JAMMI最新文献

{"title":"An atypical travel-related infection from Jamaica to Canada.","authors":"Ahmed Ghaly, Brandon Persaud, Bailey Burrell","doi":"10.3138/jammi-2025-0011","DOIUrl":"10.3138/jammi-2025-0011","url":null,"abstract":"<p><strong>Background: </strong>A fever in a returned traveller broadens the possible differential diagnosis for clinicians and can include unfamiliar diseases, making a diagnosis more challenging. Leptospirosis is a worldwide tropical zoonotic infection caused by the bacteria <i>Leptospira</i>. Most cases are mild but can progress to life-threatening infections without appropriate treatment. The severe form of the illness, sometimes called Weil's disease, can cause multiorgan dysfunction with high mortality rates.</p><p><strong>Methods: </strong>This case describes the presentation of a 16-year-old male patient with febrile illness upon returning to Canada from Jamaica. He was managed in an ICU setting for sepsis with severe pain and signs of rhabdomyolysis, hyperbilirubinemia, and renal dysfunction. He was empirically treated with broad-spectrum antibiotics, and a comprehensive infectious workup was sent to identify the responsible pathogen.</p><p><strong>Results: </strong>A polymerase chain reaction (PCR) assay was used to confirm the diagnosis of leptospirosis, and the patient recovered with appropriate antibiotic treatment. Incidentally, the patient was seropositive for prior arbovirus infection.</p><p><strong>Conclusions: </strong>This report documents the first PCR-confirmed case of human leptospirosis in the province of Nova Scotia, Canada, and highlights the potentially severe nature of the disease. Early suspicion is crucial for a positive clinical outcome, and leptospirosis should be on the differential for any febrile traveller returning from an endemic area.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 2","pages":"232-238"},"PeriodicalIF":1.1,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual paradoxical reactions in tuberculous lymphadenitis during and after pregnancy: A case report.","authors":"Fabiana Kellen, Lili Ataie, Fatimah AlMutawa, Michael Silverman, MohammadReza Rahimi Shahmirzadi","doi":"10.3138/jammi-2025-0031","DOIUrl":"10.3138/jammi-2025-0031","url":null,"abstract":"<p><p>We report the case of a 23-year-old woman with tuberculous lymphadenitis diagnosed prior to pregnancy who developed paradoxical lymph node enlargement during pregnancy and again in the post-partum period. Despite completing a full 9-month course of standard anti-tuberculosis therapy, she experienced recurrent cervical lymphadenopathy and a transient pulmonary opacity following delivery. Extensive investigations, including repeat biopsies and cultures, excluded relapse or drug resistance, supporting the diagnosis of a paradoxical reaction. She was managed conservatively with drainage procedures, nonsteroidal anti-inflammatory drugs, and close monitoring, without the need for additional anti-tuberculosis medications or corticosteroids. Her lymphadenopathy resolved and she remained systemically well. This case is unique, as an extensive literature search in MEDLINE via PubMed and Embase from inception to September 2025 revealed no previously reported cases of paradoxical tuberculosis reactions occurring during pregnancy. This case underscores the importance of distinguishing paradoxical reactions from treatment failure, avoiding unnecessary therapy changes, and recognizing that conservative management is often sufficient in pregnancy and post-partum settings.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 2","pages":"196-204"},"PeriodicalIF":1.1,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of colonization and infection with carbapenemase-producing Enterobacterales in Toronto and Peel Region, Ontario, 2007-2024.","authors":"Angel Xinliu Li, Maxime Lefebvre, Zoe Zhong, Huda Almohri, Irene Armstrong, Mahin Baqi, Kevin R Barker, Sergio Borgia, Brenda L Coleman, Mark Downing, Amna Faheem, Wayne L Gold, Lee Goneau, Alainna Jamal, Jennie Johnstone, Christopher Kandel, Kevin Katz, Philipp Kohler, Julianne V Kus, Tony Mazzulli, Roberto G Melano, Samira Mubareka, Matthew Muller, Sarah Nayani, Samir Patel, Susan M Poutanen, Jeff Powis, Anu Rebbapragada, Daniel Ricciuto, David Richardson, Andrew E Simor, Christie Vermeiren, Deborah Yamamura, Gloria Crowl, Lubna Farooqi, Karen A Green, Nadia Malik, Mare Pejkovska, Agron Plevneshi, Asfia Sultana, Tamara Vikulova, Allison McGeer","doi":"10.3138/jammi-2025-0027","DOIUrl":"10.3138/jammi-2025-0027","url":null,"abstract":"<p><strong>Background: </strong>Carbapenemase-producing Enterobacterales (CPE) are an urgent public health threat. Monitoring changes in the epidemiology of CPE is critical to the development of action plans against antimicrobial resistance.</p><p><strong>Methods: </strong>The Toronto Invasive Bacterial Diseases Network (TIBDN) has conducted population-based surveillance for CPE in Toronto and Peel Region, Ontario, since its first identification in the population in 2007. Laboratories report all isolates of CPE to the study; confirmation of CPE is by polymerase chain reaction (PCR). Population data are obtained from Statistics Canada. This analysis includes data from 2007 to 2024.</p><p><strong>Results: </strong>The incidence of CPE colonization/infection increased steadily from 0.03/100,000/year to 3.99/100,000/year in 2024, with the exception of the pandemic years (2020-2021). The incidence was higher in Peel Region than Toronto (average IRR 2.2, range 1.8-2.5), with the exception of 2020, when the decrease in Peel Region (IRR 0.51, 95% CI 0.30 to 0.83) was greater than Toronto (IRR 0.86, 95% CI 0.54 to 1.38). <i>Escherichia coli-</i> and <i>Klebsiella pneumoniae-</i>producing <i>bla</i> _NDM and/or <i>bla</i> _OXA-48-like were dominant. The proportion of cases first identified in hospital laboratories as colonized increased from 45.6% (67/147) in 2010-2014 to 75.1% (948/1263) in 2020-2024. Of 273 patients rectally colonized with CP-<i>K. pneumoniae</i>, 50 (18%) had a clinical isolate, and 20 (7%) became bacteremic a median of 35 and 53 days later, respectively.</p><p><strong>Conclusions: </strong>The incidence of CPE increased steadily after first detection, although cases decreased during the pandemic. Post-pandemic, substantial increases occurred in both population areas. Screening for colonization can identify patients at increased risk of infection. Improved transmission control programs are needed to mitigate the impact of CPE.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 2","pages":"107-122"},"PeriodicalIF":1.1,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First endogenous case of <i>Blastomyces dermatitidis</i> ARDS in an immunocompetent man in Newfoundland and Labrador: Case report and mini-review.","authors":"Nessika Eilersen, Suzette Rutihinda, Patricia Wadden, Robert Taylor, Samuel Bourassa-Blanchette","doi":"10.3138/jammi-2025-0023","DOIUrl":"10.3138/jammi-2025-0023","url":null,"abstract":"<p><strong>Background: </strong>Blastomycosis is a fungal infection that can be localized to the lungs or disseminated to the skin, bone, and the central nervous system. Blastomycosis is endemic in parts of North America, specifically the Great Lakes region; the endemicity of the pathogen is a crucial diagnostic clue.</p><p><strong>Case presentation: </strong>An adult immunocompetent man with no travel history outside of Newfoundland presented to a community centre with respiratory symptoms and several months of constitutional symptoms. He had several new papulo-ulcerated skin lesions and a single mucosal ulcer on the dorsal posterior tongue. Initial septic workup was negative. He was initially treated with empiric piperacillin-tazobactam, azithromycin, and vancomycin. His condition progressed to respiratory failure in keeping with acute respiratory distress syndrome (ARDS), necessitating intubation and mechanical ventilation. A bronchoalveolar lavage specimen submitted to the microbiology laboratory just prior to withdrawal of care showed budding yeast; the patient died before treatment could be initiated. An autopsy was performed, which demonstrated fungal pneumonia, confirmed as <i>Blastomyces</i> on polymerase chain reaction testing of formalin-fixed lung tissue.</p><p><strong>Discussion: </strong>This case represents a probable shift in the Canadian epidemiology pattern of blastomycosis, as this is the first reported endogenous case in the province. Given this, clinicians should consider blastomycosis in their differential beyond the Great Lakes region, especially when no other etiology of ARDS has been found. This case represented numerous diagnostic challenges, especially in distinguishing various dimorphic fungi on histopathology. A mini-review of morphologically related fungi of clinical importance in North America is included.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 2","pages":"183-195"},"PeriodicalIF":1.1,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a planetary health lens to quantify intravenous use of bioequivalent antimicrobials when oral administration is feasible.","authors":"Meghan MacLaren, Rosanne Thalakada, Hui Zhu, Tim Ty Lau, Salomeh Shajari, Xiaotao Bi, Shaqil Peermohamed","doi":"10.3138/jammi-2025-0029","DOIUrl":"10.3138/jammi-2025-0029","url":null,"abstract":"<p><strong>Background: </strong>Health care accounts for 4.6% of Canada's greenhouse gas (GHG) emissions, 25% of which comes from medications. Antimicrobials with high bioavailability offer no additional benefit when given intravenously, except when oral (PO) administration is not feasible. Intravenous (IV) formulations have a higher carbon footprint than their PO counterparts. IV-to-PO switch strategies benefit patients and the health care system by reducing line-related adverse events, nursing time, length of hospital stay, and costs and can also reduce carbon emissions.Our primary objective was to quantify IV use of bioequivalent antimicrobials when PO administration is feasible. Secondary objectives were to determine GHG emissions and antimicrobial costs associated with unnecessary IV use of bioequivalent antimicrobials.</p><p><strong>Methods: </strong>We performed a retrospective, cross-sectional study of hospitalized adults who received IV azithromycin, ciprofloxacin, clindamycin, cotrimoxazole, fluconazole, levofloxacin, linezolid, metronidazole, moxifloxacin, or voriconazole at Vancouver General Hospital on five dates. We determined the proportion of patients receiving these antimicrobials who met criteria for PO administration. We also applied a life cycle assessment (LCA) to assess the GHG emissions of the antimicrobial drug delivery systems using OpenLCA with the Ecoinvent database. Using these data, we calculated the GHG emissions and costs associated with unnecessary IV use.</p><p><strong>Results: </strong>In total, 128 patients were identified. Seventy-eight (61%) met IV-to-PO switch criteria on the audit dates. Most eligible patients were admitted to general surgery, internal medicine, or critical care. The antimicrobial with the highest IV-to-PO switch eligibility was metronidazole (51%), most often prescribed for intra-abdominal infections. Over the five study dates, potential GHG savings were about 80,000 gCO₂-eq. Potential annual cost savings were about $59,000.</p><p><strong>Conclusion: </strong>Over 60% of patients receiving highly bioavailable IV antimicrobials were eligible for PO therapy, highlighting an opportunity to optimize prescribing. Promoting an IV-to-PO switch can improve patient outcomes and reduce environmental impact, supporting both patient-centred care and planetary health.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 1","pages":"70-81"},"PeriodicalIF":1.1,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic prescribing for aspiration pneumonia in the intensive care unit.","authors":"Elaf Alzarnougi, Mansor Binhashr, Rasha Alshawaf, Si Yuan Pan, Pardeep Singh, Amy Bartholomew, Dominik Mertz, Mark Loeb","doi":"10.3138/jammi-2025-0024","DOIUrl":"10.3138/jammi-2025-0024","url":null,"abstract":"<p><strong>Background: </strong>Antibiotics are frequently prescribed for aspiration pneumonia in ICU patients. We sought to determine the proportion of ICU patients treated for aspiration pneumonia who meet the diagnostic criteria.</p><p><strong>Methods: </strong>A retrospective review of electronic medical records was conducted in adult patients who were admitted to one of two intensive care units at an Ontario tertiary care hospital between June 1, 2022, and October 1, 2023. Patients who were exposed to antibiotics were first identified and then systematically assessed using electronic medical records to identify occurrences in which aspiration was suspected and antibiotics were potentially used to treat aspiration pneumonia within 14 days of the aspiration event. For each episode, we assessed whether patients met the criteria for either confirmed or suspected aspiration pneumonia. Factors associated with inappropriate prescribing were determined.</p><p><strong>Results: </strong>Of 497 patients treated with antibiotics, 104 (22.0%) were treated for aspiration pneumonia. More than one-half (67 patients, 64.4%) were categorized as either confirmed or suspected aspiration pneumonia. There were 35.6% cases (37 of 104) in which antibiotic courses were prescribed for aspiration pneumonia without meeting the criteria for confirmed or suspected cases. Factors associated with not meeting criteria included prescribing by attending physicians compared with residents or fellows (OR 1.53 [95% CI 0.63 to 3.67], <i>p</i> = 0.34) and admitting patients from the emergency department compared with other non-ICU areas (OR 1.96 [95% CI 0.86 to 4.65], <i>p</i> = 0.12). Intubation was associated with a higher odds of confirmed or suspected aspiration pneumonia (OR 1.11 [95% CI 0.47 to 2.57], <i>p</i> = 0.81).</p><p><strong>Conclusions: </strong>Inappropriate antibiotic prescribing for aspiration pneumonia remains common in the ICU.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 1","pages":"92-97"},"PeriodicalIF":1.1,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbapenemase-producing hypervirulent <i>Klebsiella pneumoniae</i> in Alberta, Canada, 2016-2024.","authors":"Romaine Edirmanasinghe, Tanis C Dingle, Matthew A Croxen, David A Boyd, Laura Mataseje","doi":"10.3138/jammi-2025-0028","DOIUrl":"10.3138/jammi-2025-0028","url":null,"abstract":"<p><strong>Background: </strong>Hypervirulent <i>Klebsiella pneumoniae</i> (hvKp) can cause invasive community-acquired infections in healthy adults. HvKp is usually susceptible to most antibiotics; however, multi-drug resistance, including to carbapenems, is emerging. This is especially concerning due to the combination of disease severity and antibiotic resistance. Recent reports of the ST23 lineage of hvKp has raised alarms globally, making reporting of these cases significant.</p><p><strong>Methods: </strong>Carbapenemase-producing <i>K. pneumoniae</i> (CP-Kp) in Alberta, Canada were screened for the presence of hypervirulence genes associated with the hypervirulent phenotype. A hypermucoviscous string test was performed on all isolates, and genomes were sequenced using both Illumina NextSeq and Oxford Nanopore Technologies platforms. The presence of hypervirulence-associated genes (<i>ybt</i>, <i>clb</i>, <i>iuc</i>, <i>iro</i>, <i>rmpA</i>/<i>A2</i>) in the assembled genomes was determined.</p><p><strong>Results: </strong>Eight different sequence types (ST) were observed among the 16 cases identified, including several global high-risk lineages (ST11, ST15, ST231, ST147, and ST395) and one hypervirulent lineage (ST23). Carbapenemase genes included <i>bla</i> _NDM-1 (n = 1), <i>bla</i> _OXA-48-type (n = 7), or both <i>bla</i> _NDM + <i>bla</i> _OXA-48-type (n = 8). The ST23 isolate harboured <i>ybt</i> and <i>clb</i> on the chromosome, <i>iro</i> and <i>iuc</i> on a 229.9 kb IncFIB,IncHI1B virulence plasmid, and <i>bla</i> _OXA-48 on a 92.3 kb IncFIA,IncFII plasmid. Almost half of the isolates co-harboured virulence genes and a carbapenemase (<i>bla</i> _NDM-1, n = 4 or <i>bla</i> _NDM-5, n = 3) on the same plasmid, creating hybrid plasmids. Phenotypically, however, 81% of isolates (n = 13) were string test-negative.</p><p><strong>Conclusion: </strong>These data highlights the presence of high-risk lineages of hvKp in the Canadian landscape, as well as the first report of ST23 in Canada.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 1","pages":"51-69"},"PeriodicalIF":1.1,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of pre-extensively drug-resistant tuberculosis in a critically ill patient using bedaquiline, pretomanid, and linezolid therapy in Canada: A brief report.","authors":"Hardit Singh Khuman, Philip Rodney Laird, Andrew James Willis Samis, Angela Ma","doi":"10.3138/jammi-2025-0021","DOIUrl":"10.3138/jammi-2025-0021","url":null,"abstract":"<p><strong>Background: </strong>Pre-extensively drug-resistant tuberculosis (pre-XDR-TB) infections are rare in Canada. Drug therapies to treat pre-XDR TB are limited and acquisition of World Health Organization guideline regimens that are not marketed in Canada pose delays in patient care. Our report describes the case of a critically ill patient with pre-XDR TB and their journey to recovery using bedaquiline, pretomanid, and linezolid (BPaL) therapy.</p><p><strong>Methods: </strong>In 2024, a 20-year-old international student from India with no past medical history presented to hospital complaining of respiratory symptoms and had evidence of cavitary findings on chest imaging. While hospitalized, sputum samples reported acid fast bacilli (AFB) on smear. Subsequently, <i>Mycobacterium tuberculosis</i> complex DNA was detected using molecular methods and confirmed in culture.</p><p><strong>Results: </strong>The standard four-drug regimen was initiated after the positive AFB report. Upon staged availability of drug susceptibility results, drug therapy was altered as the strain was resistant to the entire empiric regimen. Due to challenges in the early detection of resistance, the patient clinically worsened resulting in mechanical ventilation. The patient was converted from four-drug intravenous therapy to BPaL therapy obtained through Health Canada's Special Access Program on hospital day 70. The patient reached non-infectious status on hospital day 200.</p><p><strong>Conclusion: </strong>This case highlights clinical challenges encountered in the management of pre-XDR TB in Canada and describes the successful use of BPaL therapy in a mechanically ventilated patient.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 1","pages":"86-91"},"PeriodicalIF":1.1,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis, treatment, and prophylaxis of <i>Clostridioides difficile</i> infections: A cross-sectional survey of Canadian clinicians.","authors":"Connor Prosty, Bennet Desormeau, Todd C Lee, Emily G McDonald","doi":"10.3138/jammi-2025-0014","DOIUrl":"10.3138/jammi-2025-0014","url":null,"abstract":"<p><strong>Background: </strong>A recent international survey of clinician practices in the management of <i>Clostridioides difficile</i> infections (CDIs) identified numerous areas of practice heterogeneity. The degree of practice variability within Canada is unknown.</p><p><strong>Methods: </strong>Data from Canadian participants of an international survey of clinician CDI practices were extracted. Practice alignment with the Association of Medical Microbiology and Infectious Disease (AMMI) Canada CDI treatment guidelines was assessed. CDI practices were compared across provinces using the Fisher exact test with a simulated <i>P</i> value.</p><p><strong>Results: </strong>A total of 112 responses were obtained from eight provinces. Vancomycin (85.3% for first episode), vancomycin pulse and taper (P-T) (61.8% and 32.4% for first and second recurrences, respectively), and fecal microbiota transplant (32.4% for third recurrence) were preferred treatment strategies. Practice alignment with the AMMI Canada CDI guidelines for the treatment of recurrences was low (range 23.5%-32.4%, depending on the recurrence number). With respect to secondary CDI prophylaxis during antibiotic reexposure, there were interprovincial differences in the perceived indication (<i>P</i> = .03), whether to prescribe at all (<i>P</i> < .001), and duration of prophylaxis (<i>P</i> = .004). There was significant clinician support (>50%) for randomized clinical trials testing treatment strategies for recurrent episodes and for secondary prophylaxis.</p><p><strong>Conclusion: </strong>Despite the availability of national guidelines, we found significant heterogeneity in practice across Canada, often not aligned with guideline recommendations. These findings underscore the need for a platform trial comparing treatment strategies and a trial to establish the efficacy of secondary prophylaxis.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 1","pages":"37-50"},"PeriodicalIF":1.1,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonresolving oral candidiasis and squamous cell carcinoma of the tongue: Case report.","authors":"Lauren Shute, Rotem Keynan, Elly Trepman, Paul Kerr, John M Embil","doi":"10.3138/jammi-2025-0034","DOIUrl":"10.3138/jammi-2025-0034","url":null,"abstract":"<p><strong>Background: </strong><i>Candida</i> species are among the most common oral fungal pathogens. Oral <i>Candida</i> infection may obscure the presence of tongue cancer, resulting in delayed diagnosis.</p><p><strong>Method: </strong>We conducted a retrospective clinical case review.</p><p><strong>Results: </strong>A 59-year-old man had a white plaque on the left ventral surface of his tongue, noted during a routine dental visit. The plaque was painless and could not be removed by scraping. An incisional biopsy specimen showed hyperplastic candidiasis, and <i>Candida albicans</i> was recovered in culture. The plaque did not resolve despite antifungal treatment. A repeat tongue biopsy 14 months after the initial biopsy showed mild to moderate epithelial dysplasia and papillary squamous cell carcinoma without invasion (squamous cell carcinoma in situ). Treatment included surgical excision of the carcinoma with wide margins. Follow-up at 7 years showed no recurrence.</p><p><strong>Conclusions: </strong>This case suggests that a high index of suspicion for malignancy is warranted in patients with oral candidal lesions that persist beyond 14 days of systemic antifungal therapy. Close monitoring and repeat biopsy may help minimize delays in cancer diagnosis and treatment.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"11 1","pages":"98-101"},"PeriodicalIF":1.1,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}