have bacteremia, initially attributed to Streptococcus uberis, but later correctly identified as S. iniae. In February 1996, a Chinese man was admitted to the same hospital with sepsis one week after preparing a fresh whole tilapia, and was also diagnosed with S. iniae bacteremia. A subsequent epidemiological investigation found other cases in the Toronto area, for a total of nine patients; all were of Asian descent and all had handled raw fish (mostly tilapia) before developing infection. Other cases were later identified in the United States and elsewhere in Canada, and have since been reported in Asia (Hong Kong, Taiwan, and Singapore). Asian descent is a common trend in the majority of invasive human cases, but it is unknown whether this is due to inherent differences in immunity or because of cultural differences in the fish preparation which lend themselves to a higher incidence of infection. Control and treatment Several measures can be taken to control infection in aquaculture once an S. iniae outbreak has been confirmed. Decreasing the quantity of feed given to fish has been shown to reduce mortality rates, as the uptake of bacteria in water is expedited by feeding. Decreasing the density of the fish stock increases survival by reducing injury to fish and lowering the general stress level in the population. Lowering the water temperature and keeping optimal oxygen levels has also been shown to reduce stress to fish and inhibit bacterial growth. A 2005 study showed the potential for using probiotics for controlling S. iniae infection in trout. This study used the gastrointestinal contents of rainbow trout to scan for bacteria that inhibited growth of S. iniae and Lactococcus garvieae. They identified Aeromonas sobria as a potential candidate for control of S. iniae and L. garvieae infections in aquaculture. A. sobria, given live in the feed, protected the trout when challenged with S. iniae or L. garvieae. Several antibiotics have been used successfully to treat S. iniae infection in fish. Enrofloxacin, a quinolone antibiotic, has been used to great effect in hybrid striped bass (Morone chrysops × M. saxatilis), although evidence suggested the development of a resistant strain during this trial. Amoxicillin, erythromycin, furazolidone, and oxytetracycline have also been used (the last with varying success, only in barramundi). Vaccination against S. iniae has been attempted with limited success as it only provides up to 6 months' immunity. Penicillin has been suggested as the drug