Extended-spectrum b-lactamase (ESBL)-producing Escherichia coli isolates were obtained from hospitalized and nonhospitalized patients in Belgium between August 2006 and November 2007. The antimicrobial susceptibility of these isolates was determined and their ESBL genes were characterized. Clonal relationships between the CTX-Mproducing E. coli isolates causing urinary tract infections were also studied. A total of 90 hospital-and 45 community-acquired cephalosporin-resistant E. coli isolates were obtained. Tetracycline, enrofloxacine, gentamicin, and trimethoprim-sulfamethaxozole resistance rates were significantly different between the community-onset and hospital-acquired isolates. A high diversity of different ESBLs was observed among the hospital-acquired E. coli isolates, whereas CTX-M-15 was dominating among the community-acquired E. coli isolates (n ¼ 28). Thirteen different pulsed-field gel electrophoresis profiles were observed in the community-acquired CTX-M-15-producing E. coli, indicating that multiple clones have acquired the bla CTX-M-15 gene. All community-acquired CTX-M-15-producing E. coli isolates of phylogroups B2 and D were assigned to the sequence type ST131. The hospital-acquired CTX-M-15-producing E. coli isolates of phylogroups B2, B1, A, and D corresponded to ST131, ST617, ST48, and ST405, respectively. In conclusion, CTX-M-type ESBLs have emerged as the predominant class of ESBLs produced by E. coli isolates in the hospital and community in Belgium. Of particular concern is the predominant presence of the CTX-M-15 enzyme in ST131 community-acquired E. coli.

A case of autopsy-proven fungal pneumonia in a relapsed leukaemia patient is reported. The fungus Hormographiella aspergillata was cultured from two bronchoalveolar fluid samples and identified through morphological examination and ITS2 sequence analysis. In addition, galactomannan was detected in eight consecutive serum samples, which suggested a co-infection with Aspergillus species. The patient was treated with caspofungin. Case reportIn April 2003, a 34-year-old man was diagnosed with acute myeloid leukaemia. He responded favourably to remissioninduction chemotherapy followed by two courses of intensive consolidation. In September 2003, the patient underwent an uncomplicated allogeneic peripheral blood stem cell transplantation from an HLA-identical sibling. However, a relapse was diagnosed in December 2003. Reinduction chemotherapy with high-dose cytarabine (3 g m À2 b.i.d. for 4 consecutive days) was initiated, complicated by serious capillary leak syndrome, hepatic and renal failure and progressive encephalopathy. On day 6 of reinduction, the patient was transferred to the intensive care unit for mechanical ventilation, inotropic support and haemodialysis. On day 13, he experienced a new episode of neutropenic fever while already receiving meropenem therapy empirically. Blood cultures yielded Staphylococcus epidermidis; daily radiographs of the chest showed bilateral pulmonary infiltrates that remained unchanged. The patient defervesced after the initiation of vancomycin. On day 28, a diagnosis of probable invasive aspergillosis (according to EORTC/MSG consensus criteria) was made based on a progressive increase in serum galactomannan antigenaemia (Fig. 1), progression of pulmonary infiltrates and development of new consolidations on chest X-ray, dyspnoea and cough, and the microscopic demonstration (Grocott staining) of moulds (compatible with Aspergillus species) in a bronchoalveolar fluid (BAL) sample. In addition, cultures taken from two consecutive BAL samples (with an interval of 3 days) yielded 'fungi'. Because of severe hepatic impairment, therapy was started with caspofungin (70 mg loading dose, followed by 50 mg daily dose). However, on day 34, while still neutropenic, his clinical condition deteriorated rapidly. A high-resolution CT scan (Fig. 2) of the lungs demonstrated multiple large nodules in both lungs, surrounded by a halo of lower attenuation. The patient died on day 35 from respiratory failure and refractory septic shock.Autopsy was performed within 6 h of death. Tissue samples were taken from all major organs (except the brain) and from macroscopic abnormalities. On macroscopic examination, multiple intraparenchymal and subpleural haemorrhagic nodules were found in both lungs. Haematoxylin and eosin staining confirmed the presence of septated hyphae (Fig. 3), which had also invaded the surrounding blood vessels. There was no evidence of dissemination of the infection to other

Imported malaria remains a difficult problem in nonendemic areas of the world. We describe the clinical presentation of 101 cases of malaria diagnosed at the Leuven University Hospital between 1 January 1990 and 31 December 1999. Ninety-three patients (92%) presented initially at the emergency department. Diagnosis was initially not suspected by the referring physician in 48 patients (47%). Plasmodium falciparum was the commonest species, accounting for 67% of the cases. All but three patients had fever as the presenting symptom, but only 10 had a typical tertian fever pattern. Haemolytic anaemia, thrombocytopenia and hyponatraemia represented a typical triad in 20% of the cases. Only 13% of the malaria patients had taken correct chemoprophylaxis according to WHO recommendations. Eighty-three per cent of the patients were admitted to the hospital with a median duration of hospitalization of 4 days. All complications occurred in cases with P. falciparum. All patients were cured.

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