Paul E. Bunce

Fluoroquinolone antimicrobial drugs

Fluoroquinolones are bactericidal agents that inhibit DNA synthesis in bacteria. Early fluoroquinolones (e.g., ciprofloxacin) primarily target gram-negative bacteria, including Pseudomonas species. Newer agents (e.g., levofloxacin and moxifloxacin) have expanded coverage against gram-positive

A woman with community-acquired Clostridium difficile infection.

A 66-year-old woman who recently completed a course of levofloxacin to treat community-acquired pneumonia presents to her family physician with a two-day history of watery diarrhea. Her stool tests positive for Clostridium difficile toxin. She takes pantoprazole daily for symptoms of dyspepsia and

Brain and lung lesions in an immunocompromised man.

A 62-year-old man presented with a one-week history of fever and confusion. His family had noted progressive memory impairment and difficulty following verbal instructions. He also had a two-week history of productive cough that had failed to respond to clarithromycin. There was no history of

Case of Mycobacterium mucogenicum in home hemodialysis patient

We present a case of a patient on home hemodialysis who developed Mycobacterium mucogenicum bacteremia. While infections with this particular organism are rare, disseminated infections have been reported and have been associated with significant morbidity and mortality. Diagnosis required appropriate cultures, understanding of natural habitat of organism and complete environmental analysis including blood, dialysis sample port, reverse osmosis and incoming water supply cultures. The patient was treated successfully with systemic antibiotics, removal of central venous catheter, patient education and complete exchange of the hemodialysis circuit.

A 35-year-old man with a positive Lyme test result from a private laboratory

See also page [1193][1] and [www.cmaj.ca/lookup/doi/10.1503/cmaj.150874][2] A 35-year-old man with a 12-month history of fatigue is concerned about Lyme disease. He has not lived in or travelled to a Lyme endemic area. His physical examination and blood work, including complete blood count,

Reducing the risk of infection in a 74-year-old man who is to receive prednisone

A 74-year-old man presents with a one-month history of cutaneous bullae. Skin biopsy confirms a diagnosis of bullous pemphigoid. His dermatologist plans to start treatment with prednisone (40 mg/d for four weeks followed by a tapering regimen) and considers potential infectious complications of the

Progressive multifocal leukoencephalopathy unmasked by antiretroviral therapy for HIV

A 51-year-old man with chronic HIV presented to the emergency department with right-hand monoparesis. After years of nonadherence with medication, he had restarted antiretroviral therapy two months before, with successful achievement of viral suppression and an increase in CD4 count from 50 to 84

A 65-year-old HIV-positive man with acute diarrhea.

A 65-year-old man with chronic HIV infection presents with a one-week history of diarrhea. He describes six to eight loose bowel movements daily. His most recent CD4 count is 0.22 × 109/L, with an undetectable viral load. His current antiretroviral (ARV) regimen consists of ritonavir-boosted

A 52-year-old woman with a positive tuberculin skin test

A 52-year-old woman with end-stage renal disease secondary to diabetes requires hemodialysis. Her physician reviewed her history of tuberculosis (TB) exposure, noting that she immigrated to Canada from the Philippines two years prior and had never been tested for TB. She reported no known exposure

West Nile virus infection

First identified in North America in 1999, West Nile virus is now endemic in Canada, excluding the Atlantic provinces and the North.[1][1] Infection in humans peaks in late summer after the transmission cycle between birds and mosquitoes has increased the prevalence of infected mosquito vectors; 428