A patient with aplastic anaemia, successively treated with caspofungin then liposomal amphotericin, developed a disseminated infection due to Acremonium, further confirmed as resistant in vitro to these drugs. Successful treatment was achieved with voriconazole. Multiple antifungal treatments may expose to the risk of breakthrough of multi-resistant pathogens in haematology patients.
While investigations on fungal contamination of swimming pools usually focus on dermatophytes, data on other potentially pathogenic molds are scarce. Here, we report the investigation of fungal colonization of the deck surrounding a hospital physical therapy swimming pool. Five series of samples from 8 sites were collected over one year from the pool surroundings. Concomitantly, 58 patients using the swimming pool were examined and samples obtained from those with suspected onychomycosis. All surface samples were positive for fungi, with Fusarium the most frequently recovered from 22 of 27 samples of sites surrounding the pool. Among the outpatients evaluated, two presented with a mixed onychomycosis from which Fusarium and Trichophyton rubrum were isolated. The questions of possible acquisition from the swimming pool area must be considered in both cases as the ungual lesions had developed within the previous three months. This warrants further studies to better understand the epidemiology of potentially pathogenic molds in areas surrounding pools in order to adopt appropriate measures to avoid contamination. This is of particular importance within medical institutions, considering the potential role of Fusarium onychomycosis as a starting point for disseminated infections in immunocompromised patients.
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