Suspect Hepatitis A and Adenovirus 14 Pneumonia Reporting

From the office of the Medical Health Officer

Could it Be Hepatitis A? Call Health Unit if You Suspect Acute Viral Hepatitis. 

It is very important to find out quickly if a patient might have hepatitis A. The hepatitis A vaccination campaign for patrons of the Old Spaghetti Factory Restaurant in Langley highlights the value of early recognition. Hepatitis A is contagious 1 to 2 weeks before symptoms and up to 1 week after onset of jaundice. Post-exposure vaccination protects contacts only if given within 14 days of exposure. Anti-HAV IgM is generally detectable by the time symptoms develop, but test results may not be available until a week or more after the lab receives the specimen. Please alert your local health unit whenever you have a patient with possible acute viral hepatitis and we can expedite lab testing. This allows you and your patient to have results sooner, and helps us find contacts who could benefit from post-exposure vaccination.

More on the Old Spaghetti Factory exposure: The risk of acquiring hepatitis A from dining at the Old Spaghetti Factory in Langley is low. The food handler had very good hand hygiene, had limited contact with uncooked food, and the restaurant has excellent food safety practices. Those who ate after 3:00 pm on April 10-14, 17, 18, 19, or after 12:45 pm on April 20-21, may have been exposed. Exposed individuals who were not vaccinated should be informed that symptoms of hepatitis A may develop 15 to 50 days after exposure (average 30 days) which may consist of nausea, abdominal cramps, fever, dark urine, pale feces, and jaundice. People who develop these symptoms should contact their physician and not handle or serve food to others until a diagnosis is made. The illness can last for several weeks. Most recover completely, but the disease can be fatal in the elderly and those with chronic liver disease.
Prevention includes thorough frequent hand washing, especially after using the toilet and before handling food. Vaccination is highly effective and is provided free for people with chronic liver disease, including patients with chronic hepatitis B and/or C infection. Travellers out of country are well-advised to purchase a hepatitis A-containing vaccine and be vaccinated before departure.

COULD IT BE ADENOVIRUS 14? SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN OREGON.

Oregon state reported 16 severe cases of adenovirus type 14 infection, a rare serotype not previously recognized as a cause of severe community-acquired pneumonia. Fifteen of the 16 people have been hospitalized. Patients are residents of Multnomah, Washington, and Clackamas Counties in Oregon and Clark County in Washington.

BCCDC asks that patients with severe community-acquired pneumonia, particularly those with travel to the affected communities in Washington or Oregon, have nasopharyngeal swabs or aspirates, oropharyngeal swabs, or bronchoalveolar lavage samples taken, preferably within the first three days of illness. Samples should be placed in viral transport medium and submitted via the local lab to BCCDC.

COULD THAT MYSTERIOUS COUGH OR NODULE BE DUE TO CRYPTOCOCCUS GATTII?

Evidence for the presence of Cryptococcus gattii in the Lower Mainland and Fraser Valley was faxed to Fraser Health physicians in June 2005. Cryptococcal infections reported in Fraser Health increased from 10 in 2005 to 21 in 2006. Some of the infections confirmed as var. gattii were challenging to diagnose. Unlike C. neoformans, which causes opportunistic infections in immunocompromised individuals, C. gattii often affects otherwise healthy people.

Please include C. gattii in your differential diagnosis for patients with prolonged cough, pleuritic chest pain, shortness of breath or other chronic respiratory symptoms, nodular lung disease, meningitis, or severe headache of several days duration and unresponsive to treatment. Other symptoms include weight loss, decreased appetite, fever and/or night sweats. Chest X-rays often show pulmonary nodules, infiltrates, or pneumothorax, but can also be normal. Some cases are found incidentally on chest X-ray in asymptomatic patients. Diagnosis is by fungal culture of specimens from bronchoscopy, tissue biopsy, or cerebrospinal fluid. Sputum cultures, which can reflect colonization, should be submitted only when collection of other specimens is not possible. Serology and histopathology can diagnose cryptococcal infection in general, but not C. gattii specifically. Please clearly mark the lab requisition for fungal culture or cryptococcal work-up. Cryptococcal infection is treated with amphotericin B and/or fluconazole.

A Cryptococcus HealthFile is available at HealthLink BC.