Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease

Background The number of invasive group A Streptococcus (iGAS) infections due to hitherto extremely rare type emm74 strains has increased in several Canadian provinces since late 2015. We hypothesized that the cases recorded in the different provinces are linked and caused by strains of an emm74 clone that recently emerged and expanded explosively. Methods We analyzed both active and passive surveillance data for iGAS infections and used whole-genome sequencing to investigate the phylogenetic relationships of the emm74 strains responsible for these invasive infections country-wide. Results Genome analysis showed that highly clonal emm74 strains, genetically different from emm74 organisms previously circulating in Canada, were responsible for a country-wide epidemic of >160 invasive disease cases. The emerging clone belonged to multilocus sequence typing ST120. The analysis also revealed dissemination patterns of emm74 subclonal lineages across Canadian provinces. Clinical data analysis indicated that the emm74 epidemic disproportionally affected middle-aged or older male individuals. Homelessness, alcohol abuse, and intravenous drug usage were significantly associated with invasive emm74 infections. Conclusions In a period of 20 months, an emm74 GAS clone emerged and rapidly spread across several Canadian provinces located more than 4500 km apart, causing invasive infections primarily among disadvantaged persons.

A Deleterious Combination of Intravenous Drug Usage with HIV and Chronic Hepatitis Infection; How Renal Replacement Therapy Emanated?

Intravenous drug usage of substances like cocaine and heroin; encompasses a spectrum of generalized state of illness. A continuum insult which predispose patients to chronic viral illnesses, bacterial infections and subsequently end organ damage due to multiple factors. The renal structure is one of the target organs involved in this process, by which a majority of them will lately developed end stage renal disease and as a result renal replacement therapy. However, the spectrum of complications of this population is enormous starting with acquire infections like HIV, Hepatitis C, Hepatitis B, severe skin infections, pneumonias, cardiovascular diseases, endovascular complications as the well-known Lemierre’s syndrome, central nervous system infections, systemic complications like renal failure ending up in hemodialysis and most of them with a low expectancy of life. In our population 69 patients were randomly with a mean age of 44 years assign for investigation all of them known to have a poor social support in conjunction with intravenous drug usage of cocaine and heroin. All these patients were study using the electronic medical record system, several conditions were measure like HIV, Hepatitis B, Hepatitis C, Hypertension and Diabetes mellitus. Of the patients been study the admission diagnosis that lead to renal replacement therapy was recorded, and later in the process compared. Our population of 69 patients, 16 of them ended up in hemodialysis 23% (16/69), of this patients that had renal replacement therapy 4 of them had Hepatitis C 25% (4/16), Hepatitis B 19% (3/16), HIV 13% (2/16), Hypertension 6% (1/16) and Diabetes mellitus 6% (1/16) respectively. There were several precise findings that lead to hemodialysis in the population, with the majority been infected ulcers 25% (17/69), pneumonia 20% (14/69), upper gastrointestinal bleeding in 10 %(7/69) and symptomatic anemia 10% (7/69) respectively. All of this patient did not have good social support, none of them knew about the long-term consequences of renal failure and most of them did not had positive approach of stopping intravenous drug usage. As a whole, illicit intravenous drug usage is associated with a broad spectrum of diseases, all of them creating a rapid deleterious clinical picture; mostly debuting to medical assistance with infectious etiologies.

Assessment of Knowledge, Attitude, and Practice of Risky Sexual Behavior Leading to HIV and Sexually Transmitted Infections among Egyptian Substance Abusers: A Cross-Sectional Study

Background. Rapidly growing youth population with changing sexual trend in Egypt raised HIV potential. The aim of this study is to assess knowledge, attitude, and practice regarding unsafe sexual behavior among Egyptian drug abusers.Methods. This cross-sectional study was conducted in 2008 in the Freedom Drugs and HIV Program on 410 drug abusers in Egypt. Included respondents were subanalyzed by gender, age, education, and intravenous drug usage.Results. KAP average scores on safe sexual behavior were low compared to the maximum possible denoting low awareness and action of drug addicts towards avoidance of infection. Respondents with higher education had significantly better knowledge about safe sexual behavior. Significant positive correlation was shown between age and knowledge of safe sexual behavior. Older age groups were predicted to know more about safe sex, while gender; educational level and intravenous drug usage were not. Similarly, females and intravenous drug users were predicted to have higher attitude for safe sex while age and educational level did not.Conclusion. KAP of safe sexual behavior were low among drug addicts in Egypt increasing potential towards infection with STDs including HIV. The more the age and education level, the better the knowledge towards safe sexual behavior.