Infections caused by Cunninghamella bertholletiae are rare but severe. Only 32 cases have been reported as yet, but in 26 of these this species was a contributing cause of the death of the patient. This opportunistic mould in the order Mucorales infects immunocompromized patients suffering from haematological malignancies or diabetes mellitus, as well as solid organ transplant patients. The lung is the organ most often involved. Two cases of primary cutaneous infection have been previously reported subsequent to soft-tissue injuries. We report a case of primary cutaneous C. bertholletiae zygomycosis in a 54-year-old, insulin-dependent diabetic man who was treated with tacrolimus and steroids after kidney transplantation. No extracutaneous involvement was found. In this patient, the infection may have been related to insulin injections. The patient recovered after an early surgical excision of the lesion and daily administration of itraconazole for 2 months. This case emphasizes the importance of an early diagnosis of cutaneous zygomycosis, which often presents as necrotic-looking lesions. Prompt institution of antifungal therapy and rapid surgical intervention are necessary to improve the prospects of patients who have contracted these potentially severe infections.
The incidence of Malassezia furfur-related colonization of central venous catheters appears to be low but not negligible, which warrants the use of specific culture techniques.
We read with considerable interest the report by Gay and coauthors on Entamoeba polecki infection in South east Asian refugees, which was published in the August issue of the Proceedings (pages 523 to 530). We would like to correct an erroneous statement that appeared in the discussion of that article. The authors stated that E. polecki was identified for the first time in Strasbourg, France, in 1982. 1 In 1980, we 2 published a case of E. polecki infection in a 53-year-old Briton woman who had never left France. She lived on a farm with pigs and was the only person in the family to experience such an infection. Cysts definitely disappeared from the feces after administration of two regimens of metronidazole (250 mg four times a day for 10 days and 500 mg four times a day for 14 days); this outcome supports the results of Gay and colleagues. In rare cases, E. polecki may be a pathogen for humans, attributable to domestic animals. We regret that our case was not reported in the references of the Proceedings article by Gay and associates.
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