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We describe a case of noninvasive sinusitis caused by Paecilomyces lilacinus in a patient with diabetes mellitus. Cure was achieved by endoscopic drainage and aspiration of the fungal mass. We discuss the difficulty in and clinical importance of distinguishing Paecilomyces from Aspergillus, Pseudallescheria, a Zygomycete, or other molds.Empirical therapy for fungal infections continues to grow in paralysis of the left third cranial nerve. Three weeks before admission, the patient had noted an inability to open her left scope because of the increasing number of effective drugs that have become available and the increasing incidence and variety eye, which was accompanied by severe headaches and leftsided facial pain. A CT scan revealed a soft-tissue mass with of opportunistic fungal pathogens. Furthermore, until microbiological identification is provided, invasive fungal infections in an air fluid level in the left sphenoid sinus. The bone margins were intact (figure 1). She was transferred to our hospital for immunocompromised hosts must be dealt with in an urgent and expeditious manner by administering empirical antifungal further evaluation. On physical examination, the patient was unable to open her left eye, the left pupil was dilated, and therapy on the basis of clinical criteria.We describe a case of fungal sinusitis associated with ocular extraocular motion was severely limited. There was no erythema or swelling of the orbit, and no necrotic tissue was palsy in a patient with insulin-dependent diabetes mellitus. Fungal sinus infections in diabetics are often severe and may observed around the eye or buccal mucosa. Findings of the remainder of the physical examination were unremarkable. be disfiguring and even life-threatening when caused by a Zygomycete. Antifungal therapy differs for the many differentThe patient had received an empirical course of oral amoxifungi, and exenterative surgery may be required to cure some cillin/clavulanate as an outpatient, but her condition did not infections. A biopsy obtained at endoscopy of our patient's improve. She underwent endoscopic exploration and drainage sinus demonstrated numerous fungal elements without eviof the sphenoid sinus. The sinus epithelium was intact and dence of tissue invasion. On histological examination of the without erosion. The posterior aspect of the sinus was filled specimens, we could not determine with accuracy whether the by a mass. Microscopic examination of the biopsied mass and fungus was a Zygomycete, Aspergillus, Pseudallescheria, or a adjacent tissue showed entangled hyphae with moderately serepresentative of some other genus. There were features in the vere chronic and acute inflammation of the adjacent mucosa biopsy specimen compatible with several of the invasive and and submucosa; there was no evidence of oxalate crystals, more-often encountered fungi such as Aspergillus or a Zygowhich may occur with aspergillosis. There was no evidence of mycete. Paecilomyces lilacinus was subsequently cultured from tissue invasion. Dark flecks ...

Mycobacterium haemophilum was isolated from wrist and ankle aspirates as the organism responsible for tenosynovitis in a patient with acquired immune deficiency syndrome. Mycobacterium isolates recovered from synovial fluid were identified as hemin requiring by their failure to grow on subculture unless the medium was supplemented with hemin. M. haemophilum is of low virulence and rarely associated with infections in humans. This is the first documented case of M. haemophilum infection in a patient with acquired immune deficiency syndrome.

Staphylococcus simulans was identified as the etiological agent of osteomyelitis and septic arthritis in an adult male who had sustained a fracture of the fibula and syndesmosis separation which required the installation of orthopedic hardware. Identifying characteristics and antibiograms for this organism, recovered from blood, wound exudate, and deep tissue samples, were determined. Recent evidence has linked slime production (adherence to smooth surfaces) by coagulase-negative staphylococci to infections by these organisms at sites where foreign bodies had been inserted. Tests for adherence showed this S. simulans strain to be a strong slime producer. This is the first reported case of osteomyelitis and septicemia due to S. simulans.

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Diagnosis of brucellosis requires prompt detection and identification of the coccobacillus for appropriate patient management, as the organism is associated with a potentially severe outcome. In a recent experience, an 18-year-old migrant farm worker presented at a local hospital with nonspecific symptoms. A significant Brucella titer of 2,560 was followed by the recovery of a gram-negative coccobacillus, subsequently identified as Brucella abortus, from subcultured 5-day-old BACTEC NR730 negative blood cultures. The organism proved to be susceptible to a variety of antimicrobial agents and resistant to nitrofurantoin. The patient was administered antimicrobial therapy for Brucella spp. consisting of tetracycline and streptomycin for 21 days. During the course of therapy the patient experienced defervescence and was discharged with the recommendation for periodic follow-up examinations. Seeded culture studies of this isolate with fresh human blood and target inocula of 5 and 500 CFU/ml indicated that the larger (500-CFU/ml) inoculum produced positive instrument detection within 2 days, whereas the smaller (5-CFU/ml) inoculum required 5.5 to 7.5 days for detection, depending on the medium used. These findings underscore the potential for Brucella bacteremia to escape instrument detection given a low bacterial inoculum.

A large city hospital experienced an infestation of mice combated in part by broadcasting poisoned baits. Months later there was an invasion of flies into the hospital, and 2 comatose patients in an intensive care unit contracted nasal maggots. Adult flies were trapped and maggots removed from the nares of the second patient. These were identified as the green blowfly (Phaenicia sericata). Recent downsizing of hospital personnel had led to the unintended and unrecognized loss of housekeeping services in the canteen food storage areas. A mouse infestation of the hospital occurred, with the epicenter in the canteen area. This was initially addressed by scattering poisoned bait and using rodent glue boards. The result of such treatment was the presence of numerous mouse carcasses scattered throughout the building attracting the green blowfly. Adult gravid female flies trapped in the new intensive care unit (where mice were not present) laid eggs in the fetid nasal discharge of 2 comatose patients. Live trapping of mice and removal of carcasses led to an abatement of the fly infestation. The cause-and-effect nature of the mouse carcasses and flies was underscored a year later when an outbreak of P. sericata occurred in the operating department and was linked to the presence of mouse carcasses on glue boards not removed the previous fall. Hence, the disruption or loss of 1 vital link in hospital organization (in this case, housekeeping support) may lead to an unintended and bizarre outcome.

We describe a sporotrichoid presentation of infection with Mycobacterium chelonae (M. chelonae subspecies chelonae). The disease occurred in a patient receiving corticosteroid therapy and was cured by the use of clarithromycin and ciprofloxacin.