Canadian Journal of Infectious Diseases & Medical Microbiology

Winter  2012Volume 23Issue 4  

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A review of 11 years of Stenotrophomonas maltophilia blood isolates at a tertiary care institute in Canada
P Naidu, S Smith

Nosocomial oppurtunistic infections are a major problem in Canadian hospitals. The problem is further compounded by the resistance of many common pathogens to the antimicrobials and disinfectants routinely used in health care facilities. Prompted by the lack of studies examining Stentrophomonas maltophilia in Canadian hospitals, this study investigated the incidence of bloodstream infections involving this pathogen, and the clinical characteristics and mortality rate of patients who acquired the infection.

Community-onset bloodstream infection during the 'after hours' is not associated with an increased risk for death
KB Laupland, PC Kibsey, JC Galbraith

Many studies have indicated that patients admitted to hospitals on weekends and evenings (‘after hours’) may experience a higher mortality rate, and it is not known whether the after hours effect observed in these studies is disease or centre specific. Possible explanations for these observations include physician fatigue, lower levels of staffing, restricted availability of tests and procedures, and differences in case-mix, with a potentially higher acuity during these times. The aim of this study was to determine whether the admission of patients with community-onset bloodstream infection in the after hours influenced the risk of death in Victoria, British Columbia, between 1998 and 2005.

Tuberculosis in the intensive care unit: A retrospective descriptive cohort study with determination of a predictive score of fatality
S Valade, L Raskine, M Aout, I Malissin, P Brun, N Deye, FJ Baud, B Megarbane

Tuberculosis remains a major public health issue and, despite effective treatments, tuberculosis-related mortality remains high among patients requiring admission to the intensive care unit (ICU). The sparse data available regarding tuberculosis in the ICU indicates that the prognosis for tuberculosis patients appears significantly worse compared with individuals experiencing nontuberculous pneumonia requiring mechanical ventilation. To address this lack of data concerning tuberculosis in the ICU, this study investigated the circumstances associated with ICU admission leading to the diagnosis of tuberculosis, with the aim of developing a simple scoring system to determine prognostic factors for death.

Breakthrough filamentous fungal infections in pediatric hematopoetic stem cell transplant and oncology patients receiving caspofungin
SK Morris, UD Allen, S Gupta, SE Richardson

Caspofungin is an echinocandin class antifungal medication, which, due to its wide spectrum of antifungal activity, is commonly used as empirical therapy in patients at high risk for invasive fungal infections. Despite having excellent activity against the most commonly encountered invasive fungal pathogens, it only has limited activity against some filamentous fungi including the Zygomycetes class and Fusarium species, and there are limited data examining breakthrough infections by filamentous molds in patients receiving empirical caspofungin. To address this lack of data, a five-year retrospective review, from 2004 through 2008, of all cases of proven invasive filamentous fungal infection of children admitted to The Hospital for Sick Children (Toronto, Ontario) was conducted to describe the clinical characteristics of breakthrough fungal infections in pediatric hematopoetic stem cell transplant recipients, and oncology and hematology patients receiving caspofungin.

Application and interpretation of interferon-gamma release assay: Results of an audit in a Canadian centre
S Vat, M Ghannoum, P Laflamme, M Dugas, M Labrecque, V Lavergne

Presently, one of the world’s major public health issues is tuberculosis (TB) infection. Prevention, diagnosis, screening and treatment of TB are currently the focus of global efforts, with identification and treatment of latent TB infection (LTBI) among the preferred strategies to control dissemination of the disease. Until recently, tuberculin skin testing was the only available test for diagnosis of LTBI; however, interferon-gamma release assays have recently been approved for diagnosing LTBI. Performance indicators are required for the evaluation of quality improvement in health care and, to this end, the authors conducted an internal audit, the goals of which were to review the use of a newly implemented interferon-gamma release assay at Hôpital du Sacré-Coeur de Montréal (Montréal, Québec) to determine its agreement with Canadian recommendations and to understand its implication on diagnosis.

Cost comparison of linezolid versus vancomycin for treatment of complicated skin and skin-structure infection caused by methicillin-resistant Staphylococcus aureus in Quebec
M Pettigrew, DJ Thirion, M Libman, G Zanotti

Methicillin-resistant Staphylococcus aureus (MRSA) infections are an escalating problem within the Canadian health care system, with MRSA most commonly associated with skin and soft-tissue infection, including skin and skin-structure infections and infections of the fascia and muscles. MRSA-related infections are responsible for a large and growing financial burden on the health care system, with patients with complicated infections expected to account for a disproportionately large share of this expenditure because of higher per-patient hospital costs. Prompted by the seriousness of these growing concerns, this study, based on current treatment patterns in Quebec, evaluated the potential cost impact of using intravenous and oral linezolid instead of intravenous vancomycin to treat cases of complicated skin and skin-structure infections caused by MRSA that are severe enough to require hospitalization.

Penicillin susceptibility and macrolide-lincosamide-streptogramin B resistance in group B Streptococcus isolates from a Canadian hospital
K Sherman, S Whitehead, E Blondel-Hill, K Wagner, N Cheeptham

Group B Streptococcus (GBS), a commensal bacteria of the human gastrointestinal and genitourinary tract, are a major cause of neonatal sepsis and meningitis. To prevent GBS-induced neonatal sepsis, intrapartum antibiotic prophylaxis is recommended for pregnant women who test positive for GBS in their genitourinary tract. The primary antibiotic used for this purpose is penicillin G, with clindamycin or erythromycin used as the secondary antibiotic, if allergies exist. Decreased susceptibility to penicillin G has occasionally been reported; however, clindamycin and erythromycin resistance in GBS is well documented. The aim of this study was to determine clindamycin and erythromycin resistance in GBS at the Royal Inland Hospital, which serves the Thompson, Nicola and Cariboo regions of British Columbia.

Risk factors and outcomes for pandemic H1N1 influenza compared with seasonal influenza in hospitalized children in China
Q Zhang, W Ji, Z Guo, Z Bai, NE MacDonald

In spring 2009, the occurrence of a novel influenza A strain pandemic (p)H1N1 in two children in southern California was reported. Subsequently, infection with this new pandemic strain of virus was reported in virtually every country. Seasonal influenza itself is a significant cause of morbidity and mortality in younger children, and case series comparing the severity of illness in children hospitalized with pH1N1 with previous seasonal influenza years, as well as data on acute respiratory distress syndrome in these patients in China are not available. To address this lack of important data, the authors reviewed the cases of all children admitted to the Children’s Hospital affiliated with Soochow University in Suzhou, China with confirmed pH1N1 influenza compared with children admitted with seasonal influenza A H1N1 or H3N2 in 2008 and 2009. The goal of this study was to compare the severity of illness and outcomes between pH1N1 and seasonal influenza in this cohort, and to compare the findings for pH1N1 with those in published cohorts from South America and North America.

Coagulase-negative Staphylococcus, catheter-related, bloodstream infections and their association with acute phase markers of inflammation in the intensive care unit: An observational study
O Rewa, J Muscedere, S Reynolds, X Jiang, DK Heyland

Catheter-related, bloodstream infections (CRBSIs) represent a significant source of morbidity and mortality in the intensive care unit, with coagulase-negative Staphylococcus (CoNS) being the most commonly encountered organism in CRBSIs. Blood cultures are routinely performed for suspected infection and, when positive for CoNS, it is often difficult to determine whether the presence of CoNs in the blood is a pathogen or a contaminant. Systemic inflammation in the intensive care unit, as manifested by systemic inflammatory response syndrome (SIRS), is very common; however, distinguishing between SIRS caused by infection and SIRS secondary to other causes is challenging clinically, and there is an increasing amount of literature regarding the utility of biomarkers for this. Adding to this growing area of research, this study investigated whether patients with CoNS-positive blood cultures also had associated elevations of inflammatory biomarkers.

Recognizing cognitive and psychiatric changes in the post-highly active antiretroviral therapy era
A Carvalhal, J-G Baril, F Crouzat, J De Wet, P Junod, C Kovacs, N Sheehan

Neurocognitive and psychiatric illnesses pose unique challenges for people living with HIV. Although the pathophysiology surrounding these disorders remains uncertain and an area of active research, their adverse implications have become increasingly recognized. If left undetected, they have the potential to significantly impact overall health outcomes. As such, early identification of HIV-associated neurocognitive disorders and psychiatric illnesses is crucial in the proactive management of affected individuals. This review focuses on the screening and detection of mental illness in HIV-infected individuals to help identify patients who may benefit from specialized neurocognitive or psychiatric testing and/or referrals. A brief review of management strategies is also provided.

Culture-negative endocarditis diagnosed with 16S DNA polymerase chain reaction
S Duffett, B Missaghi, P Daley

In the case of culture-negative endocarditis, empirical antibiotic treatment is appropriate to cover all likely organisms, but the identification of a specific organism is preferred for appropriate medical and surgical management. 16S DNA polymerase chain reaction is a molecular amplification technique that can be used to identify bacterial pathogens in culture-negative endocarditis. Bacterial DNA can be isolated from surgically excised valve tissue or from blood collected in EDTA vials. This report describes a case involving a 48-year-old man who presented with severe aortic regurgitation and a four-month prodrome of low-grade fever.
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Erratum: Une endocardite à apparition très tardive associée à une électrode
M-S Cho

Erratum: Detection of Clostridium difficile in retail ground meat products in Manitoba
M Visser

The use of antiviral drugs for influenza: Guidance for practitioners 2012/2013
FY Aoki, UD Allen, H Grant Stiver, GA Evans

This AMMI Canada Guideline addresses the use of antiviral drugs in the management of seasonal influenza illness for 2012/2013 and updates the previous document published in 2011.

2012 Mandatory influenza immunization of health care workers
E Bryce, J Embree, G Evans, L Johnston, K Katz, A McGeer, D Moore, V Roth, A Simor, K Suh, M Vearncombe

Influenza remains the most commom infectious disease cause of death in Canada, and a frequent cause of outbreaks in both acute and long-term care facilities. This position paper outlines the reasoning behind why Canadian public health officials have, for nearly 30 years, recommended immunization of at-risk populations, as well as close contacts and caregivers who may transmit influenza to them.

Comparison of late HIV diagnosis as a marker of care for Aboriginal versus non-Aboriginal people living with HIV in Ontario
D Jaworsky, L Monette, J Raboud, D O'Brien-Teengs, C Diong, S Blitz, S Rourke, MR Loutfy, and the OHTN Cohort Study Team

Aboriginal peoples face many barriers to accessing health care in Canada. A direct consequence of this inequality is that Aboriginal people living with HIV/AIDS are more likely than non-Aboriginal people living with HIV/AIDS to receive suboptimal HIV care and to have late diagnosis of HIV, both of which have important consequences for clinical outcomes, as well as health care costs. In addition to being at risk for late diagnosis of HIV, Aboriginal peoples may receive poorer quality of care once an HIV diagnosis is established. Despite this, however, Aboriginal people living with HIV/AIDS achieve similar clinical outcomes with proper care. In an attempt to gauge and quantify the extent of this serious health care issue, this study investigated the proportion of Aboriginal people living with HIV/AIDS compared with non-Aboriginal people living with HIV/AIDS diagnosed late with HIV within the Ontario HIV Treatment Network Cohort Study.

The coincidence of necrotizing enterocolitis and rotavirus infections and potentional associations with cytokines
E Sizmaz, M Satar, F Özlü, A Yaman, H Yapıcıoğlu Yıldızdaş, K Özcan

Necrotizing enterocolitis (NEC) is a disease that predominantly affects premature infants and is the most common gastrointestinal disease in neonatal intensive care units (NICUs). Although the pathogenesis of NEC remains unclear, evidence suggests that infections, especially bacterial infections, may play an important causative role. The role of rotavirus in the pathogenesis of NEC has not been established, but studies have suggested that a synergism between rotavirus and other microorganisms can worsen infection in the intestine and cause NEC. To add to this growing area of resarch, this study investigated the prevalence of rotavirus infection and the potential role of specific interleukins in the clinical outcomes of infants experiencing NEC.

Mycobacterium marinum infection from sea monkeys
J LeBlanc, D Webster, GJ Tyrrell, I Chiu

Mycobacterium marinum cutaneous infections have been reported from exposure to contaminated water in aquariums or unchlorinated swimming pools, which has led to the nickname of ‘swimming pool granuloma’ or ‘fish tank granuloma’. Identified vectors include dolphins, snails, water fleas, saltwater and freshwater fish, oysters and shrimp. This report describes a case of cutaneous M marinum infection acquired from Artemia nyos (sea monkeys) involving a 43-year-old woman.

Invasive Bacillus cereus infection in renal transplant patient: A case report and review
S John, J Neary, CH Lee

Bacillus cereus is a relatively common cause of food-borne gastrointestinal illness. Immunosuppression is one of the risk factors for developing invasive disease due to B cereus, with symptoms mediated by an enterotoxin and an emetic toxin, which usually resolve with supportive management. The emetic toxin can cause rhabdomyolysis and has been associated with fulminant liver failure. This report describes a case involving a 65-year-old immunocompromised man who developed sepsis with extensive rash and rhabdomyolysis following ingestion of food contaminated with B cereus. A brief review of the relevant literature is also included.

A 45-year-old male with cough and a cavitary lung lesion
T Fazili
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