admitted to the hospital were eligible to enroll in the Grand-Aides Program. Eligible patients were identified after hospital or ED discharge and were asked to enroll in the in-home based program from March 2016 through June 2018. In-home visit protocol was defined prior to patient enrollment with intense in-home visits during the first weeks of enrollment followed by monthly visits for the duration of enrollment in the program. In-home visit frequency was adjusted on as needed basis so that patients at higher risk for ED visits or hospitalization were seen more frequently. In-home visits were performed by trained Grand-Aide who for the purpose of this study was a certified nursing assistant (CNA). The Grand-Aide underwent eighty hours of didactic training which included visit protocols, visit schedules, and data collection. The one-on-one in-home patient with every visit were supervised by a registered nurse (RN) or nurse practitioner (NP) via video or telephone contact near the conclusion of the visit. Active patients at the University of Virginia Family Medicine clinic were eligible for enrollment. Fifty-seven patients with T2DM worked with Grand-Aides for three months and an additional forty-eight T2DM patients worked with Grand-Aides for twelve months. Emergency department visits, all 30-day hospital readmissions, as well as blood pressure readings, medication adherence, weights, and glycated hemoglobin (HbA1c) were compared with the prior twelve months.Results: Systolic (p < .001) and diastolic (p < .01) blood pressures decreased (p < .01) at 1 year. At baseline 56 percent of the patients had a systolic blood pressure of >130 mmHg despite treatment; after 12 months, 48 percent of these were < 130. In those whose baseline diastolic blood pressure was > 90 mmHg, 100 percent had diastolic blood pressure < 90 mmHg at 1 year. Medication adherence by ARMS test at 1 year was 94 percent. Despite trending downward, weight and HbA1c did not change significantly. In the preceding, 58 percent had at least one ED visit, which was reduced by 50 percent (p < .01) with Grand-Aides; 30-day all-cause readmissions reduced by 50 percent to 6.3 percent. Conclusions: The Grand-Aides program was associated with a significant change in blood pressure control, high medication adherence and reductions in ED visits and readmissions that compare favorably with published comparative data. For systems “at risk” for preventable increased health care expense burden, the Grand-Aides program can result in significant savings.

Management of a cluster of invasive group A streptococcus infection in elderly patients linked to a district nursing team in the UK

The Lancet ◽  
2014 ◽  
Vol 384 ◽  
pp. S57
Author(s):  
Oluwakemi Olufon ◽  
Nalini Iyanger ◽  
Vivien Cleary ◽  
Vicki Chalker ◽  
Theresa Lamagni
Keyword(s):  
Elderly Patients ◽  
Group A Streptococcus ◽  
Invasive Group ◽  
Nursing Team ◽  
Group A ◽  
The Uk

scholarly journals Comparing the Effects of Dexmedetomidine and Midazolam on Sedation in Children with Head Trauma to Perform CT in Emergency Department / Upoređivanje efekata deksmedetomidina i midazolama na sedaciju dece sa povredom glave radi snimanja CT-om na Odeljenju urgentne medicine

2015 ◽  
Vol 32 (1) ◽  
pp. 59-65
Author(s):  
Hojjat Derakhshanfar ◽  
Farzad Bozorgi ◽  
Adel Hosseini ◽  
Shamila Noori ◽  
Abolfazl Mostafavi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Trauma ◽  
Recovery Time ◽  
Vital Signs ◽  
Loading Dose ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Pediatric Sedation ◽  
Group B

Summary Many of the children referred to the emergency complain of head trauma. Children usually require sedition to reduce their failure and fear because of high activity and fear of performing computed tomography (CT). Dexmedetomidine and Midazolam belong to short-acting drugs for this purpose. This study aimed to compare the effect of the above mentioned drugs on sedition in children. Children referred to the emergency department were randomly divided into two groups. Group A was sedated with 0.05 mg/kg IV Midazolam and group B with 2μg/kg IV Dexmedetomidine over 10 minutes (loading dose), and then repeat boluses 2μg/kg IV over 10 minutes. Measurements included induction time, recovery time, efficacy, side effects, complications, and failure with each drug and vital signs and RAMSY scale. SPSS V.20 was used for data analysis. p<0.05 was considered statistically significant. Totally, 100 patients participated in the current study (44 girls and 56 boys). The mean and standard deviation of age was 5.3 ± 2.5 years. During the study, just 5 patients (10%) from group A did not have appropriate sedition following the injection of first dose of Midazolam and received the second dose. However, in B group patients no such case was reported. No significant difference was observed among blood pressure, heart rate, respiration and RAMSY Scale among the groups. No significant difference was seen between efficacy of Midazolam and Dexmedetomidine in pediatric sedation. More research should be done for generalization of our findings .

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