TABLE OF CONTENTS Summer  2013Volume 24Issue 2  


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Something old, something new, something borrowed...
L Valiquette, KB Laupland

African tick bite fever presenting as exudative pharyngitis
II Bogoch, S Chakrabarti, J Keystone

2013 Dr Lindsay E Nicolle Award
Pulsus Group Inc

Pulmonary mucormycosis in a patient with Crohn disease treated with infliximab
AJ Wright, T Steiner, A-M Bilawich, JC English, CF Ryan

Increasing HIV subtype diversity and its clinical implications in a sentinel North American population
RAC Siemieniuk, B Beckthold, MJ Gill

HIV-1 is a highly diverse virus, and the various subtypes may exhibit differences in rates of transmission, disease progression, neurotoxicity, antiretroviral treatment failure profiles and accuracy of viral load measurements. While subtype B has been largely behind the HIV epidemic worldwide, documented shifts in viral diversity may have significant implications. A geographically defined cohort of HIV-infected patients in Canada is presented with respect to viral diversity, impact on public health, research and clinical consquences.

Outpatient parenteral antimicobial therapy for surgery patients: A comparison with previous standard of care
A Yang, R Fung, J Brunton, L Dresser

The administration of intravenous antimicrobial therapy to patients in an outpatient setting or in their own home is an effective treatment that results in cost savings, reductions in hospitalization, similar or improved efficacy and safety compared with inpatient therapy, as well as improvements in quality of life. This study evaluated the benefits of an outpatient parenteral antimicrobial therapy program initiated at a multispecialty tertiary care facility in Toronto, Ontario.

Zoonotic infections in communities of the James Bay Cree territory: An overview of seroprevalence
H Sampasa-Kanyinga, B Lévesque, E Anassour-Laouan-Sidi, S Côté, B Serhir, BJ Ward, MD Libman, MA Drebot, K Makowski, K Dimitrova, M Ndao, É Dewailly

Zoonoses are an important public health concern. It has recently been estimated that 75% of emerging infectious diseases in humans over the past 10 years were caused by pathogens from animals or animal products. Data from populations at risk of contracting infectious diseases transmitted by wildlife, particularly those most heavily exposed to fauna, as well as the medical staff living in these regions, are important to provide an overview of the seroprevalences of targeted zoonoses. In this study, Cree communities of the James Bay territory of Canada were evaluated for exposure to zoonotic pathogens, and information on reservoirs and modes of transmission are discussed.

Influence of 16S ribosomal RNA gene polymerase chain reaction and sequencing on antibiotic management of bone and joint infections
B Alraddadi, S Al-Azri, K Forward

Misdiagnosis of the inflamed joint can result in inappropriate treatment of an infected patient or, conversely, prolonged use of unnecessary antibiotics, adding considerably to health care costs and exposing patients to avoidable side effects. Conventional culture results may not provide enough information; in this article, as an adjunct to conventional culture, amplification of the 16S ribosomal RNA gene using polymerase chain reaction followed by analysis of generated sequences was assessed to determine how the results of this approach influence physicians’ decisions regarding the management of bone and joint infections.

Combination of culture, antigen and toxin detection, and cytotoxin neutralization assay for optimal Clostridium difficile diagnostic testing
MJ Alfa, S Sepehri

There has been a growing interest in developing an appropriate laboratory diagnostic algorithm for Clostridium difficile, mainly as a result of increases in both the number and severity of cases of C difficile infection in the past decade. A C difficile diagnostic algorithm is necessary because diagnostic kits, mostly for the detection of toxins A and B or glutamate dehydrogenase antigen, are not sufficient as stand-alone assays for optimal diagnosis of C difficile infection. The authors introduce a four-step algorithm for C difficile specimen processing and report data collected over a one-year period to demonstrate the value of following such an algorithm.

Eosinophilia: A poor predictor of Strongyloides infection in refugees
P Naidu, S Yanow, K Kowalewska-Grochowska

Canada resettles the second highest number of refugees accepted after the United States; despite the high epidemiological risks involved, there are little Canadian data on subclinical tropical diseases harboured in this population over the past 20 years. While Strongyloides infection is not life threatening in a normal host, any form of immune suppression, even pregnancy, can result in a hyperinfection syndrome, which can be fatal. This study reports the seroprevalence and predictors of Strongyloides infection in refugees arriving in Edmonton, Alberta.

HIV disease progression to CD4 count <200 cells/µL and death in Saskatoon, Saskatchewan
S Konrad, S Skinner, G Bukassa Kazadi, K Gartner, HJ Lim

HIV disease progression is a continuum of progressive damage to the immune system that advances to severe immunological damage defined as AIDS. Highly active antiretroviral therapy (HAART) has significantly altered HIV disease progression by reducing the incidence of AIDS and death. However, while HAART is now widely available, disparities in disease progression have been noted among ethnic groups in numerous countries, as well as injection drug users. This study characterizes HIV disease progression following HIV diagnosis in the HAART era among an HIV-positive population that is comprised predominantly of injection drug users and individuals of Aboriginal ethnicity.

More than just great quotes: An introduction to Canadian Tri-Council's qualitative requirements
J Boffa, N Moules, M Mayan, RL Cowie

Successful use of locally applied polyhexamethylene biguanide as an adjunct to the treatment of fungal osteomyelitis
G Walls, L Noonan, E Wilson, D Holland, S Briggs

Fungi are uncommon causes of osteomyelitis in immunocompetent patients. Fungal osteomyelitis can be difficult to treat; the optimal management is a combination of antifungal treatment and surgical debridement, although this approach is not universally successful. Two cases of fungal osteomyelitis in which local application of the common swimming pool cleaner polyhexamethylene biguanide was used in conjunction with antifungal treatment and surgical debridement are presented, along with a brief literature review.

Whipple’s endocarditis: An enigmatic cause of culture-negative bacterial endocarditis
A Weisman, G Rebick, A Morris, J Butany, WC Liles

Overwhelming sepsis after a cat bite
J Blackburn, É Tremblay, C Tsimiklis, B Thivierge, V Lavergne

Molecular identification and susceptibility pattern of clinical Nocardia species: Emergence of Nocardia crassostreae as an agent of invasive nocardiosis
SJ Taj-Aldeen, A Deshmukh, S Doiphode, A Abdul Wahab, M Allangawi, A AlMuzrkchi, CH Klaassen, JF Meis

Nocardia are rare opportunistic organisms that cause diseases in immunocompetent and immunocompromised individuals, and are reported in all ages and ethnic groups. Immunocompetent patients usually develop localized cutaneous lesions, such as cellulitis, abscesses or sporotrichoid forms, and endogenous endophthalmitis. However, most cases are reported in immunocompromised patients, and manifest as deep infections or disseminated diseases. This study investigated the clinical presentations of various Nocardia infections based on the 16S ribosomal RNA gene of the isolate, related risk factors and susceptibility patterns to various antimicrobial agents.

Methicillin-resistant Staphylococcus aureus colonization among residents
P Trépanier, C Tremblay, A Ruest

There have been significant increases in the rate of methicillin-resistant Staphylococcus aureus (MRSA) colonization among health care system users. As a result, health care workers are frequently exposed to MRSA, and are at risk of acquiring the bacteria and/or becoming vectors of transmission. This article examines the rate of MRSA colonization rate among a group of medical residents in Quebec, and compares it with rates in a control group.

Community-associated methicillin-resistant Staphylococcus aureus in northwest Ontario: A five-year report of incidence and antibiotic susceptibility
J Muileboom, M Hamilton, K Parent, D Makahonouk, M Kirlew, R Saginur, F Lam, L Kelly

The incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has historically been high in remote areas of Canada with large Aboriginal populations. Northwestern Ontario is home to 28,000 First Nations people in more than 30 remote communities; rates of CA-MRSA are unknown. The objective of this study was to determine the CA-MRSA rates and antibiotic susceptibilities in this region based on a five-year review of laboratory and patient data.

Streptococcus anginosus pyogenic liver abscess following a screening colonoscopy
F Bonenfant, É Rousseau, P Farand

Pyogenic liver abscesses have a high potential for mortality and morbidity, but due to their nonspecific presentation a high index of suspicion is essential for early diagnosis and treatment. This article describes a case involving a previously healthy patient with septic thrombosis and pyogenic liver abscess, with particular focus on diagnosis and precipitating factors.

Sporotrichosis in renal transplant patients
P Gewehr, B Jung, V Aquino, RC Manfro, F Spuldaro, RG Rosa, L Goldani

Transplant patients are at increased risk for infection because of the effects of immunosuppressive therapy. Sporotrichosis is a rare fungal infection in renal transplant patients, and can be difficult to diagnose. This article discusses the diagnosis and treatment of sportrichosis in two patients, along with a brief literature review.

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