We report on a rare case of disseminated nosocomial fungal infection due to Aureobasidium pullulans var. melanigenum in a severely traumatized patient. Repeated blood and urine cultures yielded multicellular filamentous hyphal structures of varying size accompanied by budding yeast-like-cells of ellipsoidal morphology. The patient became asymptomatic after fluconazole therapy. CASE REPORTThe patient, a 28-year-old male, was admitted to the intensive care unit of the Ospedali Riuniti of Reggio Calabria, Reggio Calabria, Italy, following multiple traumas due to a road accident. The patient suffered a head trauma and had a Glasgow coma scale rating of III-IV. After initial treatment with standard life support measures to stabilize hemodynamic and respiratory parameters, the patient underwent a total-body computed tomography scan, which showed diffuse cerebral edema, hemoperitoneum, multiple fractures of the left femur and tibia, a suspected pelvic fracture, and multiple ruptures of the liver's right lobe, which made immediate surgery mandatory. After surgery, the patient underwent mechanical ventilation and prolonged total parenteral nutrition.Following the isolation of a methicillin-resistant strain of Staphylococcus epidermidis from a blood culture (BCB-Slide system; Roche Products Pty. Ltd.) antibiotic therapy was started, with teicoplanin at 800 mg/day plus vancomycin at 2 g/day, divided into two doses daily. Four days later, following the onset of dyspnea and fever (37.5 to 38°C), a pulmonary infection was suspected. Laboratory data included a total leukocyte count of 10.7 ϫ 10 9 /liter with 70% neutrophils, 26% lymphocytes, and 4% monocytes. Microbiological examination of a bronchial aspirate showed the presence of Acinetobacter anitratus var. anitratus. Antibiotic therapy was therefore changed, replacing teicoplanin with ceftazidime pentahydrate at 4 g/day. After an initial decrease in body temperature lasting 3 days, fever increased again to 40°C. Therefore, a new blood culture was carried out, leading to the isolation of Pseudomonas aeruginosa. On the basis of antibiogram results, antibiotic treatment was changed again, with aztreonam at 6 g/day plus tobramycin at 300 mg/day, divided into three doses daily. Six days later, since fever was stable at around 38°C and the patient's condition was not improving, new cultures from blood and urine were made. After 72 h of incubation, the blood culture became diffusely turbid and several smooth and mucoid colonies appeared on agar growth media (chocolate agar and malt agar) enclosed in the BCB-Slide Roche system (Fig. 1). The urine culture, in contrast, was negative.Microscopic examination of fungal cultures revealed multicellular filamentous hyphal structures of varying size accompanied by budding ellipsoidal yeast-like cells, both in the blood culture and in the colonies growing on agar media. These fungal isolates were subsequently classified as Aureobasidium pullulans.Immediately before starting antifungal therapy, a new set of blood and urine cultures and a cu...

Summary. The authors report a case of crypto‐coccal meningoencephalitis in a 22‐year‐old male with Hodgkin's disease at third stage B. Cryptococ‐cus neoformans was isolated from cerebral spinal fluid (CSF) and blood specimens. Latex antigen agglutination tests and India ink preparations also were positive for this pathogenic yeast. Drug treatment for a week with 20 mg i.v./day of amphotericin B in combination with 2.5 g i.v./day of 5‐fluorocy‐tosine did not lead to any improvement in the patient. The patient became asymptomatic after the first week of treatment with a daily dose of 400 mg of fluconazole, administered intravenously. After two months of this regimen, all laboratory tests on CSF and blood specimens were negative. Zusammenfassung. Es wird über eine Crypto‐coccus‐Meningoenzephalitis bei einem 22jährigen Mann mit Morbus Hodgkin im Stadium 3 B berichtet. Aus Liquor‐ und Blutproben wurde Cryp‐tococcus neoformans isoliert. Latex‐Antigen‐Nach‐weise und Tuschepräparate waren ebenfalls Cryptococcus‐positiv. Die einwöchige Behandlung mit Amphotericin B (20 mg/Tag i.v.) in Kombination mit 5‐Fluorcytosin (2,5 g/Tag i.v.) führte beim Patienten nicht zur Besserung. Dagegen wurde der Patient nach einer Woche Fluconazol‐Behandlung mit 400 mg täglich i.v. asymptomatisch. Zwei Monate nach der Fluconazol‐Behandlung waren alle Laboruntersuchungen des Liquors und der Blutkulturen negativ.