A 44-year-old diabetic female presented to a hospital in Jamaica with thermal burns. Trichosporon asahii was isolated from facial wounds, sputum, and a meningeal swab. Dissemination of the fungus was demonstrated in stained histological sections of the meninges and a brain abscess at autopsy. Pure growth of the fungus from patient samples submitted and an environmental isolate obtained from a wash basin in the hospital supported the diagnosis. CASE REPORTA 44-year-old hypertensive, diabetic woman presented with partial and full-thickness thermal burns involving 50% of her total body surface area, including the face and neck, torso, upper limbs, and proximal portion of the lower limbs. She was admitted to the intensive care unit (ICU) for ventilatory support for suspected inhalational injury. Her initial hemoglobin level was 5.2 g/dl, her white blood cell count was 6.4 ϫ 10 9 /liter, her platelet count was 239 ϫ 10 9 /liter, and her blood urea nitrogen (BUN) and creatinine levels were 2 mmol/liter and 54 mol/liter, respectively. Management included fluid resuscitation, topical and systemic antibiotic therapy, surgical intervention for control of wound sepsis, and limb perfusion. She also received ceftriaxone for empirical antibiotic coverage, tetracycline ointment for facial burn wounds, and twice daily application of dressings using flumazine to the wounds on the body. Nursing and dietary supportive measures were also instituted.The patient was clinically stable on admission when a primary culture of sputum yielded a light growth of a yeast reported as "yeast not Candida albicans." However, despite broad-spectrum antibiotic coverage, signs of sepsis appeared within 5 days of admission. She developed multiorganism infection of the burn wounds, which were culture positive for Pseudomonas aeruginosa, Streptococcus group D, Bacteroides, Alcaligenes sp., and Stenotrophomonas maltophilia. Blood culture and culture of a femoral central venous catheter tip were also positive for Streptococcus group D and Acinetobacter sp. Sputum and urine cultures were negative at that time. Appropriate antibiotic intervention following antibiotic susceptibility testing of isolates was commenced, and 0.25% acetic acid was included in the dressings applied to wounds that were positive for Pseudomonas. Despite the continued use of antibiotics, she persistently showed clinical, biochemical, and hematological signs of sepsis. The patient's clinical status continued to deteriorate, and she developed multiorgan dysfunction.Over the period of hospitalization, gradually increasing BUN levels (mean, 20.9 mmol/liter; range, 9.1 to 32.1 mmol/ liter) and creatinine levels (mean, 287.2 mol/liter; range, 54 to 353 mol/liter) were recorded. Levels remained relatively high throughout the remainder of the patient's hospital stay and were consistent with renal failure.

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We analyzed genetic diversity and phylogenetic relationships among 124 HIV-1 and 19 HIV-2 strains in sera collected in 1986 from patients of the state hospital in Ouagadougou, Burkina Faso. Phylogenetic analysis of the HIV-1 env gp41 region of 65 sequences characterized 37 (56.9%) as CRF06_cpx strains, 25 (38.5%) as CRF02_AG, 2 (3.1%) as CRF09_cpx, and 1 (1.5%) as subtype A. Similarly, phylogenetic analysis of the protease (PR) gene region of 73 sequences identified 52 (71.2%) as CRF06_cpx, 15 (20.5%) as CRF02_AG, 5 (6.8%) as subtype A, and 1 (1.4%) was a unique strain that clustered along the B/D lineage but basal to the node connecting the two lineages. HIV-2 PR or integrase (INT) groups A (n = 17 [89.5%]) and B (n = 2 [10.5%]) were found in both monotypic (n = 11) and heterotypic HIV-1/HIV-2 (n = 8) infections, with few HIV-2 group B infections. Based on limited available sampling, evidence suggests two recombinant viruses, CRF06_cpx and CRF02_AG, appear to have driven the beginning of the mid-1980s HIV-1 epidemic in Burkina Faso.

We report a case of persistent Candida orthopsilosis associated septic arthritis. Repeated isolation of C. orthopsilosis from tissue and joint fluid was confirmed by identification of the ITS region of the rRNA gene using a Candida-Specific Luminex based assay and gene sequencing of the D1/D2 regions. This was the first case of C. orthopsilosis associated septic arthritis reported in Jamaica and in the literature.

We investigated an increase in Trichosporon asahii isolates among inpatients. We identified 63 cases; 4 involved disseminated disease. Trichosporon species was recovered from equipment cleaning rooms, washbasins, and fomites, which suggests transmission through washbasins. Patient washbasins should be single-patient use only; adherence to appropriate hospital disinfection guidelines was recommended.