RATIONALE: HIV infection increases the risk of reactivation of latent tuberculosis (TB). The present study evaluates how latent TB is detected and treated to determine the effectiveness of screening in HIV-infected patients with diverse risk profiles.METHOD: A retrospective medical record database review (1988 to 2007) was conducted at a tertiary care HIV clinic. The proportion of patients receiving tuberculin skin tests (TSTs) and the rate of active TB at each stage of screening and prevention were estimated. Predictors of receiving a TST at baseline, testing positive by TST and developing active TB were evaluated.RESULTS: In the present study, 2123 patients were observed for a total of 9412 person-years. Four hundred seventy-six (22.4&#x25;) patients were tested by TST within 90 days of first clinic visit. Having a first clinic visit during the highly active antiretroviral therapy era (OR 3.64; 95&#x25; CI 2.66 to 4.99), country of birth (ORs: Africa 3.11, Asia 2.79, Haiti 3.14, and Latin America and the Caribbean 2.38), time between HIV diagnosis and first visit (OR per one-year change 0.97; 95&#x25; CI 0.94 to 0.99) and previous antiretroviral exposure (OR 0.61; 95&#x25; CI 0.45 to 0.81) were independent predictors of receiving a TST at baseline. Of the 17 patients who developed active TB during follow-up, nine (53&#x25;) had no documented TSTs at baseline or during follow-up. Forty-one per cent of all TB patients and 56&#x25; of TB patients who were not screened were born in Canada.CONCLUSION: The administration of TSTs to newly diagnosed HIV patients was inconsistent and differential according to country of birth, among other factors, resulting in missed opportunities for TB prevention.

Paul Brassard

Travis Salway Hottes

Richard G Lalonde

Marina B Klein

Tuberculosis Screening and Active Tuberculosis among HIV-Infected Persons in a Canadian Tertiary Care Centre

OBJECTIVE: To describe the clinical and microbiological features associated with Candida bloodstream infections observed at H&#xf4;pital Maisonneuve-Rosemont (Montreal, Quebec) between August 1996 and July 2006.METHODS: Episodes were retrieved from the microbiology laboratory. Different patient episodes and different isolate episodes in the same patient were selected. Antifungal susceptibility was determined by the Clinical and Laboratory Standards Institute&#x2019;s (USA) M27A2 method.RESULTS: A total of 190 different episodes of candidemia in 185 patients were identified. Eleven (6&#x25;) episodes occurred in outpatients. Candida albicans was identified in the majority of episodes (57&#x25;). Its frequency remained stable over the years. The proportion of Candida krusei candidemia episodes increased between 2003 and 2006, but this was not statistically significant. A central venous indwelling catheter or a peripherally inserted central catheter line was present in the majority of patients (167 [88&#x25;]). Of the indwelling catheters removed at the time of diagnosis, 39&#x25; were positive for Candida species on culture. Overall, voriconazole was the most active agent (the minimum inhibitory concentration required to inhibit the growth of 90&#x25; of organisms was 0.5 mg/L). Resistance to fluconazole was observed in 26 (14&#x25;) isolates (C albicans, 4&#x25;; versus non-albicans Candida species, 27&#x25;; P&#x3c;0.001). Being on the hematology-oncology unit at the time of diagnosis (adjusted OR 7.8; 95&#x25; CI 2.3 to 27.1; P=0.001) and having received fluconazole or itraconazole within the past three months (adjusted OR 8.3; 95&#x25; CI 2.8 to 24.4; P&#x3c;0.001) were significantly associated with resistance to fluconazole in multivariate analysis.CONCLUSIONS: At H&#xf4;pital Maisonneuve-Rosemont, the frequency and species distribution of blood isolates of Candida remained stable over the past decade. In vitro resistance of C albicans to fluconazole and itraconazole remained minimal; resistance of non-albicans Candida species to fluconazole did not increase significantly. The new antifungal agents all had high in vitro activity against the bloodstream Candida isolates.

Annie-Claude Labb&#xe9;

Jacques P&#xe9;pin

Carlos Pati&#xf1;o

St&#xe9;phanie Castonguay

Christiane Restieri

Michel Laverdiere

A Single-Centre 10-Year Experience with Candida Bloodstream Infections

David N Fisman

Kevin B Laupland

The Sounds of Silence: Public Goods, Externalities, and the Value of Infectious Disease Control Programs

Sarah Forgie

Jennie Johnstone

Joan Durand

Susan Gilbride

Geoffrey Taylor

Outbreaks of Vancomycin-Resistant Enterococcus faecium in Acute Care Pediatric Hospitals

Three cases of severe rash associated with the use of atazanavir are described. In all cases, the rash was maculopapular and pruritic. Rash onset occurred eight to 11 days after initiation of therapy, and resolved with atazanavir discontinuation. Clinicians prescribing atazanavir should be aware of this potential adverse effect.

Andrew Walkty

Dick Smith

Bernie Lopko

Ken Kasper

Severe Skin Rash Associated with Atazanavir

Robert B Kalina

A Thank you to Dr Nicolle, A Welcome to Dr Conly and a New Chapter for The Canadian Journal of Infectious Diseases &#x26; Medical Microbiology

About this journal

Canadian Journal of Infectious Diseases and Medical Microbiology publishes original research articles and&nbsp;review articles related to infectious diseases of bacterial, viral and parasitic origin.

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Chief Editor, Professor Tingtao Chen is currently based at Nanchang University, China. His research focuses on microbial ecology, and effects of natural microorganisms and engineered bacteria on host health.

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Canadian Journal of Infectious Diseases and Medical Microbiology - Table of contents 2009

Canadian Journal of Infectious Diseases and Medical Microbiology | Hindawi

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Canadian Journal of Infectious Diseases and Medical Microbiology publishes original research articles and review articles related to infectious diseases of bacterial, viral and parasitic origin.

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Canadian Journal of Infectious Diseases and Medical Microbiology

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