Mumps Meningoencephalitis, Toronto, 1963

Between January and June 1963, 45 children were hospitalized with mumps meningoencephalitis. Of 39 patients with laboratory evidence of mumps infection, 24 had parotitis and 15 showed no salivary gland involvement. Cerebrospinal fluids from 18 of 40 patients yielded mumps virus by inoculation of rhesus monkey kidney cultures; 33 subjects, including 12 of the 18 virus excretors, showed rising or elevated levels of mumps antihemagglutinin during convalescence. Between May 1959 and June 1963, mumps virus was recovered from cerebrospinal fluids of 50 of 126 cases of mumps meningoencephalitis; virus isolation rates were highest during the peak incidence of mumps meningoencephalitis in winter and early spring.

Mumps vaccine (inactivated) was administered to 34 parents with no history of mumps, shortly after their children developed mumps. Mumps occurred in three of 17 parents without prevaccination mumps antihemagglutinins, and in two others, but in none of 15 who had prevaccination antibodies.

     

Smallpox in Toronto, 1962

A 14-year-old boy was seen on August 17, 1962, with a vesicular eruption of five days' duration. The vesicles were about 0.5 cm. in diameter, loculated, mainly distributed centrifugally, and all were at the same stage of development. On August 8, he left his residence in a rural area of southern Brazil where alastrim is endemic. His last smallpox vaccination was received at least six years ago. Alastrim virus was isolated from vesicle fluid obtained on August 17 and 19 by inoculation of chorioallantoic membranes of embryonated eggs. A fourfold rising level of vaccinia antihemagglutinin in paired serum samples was consistent with infection by alastrim virus. The patient has since recovered uneventfully.     

Mumps and Enteroviral Meningitis in Toronto, 1966

Of 52 children admitted to hospital for apparently typical mumps meningitis in 1966, 50 had their cerebrospinal fluid (CSF) examined. In only 17 was the mumps virus isolated from the CSF. Mumps antihemagglutinin conversions or increments were detected in 32 subjects including 10 whose CSF yielded virus. Antibody conversions were found in 16 patients and fourfold increments in another nine whose serum pairs were collected only one to four days apart. Initial sera from 20 patients were obtained three days or less after the onset of meningitis. Antibody increments were frequently noted about one day after defervescence and clinical improvement. Interferon was detected in CSF from two of eight patients, both of whom yielded virus. Enteroviruses were isolated from CSF and/or feces in seven of 15 cases of aseptic meningitis which occurred between July and October. Six patients including three virus excretors showed enteroviral neutralizing antibody increments during convalescence. The dominant enteroviral serotype was coxsackievirus A9.     

Novel cases of blastomycosis acquired in Toronto, Ontario

Blastomycosis, a potentially fatal fungal disease, is well known from defined areas of endemicity in Ontario, primarily in the northern part of the province. We present 2 unusual cases that appear to extend the area of endemicity into urban southern Ontario, specifically Toronto. Both patients presented to a dermatology clinic with skin lesions. Chest radiography, history and general physical evaluation indicated no disease at other body sites. Both cases appeared to represent “inoculation blastomycosis” connected with minor gardening injuries and a cat scratch respectively. Atypical dissemination could not be completely excluded in either case. Neither patient had travelled recently to a known area of high endemicity for blastomycosis, nor had the cat that was involved in one of the cases. Physicians must become aware that blastomycosis may mimic other diseases, including dermal infections, and may occur in patients whose travel histories would not normally suggest this infection.     

Rubella Virus Infections During Pregnancy, Toronto, 1963-66

Among 670 pregnant women who attended the antenatal clinics of two Toronto city hospitals and one suburban hospital between May 1963 and January 1966, 29 of 550 patients apparently acquired rubella neutralizing antibodies, including 12 whose initial sera were collected during the first trimester. None developed overt rubella. Although rubella antibodies were detected in 61 to 79% of mothers aged 20 years or more, and antibody conversions were detected in 4 to 10% of mothers in each five-year age group between 16 and 39 years, tho rubella syndrome did not appear among any of their offspring. Five of seven other infants, aged 4 to 22 weeks, with the rubella syndrome excreted rubella virus. Rubella neutralizing antibodies were detected in all seven of these infants; these persisted at least 56 weeks in one subject. One mother who received gamma globulin during the first trimester was delivered of an infant who showed signs of the rubella syndrome.     

Myxovirus Infections in Acute Laryngotracheobronchitis, Toronto, 1961-62

Virological investigations were undertaken on nasopharyngeal secretions from 186 children who were admitted to the Hospital for Sick Children, Toronto, with acute laryngotracheobronchitis between December 1961 and March 1962. Patients who required tracheotomy for relief of respiratory obstruction were excluded from this series. Myxoviruses which were isolated from 47 patients included the following antigenic types: 29 Parainfluenza-1, four Parainfluenza-2, five Parainfluenza-3 and nine Influenza B. The average duration of hospitalization, 3.0 days, was identical for the 47 virus-positive patients and the entire group of 186 patients. Ages of 135 patients were less than three years.

Between November 1960 and March 1962, myxoviruses were isolated from 150 of 445 laryngotracheobronchitis patients. The dominant strain, Parainfluenza-1, was isolated from 119 patients who became ill between November 1960 and April 1961, and between October 1961 and March 1962. Parainfluenza-3 virus was isolated irregularly from patients during both cool and warm months. Influenza B and Parainfluenza-2 isolations were made only during 1961-62 winter. Rising antibody levels in paired sera from 20 of 23 Parainfluenza-1 virus excretors and in four patients who yielded Parainfluenza-3 virus confirmed infection with these agents.