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1/28. Necrotizing periorbital fusarium infection--an emerging pathogen in immunocompetent individuals.

    Fungal infections of the skin and deeper tissues of the periorbital region are quite rare. We report a case of a localized, deep periorbital necrotizing fusarium infection in an otherwise healthy, elderly lady. Since the clinical features and histopathological findings of fusarium infection are by no means characteristic, the definitive diagnosis was achieved with the help of microbiological examination of cultured organisms. A combined medical and surgical therapy led to adequate control of infection. To conclude, localized, deep periorbital necrotizing soft tissue infection by fusarium in an immunocompetent lady is not reported in literature. One should have a high index of suspicion for emerging fungal pathogens in the differential diagnosis of necrotizing orbital or adnexal conditions, even in an immunocompetent patient. The histologic findings of septate, branching hyphae and vascular invasion cannot distinguish fusarium species from various other moulds such as aspergillus species; microbiologic studies are essential for confirming the diagnosis. ( info)

2/28. Fasciolopslasis--a re-emerging infection in Azamgarh (Uttar Pradesh).

    Fasciolopsiasis is endemic in the far east. In india, there have been a few reports of the infection, prior to the 1990's. We report two cases from Azamgarh district of Uttar Pradesh. Both the cases were from nearby villages where water chestnuts are cultivated. These may be a source of infection. Pigs are commonly observed in these areas and and may be the source of ova. The only missing link is the finding of infected snails. Presence of at least three cases (one reported earlier) in the area indicates the potential for the infection to re-emerge. Further epidemiological studies are needed to analyse the various ecological factors of transmission. Fasciolopsiasis is endemic in china, taiwan, vietnam and thailand. In india, (Fascilopsis buski) infections in man have been reported earlier from Assam, Maharashtra, Tamil Nadu and parts of Uttar Pradesh. However, to the best of our knowledge, no such reports have been made since 1990's. We herewith report two recent cases from district Azamgarh, Uttar Pradesh (U.P.), india. Factors, such as cultivation of water chestnuts, presence of snails as intermediate hosts and pigs as definitive host in this geographical area seem to be suggestive of an endemic focus and thus needs further epidemiological survey for preventive and control measures, at the earliest. ( info)

3/28. Endemic babesiosis in another eastern state: new jersey.

    In the united states, most reported cases of babesiosis have been caused by babesia microti and acquired in the northeast. Although three cases of babesiosis acquired in new jersey were recently described by others, babesiosis has not been widely known to be endemic in new jersey. We describe a case of babesiosis acquired in new jersey in 1999 in an otherwise healthy 53-year-old woman who developed life-threatening disease. We also provide composite data on 40 cases of babesiosis acquired from 1993 through 2001 in new jersey. The 40 cases include the one we describe, the three cases previously described, and 36 other cases reported to public health agencies. The 40 cases were acquired in eight (38.1%) of the 21 counties in the state. babesiosis, a potentially serious zoonosis, is endemic in new jersey and should be considered in the differential diagnosis of patients with fever and hemolytic anemia, particularly in the spring, summer, and early fall. ( info)

4/28. photorhabdus species: bioluminescent bacteria as emerging human pathogens?

    We report two Australian patients with soft tissue infections due to photorhabdus species. Recognized as important insect pathogens, photorhabdus spp. are bioluminescent gram-negative bacilli. bacteria belonging to the genus are emerging as a cause of both localized soft tissue and disseminated infections in humans in the united states and australia. The source of infection in humans remains unknown. ( info)

5/28. Gymnophalloides seoi: a new human intestinal trematode.

    A new minute intestinal fluke, recovered from a Korean woman suffering from acute pancreatitis and gastrointestinal difficulties, was described as Gymnophalloides seoi. The coastal village where the patient resided was found to be a highly endemic area for this fluke, and 24 other endemic areas have been found. This fluke infection is now recognized as an emerging parasitic disease. Its second intermediate host is the oyster, and migrating birds are a natural definitive host. This new trematode might exist in other countries. ( info)

6/28. nocardia veterana, a new emerging pathogen.

    nocardia veterana is a newly described species named after the veteran's hospital where it was first isolated. This initial type strain was not thought to be clinically significant. We describe three cases of pulmonary disease attributable to N. veterana: two cases in patients presenting with multiple pulmonary nodules in a setting of immunocompromise and one case of exacerbation of chronic pulmonary disease. The isolates were susceptible to ampicillin, imipenem, gentamicin, amikacin, and trimethoprim-sulfamethoxazole and had reduced susceptibilities to ceftriaxone, cefotaxime, minocycline, and ciprofloxacin. The MICs of amoxicillin-clavulanate were higher than that of ampicillin alone, and the bacteria produced a beta-lactamase detectable only after induction with clavulanic acid. Phenotypically, the isolates could not be characterized beyond the nocardia genus level. All three isolates were definitively identified as N. veterana by PCR and sequencing of the 16S rRNA gene. On the basis of their susceptibility and restriction enzyme analysis profiles, our findings indicate that they could potentially be misidentified as N. nova. These cases illustrate the pathogenic potential of this newly described species and emphasize the importance of accurate identification of nocardia isolates to the species level by integrated use of phenotypic and genotypic methods. ( info)

7/28. severe acute respiratory syndrome (SARS) and coronavirus testing--united states, 2003.

    CDC and the world health organization (WHO) are continuing to investigate the multicountry outbreak of severe acute respiratory syndrome (SARS). Infection with a novel coronavirus has been implicated as a possible cause of SARS. This report updates information on U.S. residents with SARS and summarizes the clinical histories of the five U.S. residents identified as of April 9, 2003, who have both suspected SARS and laboratory evidence of infection with a novel coronavirus. ( info)

8/28. gnathostomiasis: an emerging imported disease.

    As the scope of international travel expands, an increasing number of travelers are coming into contact with helminthic parasites rarely seen outside the tropics. As a result, the occurrence of gnathostoma spinigerum infection leading to the clinical syndrome gnathostomiasis is increasing. In areas where gnathostoma is not endemic, few clinicians are familiar with this disease. To highlight this underdiagnosed parasitic infection, we describe a case series of patients with gnathostomiasis who were treated during a 12-month period at the Hospital for Tropical Diseases, london. ( info)

9/28. severe acute respiratory syndrome (SARS) in singapore: clinical features of index patient and initial contacts.

    severe acute respiratory syndrome (SARS) is an emerging viral infectious disease. One of the largest outbreaks of SARS to date began in singapore in March 2003. We describe the clinical, laboratory, and radiologic features of the index patient and the patient's initial contacts affected with probable SARS. ( info)

10/28. Human rabies: a reemerging disease in costa rica?

    Two human rabies cases caused by a bat-associated virus variant were identified in September 2001 in costa rica, after a 31-year absence of the disease in humans. Both patients lived in a rural area where cattle had a high risk for bat bites, but neither person had a definitive history of being bitten by a rabid animal. Characterization of the rabies viruses from the patients showed that the reservoir was the hematophagous Vampire Bat, Desmodus rotundus, and that a sick cat was the vector. ( info)
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