The detection of galactomannan at concentrations as low as 1 ng/ml can be useful for the early initiation of antifungal therapy and monitoring treatment in clinically documented lung aspergillosis. This technique coupled with chest computed tomography could help to restrict the need of invasive diagnostic procedures in fragile patients.

We report the first case of cutaneous mucormycosis after a scorpion sting in Tunisia. Histopathology showed broad aseptate hyphae suggestive of a Zygomycete. Saksenaea vasiformis was identified by PCR amplification and sequencing of the fungal DNA on a cutaneous biopsy. Successful treatment was obtained by surgery and liposomal amphotericin B. CASE REPORTA previously healthy 14-year-old patient was admitted to Robert Debré hospital (Paris) with a left calf lesion following a scorpion sting in Tunisia 10 days before. At that time, he had been hospitalized for 4 days in an intensive care unit for acute renal failure and pulmonary edema induced by the scorpion venom. When he came back to France, the lesion due to the scorpion sting failed to heal.On the day of admission, the patient had a limping gait. Physical examination of the left calf revealed a painful, indurated, erythematous, 5-cm lesion. Ultrasonic tomography revealed a diffuse, soft tissue swelling. The white blood cell count was 14.1 ϫ 10 9 /liter with 71% neutrophils, the platelet count was 395 ϫ 10 9 /liter, and the C-reactive protein level was less than 10 mg/liter. The patient was started on antibacterial therapy with cefotaxime and fosfomycin according to our local guidelines for antibiotic treatment (9).On day 5, the lesion grew to a 10-cm area of swelling and induration, with a central area of black blisters. No sample was taken at this stage. The patient had a fever (38.7°C) and experienced severe pain. The white blood cell count was 18.9 ϫ 10 9 /liter with 80% neutrophils, and the C-reactive protein level was 52 mg/liter. Three blood cultures performed between day 1 and day 5 were sterile. A second ultrasonic tomography showed an extension within subcutaneous tissues, with collection of fluids. Because of the increasing area of the wound, vancomycin and metronidazole were added to the treatment regimen.On day 7, the patient required local debridement to remove devitalized tissues, including muscles and fascia. A 7-cm incision was made to evacuate the necrotizing tissue. A piece of debrided tissue was submitted for microbiological and histopathological examination. On day 12, histological analysis showed many areas of necrosis and nonspecific inflammation. Within the necrotic areas, branched, broad, nonseptate fungal hyphae suggestive of Zygomycetes were found. The material was inoculated onto routine bacteriological media and Sabouraud dextrose agar. On the Sabouraud dextrose agar, there were few colonies of filamentous fungi, with no evidence of sporulation, and the loss of viability of the isolate, possibly due to growth conditions, precluded subcultures on specific media (11), impaired any further mycological identification. All other cultures on solid media were negative for bacteria. The cutaneous biopsy, kept frozen at Ϫ80°C, was then sent to the National Reference Center for Mycoses and Antifungals, Pasteur Institute, for molecular studies. Tissues were ground, and DNA extraction was performed as previously described (16). Direct examinat...

Diarrhoea in transplantation may be secondary to infectious agents and immunosuppressive drugs. The use of combined immunosuppressive drugs increases the incidence of infectious diarrhoea. We retrospectively collected all diarrhoea episodes during a 3-year period in 199 pediatric renal transplant recipients, including 47 patients receiving a kidney transplant during this period. We diagnosed 64 diarrhoea episodes (32% of the patients, 10.7% per year). Fourteen diarrhoea episodes could be attributed to the immunosuppressive treatment, and 12 remained without diagnosis. Nineteen patients (<10%) receiving mycophenolic acid (MPA) developed diarrhoea, 14 of whom had episodes attributable to the immunosuppressive treatment. Reducing the MPA dose or switching to another immunosuppressant did not induce graft rejection, if at all, for at least 6 months. Thirty-eight diarrhoea episodes were caused by infectious agents: viruses in 16 patients, bacterial agents in ten patients, Candida albicans in four cases and parasitic agents in eight cases (Giardia lambdia in one patient and Cryptosporidium in seven patients). In our cohort, Cryptosporidium was responsible for 18% of the infectious diarrhoea and 11% of all causes of diarrhoea, and it affected 3.5% of the newly transplanted patients during the 3-year study period. The clinical presentation of the disease was profuse and persistent diarrhoea with acute renal failure in all patients. We propose that oocysts be screened for in the stool during the early stages of tests for determining the origin of infectious diarrhoea. Disease treatment requires early specific treatment (nitazoxanide) for extended periods of time in conjunction with supportive rehydration.