Rapport hebdomadaire des Canada Diseases maladies au Canada

Rapport  hebdomadaire  des Canada Diseases maladies  au  Canada
Rapport hebdomadaire des
maladies au Canada
Canada Diseases
Weekly Report
Date of publication: April 2, 1983
Date de publication: 2 avril 1983
ISSN 0382-232X
CONTAINED IN THIS ISSUE:
Lactose-Positive Salmonella newport •...•••••
Botulism in Canada - Summary for 1982 •......
Botulism - Northwest Territories ••.••.•.••••.
_
9 14
CONTENU DU PRESENT NUMERO:
Salmonella newport positive a l'egard du lactose
Le botulisme au Canada - Resume pour 1982 ..•..•
Botulisme - Territoires du Nord-Ouest .......•••.
53
53
55
Alert
53
53
55
Alerte
LACTOSE-POSITIVE SALMONELLA NEWPORT
SALMONELLA NEWPORT POSITIVE
L'EGARD DU LACTOSE
A
During the past 2 months, 3 provinces have reported
a number of isolations of lactose-positive Salmonella
newport.
Au cours des 2 derniers mois, 3 provinces ant signale un
certain nombre d'isolats de Salmonella newport positive a
l'egard du lactose.
British Columbia has identified 14 cases in several
nursing homes and in Ontario 9 cases have been identified
in a nursing home outbreak. In another Ontario case, this
organism was isolated from the blood and a brain abscess
in an elderly patient. Nova Scotia is the third province to
report this organism with 1 isolation from urine. To date,
the source of infection has not been determined in any of
these cases.
On a identifie 14 cas dans plusieurs foyers pour personnes ~gees de Colombie-Britannique, et 9 !ors d'une poussee
survenue dans un de ces foyers en Ontario. Toujours en
Ontario, le microorganisme a aussi ete isole chez un sujet ~ge
a partir d'echantillons sanguins et de prelevements d'un abces
du cerveau. La Nouvelle-Ecosse, au !'on a obtenu l'isolat a
partir d'un echantillon d'urine, est la troisieme province a
signaler la presence du microorganisme.
La source de
!'infection reste inconnue dans chacun de ces cas.
Lactose-positive Salmonella may be dismissed as
coliforms on routine laboratory media.
The use of
bismuth sulphite agar (Wilson and Blair) or lysine iron agar
is recommended and will facilitate the isolation of these
organisms.
Avec Jes milieux de culture couramment employes dans
Jes laboratoires, on risque de prendre Salmonella positive au
lactose pour des coliformes. L'Rmploi de la gelose au sulfite
de bismuth (Wilson et Blair) OU de la gelose a la lysine et au
fer est recommande, car il facilite la mise en evidence de ces
microorganismes.
The National Enteric Reference Centre, Laboratory
Centre for Disease Control, Ottawa, is interested in
receiving information on any other isolations of lactosepositive Salmonella.
Le Centre national de reference en bacteriologie
enterique du Laboratoire de Jutte contre la maladie (Ottawa)
est interesse a recevoir des renseignements sur tout autre
isolat de Salmonella positive au lactose.
SOURCE:
H Liar,
MSc,
Chief
National
Enteric
Reference Centre, LCDC, Ottawa, Ontario.
SOURCE:
BOTULISM IN CANADA - SUMMARY FOR 1982
I
Vol.
H Liar, MSc, Chef du Centre national de
reference en bacteriologie enterique, LLCM,
Ottawa, Ontario.
LE BOTULISME AU CANADA RESUME POUR 1982
Three (3) food-borne incidents were confirmed as
botulism in 1982 (Table 1). Outbreaks 1 and 2 involved
Inuits; the third involved a family of native Indians.
En 1982, on a confirme que 3 intoxications d'origine
alimentaire etaient des cas de botulisme (Tableau 1). Les
episodes 1 et 2 concernaient des Inyit, et le troisieme est
survenu chez une famille d'Indiens autochtones.
Two (2) of the incriminated foods had undergone
tradi ti anal fermentations. These processes var)' considerably between types of foods and communitiestl), but the
common factor is that they contain little or no ferrnentable carbohydrate which precludes any significant acid
fermentation and is conducive to the growth of
Clostridium botulinum.
Incident 2 involving urraq
(fermented seal flippers) is described in detail in the third
article in this issue. The preparation of salmon eggs
(incident 3) was somewhat unique in that the eggs had
been frozen (for transportation from Powell River) and
Deux (2) des aliments incrimines avaient ete soumis a un
faisandage traditionnel. Quoique ces procedes varient considerablement selon le type d'aliment et la collectivite(l), ils
ant en commun le fait que Jes plats ainsi prepares contiennent peu au pas du tout de glucide fermentescible, ce qui
empeche toute fermentation acide importante et provoque la
croissance de Clostridium botulinum. L'episode noz mettant
en cause l'urraq (nageoires de phoque faisandees) est decrit
en detail dans le troisieme article du present numero. La
preparation des oeufs de saumon (episode n03) avait ceci de
particulier que Jes oeufs avaient d'abord ete conge!es (aux
Health and Welfare
Canada
Sante et Bien-etre social
Canada
- 53 -
Canada
thawed. They were then fermented in a brine at room
temperature for 11 days. The final product was putrid and
had a pH of 5.9 which is consistent with the absence of an
acid f.ermentation. A detailed description of this incident
will be published in a future issue.
fins du transport depuis Powell River), puis degeles. Ils avaient
ensuite ete mis a fermenter pendant 11 jours dans la saumure, a la
temperature ambiante. Le produit final etait putride et avait un pH
de 5,9, ce qui est caracteristique de !'absence de fermentation
acide. Nous publierons Jes details de cet episode dans un prochain
numero.
Table l - Incidents of Food-borne Botulism in Canada, 1982/
Tableau l - Episodes de botulisme d'origine alimentaire au Canada, 1982
Incidents/
Episodes
Month/
Mais
Location/
Endroit
Suspect
food/
Aliment
soupc;onne
Total
cases/
Total
des cas
Fatal
Toxin
cases/
type/
Cas
Type de
mortels toxine
Specimens positive
with C. botulinum/
Echantillons positifs a
l'egard de C. botulinurn
Toxin/
Toxine
Microorganism/
Microorganisme
·- ......_
l
July/
Ju ill et
Fort Chima,
Quebec/
Fort Chima,
Quebec
Seal meat/
Viande de phoque
2
0
E
Serum/
Serum
2
October/
Octobre
Coppermine,
N.W.T./
Copp ermine,
T. du N.-0.
Urraq
2
0
E
Serum, food/
Serum, aliments
Food/
Aliments
3
November/
Novembre
Vancouver,
B.C./
Vancouver,
C.-B.
Fermented salmon
eggs/
Oeufs de saumon
fermentes
2
0
E
Serum, food/
Serum, aliments
Food, stool/
Aliments, selles
Two (2) likely incidents of botulism involving a single
case each occurred in Labrador (May) and Northern Quebec
(August), but these could not be confirmed by laboratory
analyses. Six (6) other incidents of suspected food-borne
botulism and l case of suspected infant botulism were
investigated.
Deux (2) episodes probables de botulisme - portant chacun sur
un seul cas - se sont produits au Labrador (mai) et dans le nord du
Quebec (aoQt), mais n'ont pu etre confirmes en laboratoire. On a
examine 6 autres episodes presumes de botulisme d'origine alimentaire et l cas presume de botulisme du nourrisson.
C. botulinurn type A was isolated from a case of sudden
infant death syndrome (SIDS) which occurred in May, 1982 in
Manitoba. A California study first implicated C. botulinum
in some cases of SIDS when this microorganism was isolated
from 9 out of 211 SIDS cases(2), Since then, C. botulinurn
has been isolated from SIDS cases in the states of
Washington and Massachusetts, and in Switzerland. This was
the first association of a SIDS case with C. botulinum in
Canada. Only l case of infant botulism has been reported
previously from this country(3),
On a isole C. botulinum de type A chez un cas de mart soudaine
du nourrisson survenu en mai 1982, au Manitoba. C'est une etude
menee en Californie qui, pour la premiere fois, a incrimine C.
botulinum dans certains cas de mart soudaine du nourrisson: on
avait !sole le microorganisme chez 9 des 211 cas examines(2),
Depuis, d'autres isolats ant ete obtenus chez des cas analogues dans
Jes etats de Washington et du Massachusetts, ainsi qu'en Suisse.
Pour ce qui est du cas susmentionne, c'est la premiere fois qu'un lien
est etabli au Canada entre un cas de mart soudaine du nourrisson et
C. botulinum. Un seul cas de botulisme du nourrisson avait deja ete
signale au pays(3),
References:
References:
l.
Dolman CE. In: Lewis KH, Cassel K, eds. Botulism.
Proceedings of Symposium, 1964 Jan, Cincinnati, Ohio.
PHS publication 999-FP-l, 1964:5-32.
l.
Dolman CE.
Tire de: Lewis l<H, Cassel K, ed.
Botulism.
Proceedings of Symposium, janvier 1964, Cincinnati, Ofiio. PHS
publication 999-FP-1, 1964:5-32.
2.
Arnon SS et al. Lancet 1978; 1:1273-7.
2.
Arnon SS et al.
3.
McCurdy OM et al. Can Med Assoc J 1981; 125:741-3.
3.
McCurdy OM et al.
Journal
canadienne 1981; 125:741-3.
SOURCE:
A Hauschild, PhD, Botulism Reference Service
for Canada, Health Protection Branch, Ottawa,
Ontario; L. Gauvreau, MD, Centre Hospitalier
de
l'Universite Laval,
Ste-Foy,
Quebec;
WA Black, MD, Division of Laboratories,
Ministry
of
Health, Vancouver,
British
Columbia.
SOURCE:
- 54 -
~
1978; 1:1273-7.
de
!'Association
medicate
A Hauschild, PhD, Service de reference pour le
botulisme au Canada, Direction generale de la protection de la sante, Ottawa (Ontario); Dr L Gauvreau,
Centre hospitalier de l'Universite Laval, Sainte-Foy
(Quebec); Dr WA Black, Division des laboratoires,
Ministere
de
la
Sante,
Vancouver
(ColombieBritannique).
BOTULISME - TERRITOIRES DU NORD-GUEST
BOTULISM - NORTHWEST TERRITORIES
At about 2000 hours on the evening of 6 October 1982
at Coppermine, an Inuit family dined on fish, canned mushrooms, seal meat and "urraq" (fermented seal flipper).
However, the 2 children involved did not eat either the
mushrooms or the urraq.
Vers 20 h le 6 octobre 1982, une famille inuit de Coppermine
dfne de poisson, de champignons en conserve, de viande de phoque et
"d'urraq" (nageoires de phoque faisandees). Les 2 enfants ne prennent ni champignons ni urraq.
Both the seal meat and fish were cooked. They had
been caught or killed approximately 2 weeks earlier and
stored in the freezer.
Le phoque et le poisson sont cuits. Ils avaient ete pris ou
abattus environ 2 semaines plus tot et conserves au congelateur.
Urraq, also known as utjak or uniak, is a traditional
Inuit food made with raw seal flipper, with the fur still
attached. The flipper is packed in seal blubber and then
sewn into a sealskin to form a pouch which is tied at the
top. This is then buried in the ground for approximately
2 months until the blubber liquifies and the fur peals off, at
which stage it is ready to eat. Urraq is generally made in
the spring and eaten on special occasions.
L'urraq, aussi connu sous le nom d'utjak ou d'uniak, est une
specialite inuit faite avec une nageoire de phoque crue et non
debarrassee de sa fourrure. La nageoire est enrobee de gras de
phoque, puis emballee dans de la peau de phoque cousue en forme de
pochette fermee par le haut. Le tout est ensuite enfoui dans le sol
pendant environ 2 mois, jusqu'a ce que le gras soit liquefie et que !es
pails se detachent. L'urraq est alors prt'lt a manger. On le prepare
generalement au printemps pour le servir dans !es grandes occasions.
At lunch time the following day, the children returned
home to find their parents acutely ill. They reported this to
the nurse .in charge of the local nursing station. A specialist
in internal medicine happened to be on one of his scheduled
clinic visits to Coppermine and accompanied the nurse to
the home. They found both parents acutely ill, the father
being in markedly worse condition than the mother. Both
complained of intense dizziness and vertigo, dryness of the
mouth and weakness; the father was unable to walk unaided.
The symptoms had started at approximately 0930 hours that
day.
Le lendemain midi, Jes enfants rentrent a la maison et trouvent
leurs parents gravement malades. Ils previennent l'infirmiere responsable du paste de soins infirmiers de la localite. II se trouve
qu'un specialiste en medecine interne est a Coppermine a !'occasion
d'une de ses visites cliniques; ii accompagne l'infirmiere chez Jes
malades. Ils constatent que Jes 2 parents sont dans un etat grave,
mais que le pere est considerablement plus ma! en point que la
mere. Les 2 sujets se plaignent d'etourdissements et de vertiges
intenses, de secheresse buccale et de faiblesse.
Le pere est
incapable de marcher seul.
Les symptl'.lmes sont apparus vers
9 h 30 ce matin-la.
Clinical examination of both patients showed intense
dryness of the mucous membranes of the mouth and tongue,
making swallowing difficult and speech unintelligible.
Pupils were at midpoint \:Ind did not react to light. Tendon
reflexes were brisk and bilaterally equal. Plantar reflexes
were flexor. Cardiovascular system was normal in each
case.
L'examen clinique des 2 malades revele une secheresse intense
des muqueuses buccales et linguales rendant la deglutition difficile
et la parole inintelligible. Les pupilles sont au stade intermediaire
et ne reagissent pas a la lumiere. Les reflexes tendineux sont vifs
et egaux des 2 c{ltes. Les reflexes plantaires se font en flexion.
Dans Jes 2 cas, le systeme cardio-vasculaire est normal.
A presumptive diagnosis of botulism was made and both
patients were flown to Stanton Yellowknife Hospital where
serum samples were collected and each patient was given
2 vials of Clostridium botulinum polyvalent antiserum,
1 vial intravenously and 1 intramuscularly. The father wa·s
experiencing respiratory distress; he was using accessory
muscles for respiration and there was marked reduction of
tidal volume. An emergency tracheostomy was performed
under local anesthetic and, as it appeared that he would be
needing respiratory assistance for some time, he was transferred to the intensive care unit at the University of
Alberta Hospital in Edmonton.
On retient l'hypothese de botulisme et Jes 2 malades sont
transportes par avian au Stanton Yellowknife Hospital; des prelevements seriques sont recueillis et cfiacun des malades rec;oit
2 ampoules d'immunserum polyvalent a l'egard de Clostridium
botulinum (1 ampoule par voie intraveineuse et 1 par voie in~ra­
musculaire). Le pere manifeste une insuffisance respiratoire; on
observe qu'il se sert de la musculature accessoire de respiration et
qu'il presente une reduction notable du volume courarit. On pratique
d'urgence une tracheostomie sous anesthesie locale et, comme ii
semble que la respiration assistee sera necessaire pendant assez
longtemps, on le transfere au service des soins intensifs de l'H{lpital
de l'Universite de !'Alberta, a Edmonton.
The mother made an uneventful recovery and was ready
for discharge 3-4 days after admission.
The father
developed pneumonia which slightly delayed his discharge
but otherwise recovery was uneventful.
La mere se remet sans complications et est prllte a rentrer
chez elle 3 ou 4 jours apres son admission. Quant au pere, ii
contracte une pneumonie, ce qui retarde quelque peu son conge; pour
le reste, ii se retablit normalement.
A search made for the can which had contained the
mushrooms eaten by the family was unsuccessful, but other
cans of mushrooms were visually examined at the local store
and all were found to be in good condition. Specimens of
fish, seal meat and urraq were analyzed for C. botulinum.
Viable C. botulinum type E organisms as well as toxin of
type E were found in the urraq. C. botulinum type E toxin
was found in the father's serum at a level of 60 MLD (mouse
lethal doses)/mL and in the mother's at a level of
12 MLD/mL. Without medical intervention, these levels
would probably have proven fatal. The samples of seal meat
and fish were negative for C. botulinum.
La recherche de la boite de conserve qui contenait Jes
champignons consommes par la famille se solde par un echec.
Toutefois, on examine visuellement d'autres boftes de champignons
au magasin du coin, sans rien leur trouver d'anormal. On analyse des
echantillons de poisson, de viande de phoque et d'urraq pour detecter
C. botulinum. Des microorganismes vivants de C. botulinum de
type E, ainsi que la toxine de type E, sont mis en evidence dans
l'urraq. Les concentrations de la toxine de C. botulinum de type E
presentes dans !es serums sont 60 DLS (doses letales de souris)/mL
chez le pere, et 12 DLS/mL chez la mere. ·Sans intervention
medicale, ces concentrations se seraient sans doute revelees
mortelles. Les echantillons de viande de phoque et de poisson se
revelent negatifs a l'egard de c. botulinum.
- 55 -
Approximately 2 weeks before the incident, a seal had
been shot and the flippers prepared in seal oil, not blubber,
and kept at room temperature in a roasting pan covered
with plywood. At ti.-nes the flippers were kept on the porch
where the temperature was usually below ooc at night;
however sometimes the temperature rose as high as l0°C
during the day. Th is is not the usual method of preparing
urraq, and one wonders whether it represents an attempt to
speed the process.
Environ 2 semaines avant !'episode, un phoque avait ete abattu;
ses nageoires avaient ete appretees dans de l'huile de phoque - non
pas dans du gras - et conservees a la temperature ambiante dans une
lechefrite couverte d'un morceau de contre-plaque. De temps en
temps, le plat etait place sur le porche, au il faisait generalement
sous zero crendant la nuit, mais OU la temperature pouvait monter
jusqu'a 10 C au cours de la journee. II ne s'agit pas la de la fai;:on
traditionnelle de preparer l'urraq, et on se demande si cette
methode ne visait pas a accelerer le faisandage.
By way of comment, the following points are noted:
En guise de commentaires, on a note Les points suivants:
1.
Urraq is ci traditional food which is normally prepared
in spring and buried in the ground at a very low
temperature.
The normal and accepted routine for
preparing urraq was not followed in this instance.
l.
L'urraq est un plat traditionnel qui se prepare generalement au
printemps et qu'on enfouit dans le sol a des temperatures tres
basses. Dans le cas present, le mode de preparation habituel et
accepte n'a pas ete suivi.
2.
Both the parents and children were extremely reluctant
to admit to their consumption of urraq, or even to
discuss the matter with white staff.
The Inuit
appreciate that some white people regard the preparation and consumption of food in this manner as
distasteful, and they do not wish to upset them by
discussing it.
2.
Les parents et !es enfants ant vraiment hesite a admettre qu'il
y avait de l'urraq au menu ou meme a en parler avec le
personnel de race blanche. Conscients du fait que certains
blancs considerent la consommation d'aliments ainsi prepares
comme peu ragoOtante, !es Inuit evitent d'aborder le sujet pour
ne pas !es rebuter.
3.
The parents did not voluntarily admit to the consumption of urraq, and its discovery was almost
fortuitous. The nurse had been led to believe that seal
meat, fish and mushrooms were all that the family had
eaten the previous evening, and it was only when she
returned to the house to collect the samples of frozen
seal meat and fish and to search for the empty mushroom can that the children pointed out to her the pan
containing urraq.
3.
Les parents n'ont admis qu'a contrecoeur avoir consomme de
l'urraq. En fait, on ne l'a su que par hasard. On avait en effet
laisse croire a l'infirmiere que le menu du dfner se composait
uniquement de viande de phoque, de' poisson et de champigno:is;
ce n'est que lorsqu'elle est revenue chez !es malades pour
recueillir des echantillons de viande de phoque et de poisson
congeles et tenter de retrouver la boi:te de champignons vide
que !es enfants lui ant montre le plat d'urraq.
4.
This reluctance on the part of the Inuit to talk of urraq
may make history taking difficult and should be kept in
mind when dealing with similar situations.
4.
L'hesitation des Inuit a mentionner l'urraq peut rendre difficile
l'etablissement de l'anamnese; on devrait done en tenir compte
dans des cas semblables.
SOURCE:
S Smith,
MD,
Regional Medical Officer,
N Williamson,
Infectious
Disease
Control
Officer,
Northwest
Territories
Region,
R D'Aeth, MD, Assistant Zone Director,
J Fitzpatrick, Senior Environmental Health
Officer, MacKenzie Zone, Medical Services
Branch,
Health
and
Welfare
Canada,
Yellowknife; A Whittaker, Nurse in Charge,
Coppermine Nursing Station; M Igoe, MD,
R Wheeler, MD, Stanton Yellowknife Hospital;
P Martin, MD, University of Alberta Hospital,
FL Jackson, MD, Department of Medical
Bacteriology, University of Alberta, Edmonton;
E Todd, PhD, A Hauschild, PhD, R Szabo, MSc,
R Hilsheimer; Botulism Reference Centre,
Health Protection Branch, Health and Welfare
Canada, Ottawa.
SOURCE:
Dr S Smith, Medecin-hygieniste regional, N Williamson,
Agent de lutte contre les maladies inf ectieuses, Region
des Territoires du Nord-Ouest, Dr R D'Aeth, Directeur
adjoint de zone, J Fitzpatrick, Agent principal
d'hygiene du milieu, Zone du MacKenzie, Direction
generale des services medicau::c, Sante et Bien-etre
social Canada, Yellowlmife; A Whittaker, Infirmierechef, Paste de soins infirmiers de Coppermine;
vrs M Igoe et R Wheeler, Stanton Yellowknife Hospital;
Dr P Martin, Hopital de PUn{versftee
l'Allierta,
Dr Fl Jackson, Departement de bacteriologie medicale,
Universite de !'Alberta, Edmonton; E Todd, PhD,
A Hauschild, PhD, R Szabo, MSc, R Hilsheimer, Centre
de reference pour le botulisme, Direction generale de la
protection de la sante, Sante et Bien-etre social
Canada, Ottawa.
ae
The Canada Diseases Weekly Report presents currenl information on infectious
and other- diseases for surveillance purposes and is available free of charge upon
1... equesl.
Many of the articles contain preliminary information and further
conf1r11ation may be obtained from the sources quoted. The Depurtment of
National Health and Welfare does not assurne respon:;ibility for accuracy or
authenticity. Contributions are welcome {in the official language of your
choice) from anyone working in the health field and will not preclude
publication elsewhere.
Le Rappo:t h.ebdon~,1dair~ <les maladies au C~nada, qui fournit des donnees pertinentes sur
les maladies 111fect1euses et les autres maladies dans le but de faciliter Leur surveillance,
peut etre obtenu gratuiternent sur dem~nde, Un grand nombre d'articles ne contiennent
que des donnees sommaires mais des renseignements cornplementaires peuvent Ellre
obten1Js en s'udressant mn: sources citees. Le minist8re de la Sante nationale et du Bien!}lre sor.ial ne peut etre tenu responsable de l'ex::ictitude, ni de l'authenticite des articles,
Taula personne oeuvranl dans le dornaine de la sante est invitee ~ collaborer (dam; la
langue officielle de son choix) et la publication d'un article dans le present Rapport n'en
empf'lche pas la publication ailleurs.
Editor: Dr. S.E. Acres
Managing Editor: Eleanor Paulson
Assistant Editor: .lo-Anne Doherty
Redacteur en chef: Dr S.E. Acres
R~dacteur administralif: Eleanor Paulson
({8dacteur adjoint: Jo-Anne Doherty
Bureau of Epidemiology,
Laboratory Centre for Disease Control,
Tunney's Pasture,
OTT AW A, Ontario.
Canada. J<IA OL 2
(613) 996-4041
Bureau d'epidemiologie
Laboratoire de lutte contre la maladie
Pare Tunney
Ottawa (Ontario)
Canada l<lA OL2
(613) 996-4041
- 56 -
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