This study compared the identification of Burkholderia pseudomallei with that of related organisms. Bench tests and latex agglutination were compared with molecular identification. Using bench tests and latex agglutination alone, 100% (30/30) of B. pseudomallei isolates were correctly identified. Amoxicillin-clavulanate susceptibility testing was also a good and simple discriminatory test.Melioidosis is an infectious disease caused by Burkholderia pseudomallei, which is endemic in Southeast Asia and northern Australia. Cases occur mainly during periods of heavy rain (13). It is a clinically diverse infection affecting many organ systems and commonly presents as a fulminant septicemia (3, 4).There has been controversy as to the optimal identification system for B. pseudomallei (2,9,10,11,12,19). The reliability of the API 20NE and the Vitek 1 systems (bioMérieux, Marcy L'Etoile, France) has been questioned and molecular confirmation suggested (14). The reliability of presumptive tests (oxidase, Gram staining, resistance to gentamicin and polymyxin) in the identification of this organism has previously been described as 100% accurate (6). It should be noted that neither system will distinguish related species such as Burkholderia thailandensis from B. pseudomallei.The commonest misidentification of B. pseudomallei when using identification systems is with Burkholderia cepacia, Pseudomonas aeruginosa, Pseudomonas fluorescens, and Chromobacterium spp. (1). A recent study compared the API 20NE system and a latex agglutination assay and found that the API 20NE system identified 99% of B. pseudomallei isolates correctly. It did not however distinguish between B. thailandensis and B. pseudomallei. The addition of the latex agglutination test correctly identified 99.5% of isolates and was negative for 98% of the B. thailandensis isolates and other oxidase-positive gram-negative bacilli (1). Molecular identification of the organism has been described, using a number of genomic targets (14,17,18).A previous study compared basic bench diagnostic presumptive tests with B. pseudomallei slide agglutination using a monoclonal antibody, API 20NE (bioMérieux, Marcy L'Etoile, France), cellular fatty acid analysis, and molecular detection (10). This showed that the PCR alone had a sensitivity and specificity of 100%. API 20NE performed poorly in this study, with a sensitivity of 37% and a specificity of 92% (10). The agglutination test used had a sensitivity of 94% and a specificity of 83%. Although fatty acid analysis had a sensitivity of 98% and a specificity of 83%, it was acknowledged that this technology was not widely available. Interestingly, the presumptive tests (oxidase, Gram staining, resistance to gentamicin and polymyxin) did not distinguish between B. pseudomallei, B. cepacia, and B. thailandensis. The aim of this study was to compare the diagnostic efficacies of standard presumptive identification methods (oxidase, gentamicin resistance, and amoxicillin-clavulanate susceptibility), including a specific latex agglutin...

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Ringworm is very rarely found in the neonate, especially infants who have been confined from birth to an intensive care unit. We report an infection with the dermatophyte Trichophyton tonsurans, the most common cause of tinea capitis in children but not yet described in a premature baby who has never left the nursery. Our case illustrates the need to consider this diagnosis among the causes of dermatitis in the newborn, especially in at-risk populations such as indigenous Australians. Though our infant's presentation was the classic "ring" shape, a literature review revealed varied presentations. In contrast to the usual need for long-term antifungal medication, our case responded rapidly to a topical azole preparation. Although we did not screen visiting family members, screening would have been appropriate, and those found positive might have benefited from at least antifungal shampoo.