A case study of imported pulmonary coccidioidomycosis

Coccidioidomycosis is an endemic disease of the Western hemisphere. The cases in non-endemic areas are mostly imported. Determining a history of exposure is critical for performing the diagnosis of coccidioidomycosis, especially for cases occurring in a non-endemic area. In this study, a 71-year-old Chinese male presented to our hospital with chronic cough and malaise, and was found to have a mass in the middle lobe of right lung. He had been visiting Arizona, USA for four months before admission. Pulmonary coccidioidomycosis was confirmed by the results of histopathological examination after lobectomy. Typical microscopic features of Coccidioides are definitely diagnostic, but need be differentiated from other budding yeast infection or carcinoma histopathologically

Twelve Years Of Fluconazole In Clinical Practice: Global-Trends In Species Distribution And Fluconazole Susceptibility Of Bloodstream Isolates Of Candida

We determined the species distribution and in-vitro susceptibility of 6082 bloodstream infection (BSI)isolates ofCandidaspp. collected from 250 medical centres in 32 nations over a 10-year period from 1992through 2001. The species included 3401C. albicans, 984C. glabrata, 796C. parapsilosis, 585C. tropicalis,153C. krusei,67C. lusitaniae,48C. guilliermondii,10C. famata,10C. kefyr, sixC. pelliculosa, fiveC. rugosa,fourC. lipolytica, threeC.dubliniensis, threeC. inconspicua, twoC. sakeand one isolate each ofC. lambica,C. norvegensisandC. zeylanoides. Minimum inhibitory concentration determinations were made usingthe National Committee for Clinical Laboratory Standards reference broth microdilution method.Variation in the rank order and frequency of the different species ofCandidawas observed over time andby geographic area. The proportion of BSI due toC. albicansandC. glabrataincreased andC. parapsilosisdecreased over time in Canada, the USA and Europe.C. glabratawas an infrequent cause of BSI in LatinAmerica and the Asia-Pacific region. Very little variation in fluconazole susceptibility was observedamong isolates ofC. albicans,C. tropicalisandC. parapsilosis. These species accounted for 78%of all BSIand remained highly susceptible (91–100%susceptible) to fluconazole from 1992 to 2001 irrespective ofgeographic origin. The prevalence of fluconazole resistance amongC. glabrataisolates was variable bothover time and among the various countries and regions. Resistance to fluconazole amongC. glabrataisolates was greatest in the USA and varied by US census region (range 0–23%). These observations aregenerally encouraging relative to the sustained usefulness of fluconazole as a systemically activeantifungal agent for the treatment of candida BSI.Scopu