This report describes a case of necrotizing fasciitis presenting with septic shock due to an Aeromonas infection. The patient cut his foot while mowing the lawn and then spent time in a pool with black mold. He began feeling ill and developed swelling and a quarter-sized black area on his right lower extremity. Despite being hemodynamically unstable with systolic blood pressure in the low 70s, the patient was transferred to our facility from outside hospital 100 miles away. Upon arriving to facility, the patient appeared to be septic and the infected area of skin had grown. Irrigation and debridement were performed and appropriate antibiotic therapy was given; however, the patient subsequently died on hospital day 8. On review of the literature, cases of necrotizing fasciitis due to Aeromonas infection have been treated successfully with the aforementioned therapy; however, there is high mortality associated with these infections, many times related to a delayed diagnosis. Our patient also had multiple poor prognostic factors including hepatic dysfunction and immunosuppression.

Objective The aim of this study was to identify causative organisms of acute rhinosinusitis in immunosuppressed patients by a retrospective chart review. Methods Records were reviewed using International Classification of Disease, Ninth Edition codes for inpatient treatment of acute sinusitis. Patients were included only if they had formal sinus cultures obtained and were immunosuppressed, either carrying a diagnosis of a hematologic malignancy or receiving chemotherapy. Demographics, underlying malignancy, and culture results were recorded. Results Records of 74 patients with 104 cultures were obtained. There were 43 males and 31 females. The mean age was 51. The most common primary diagnoses were leukemia (65%) and lymphoma (23%). Sixty cultures resulted in either no growth or growth of usual respiratory flora. Of the 44 positive cultures, 5 were polymicrobial, resulting in 61 organisms isolated in total. Bacteria cultured were 73% Gram positive, whereas 27% were Gram negative. The most common Gram-positive organisms cultured were Staphylococcus species. Pseudomonas species were the predominant Gram-negative bacteria. Thirteen samples grew fungal organisms. Conclusions Medical management of sinusitis in an immunosuppressed patient seems to be adequate in most cases. Patients who fail to improve should undergo evaluation by an otolaryngologist to obtain cultures for directed antibiotic therapy. Infections by Staphylococcus species as well as quinolone- and cephalosporin-resistant Gram-negative organisms may be encountered, and clinicians should suspect their presence in patients with persistent disease and expand their antibiotic coverage appropriately.

Background178 new cases of leprosy were reported in 2015 with Florida being one of six states and contributing a large number (72%) of registered cases. It was also the only state showing an increasing occurrence compared with the previous years. Studies from other southern U.S. states in armadillos and leprosy patients demonstrate infection with the same strain of Mycobacterium leprae, confirming human armadillo exposure as the main risk factor for leprosy. In contrast, cases from Florida show no clear risk factor. We present three cases of leprosy from Hillsborough county (Florida) with no previous armadillo exposure but a different risk factor in common: being foreign-born.MethodsWe report three cases of leprosy presenting in a non-endemic area of Florida during the past five years and highlight the absence of direct armadillo exposure as a risk factor for developing the disease.ResultsCase 1: A 35-year-old male from Mexico presented with multiple erythematous non-tender cutaneous lesions and numbness in both hands. He had a history of leprosy exposure from a Haitian inmate during incarceration in Florida. Biopsy confirmed borderline lepromatous leprosy.Case 2: A 67-year-old female from Cuba presented with disseminated circular ulcerative lesions and severe hypesthesia of lower extremities. She denied leprosy or armadillo exposure. Diagnosis of borderline lepromatous leprosy was made through biopsy.Case 3: A 38-year-old female from Puerto Rico presented with disseminated painless plaques, edema of the hands with numbness and paresthesias. She worked as a nurse but denied leprosy or armadillo exposure. A biopsy confirmed borderline lepromatous leprosy with erythema nodosum leprosum.ConclusionOur case series demonstrates that a history of armadillo exposure is not always present. Other risk factors need to be considered when leprosy is a possible diagnosis in a patient. Place of birth is a very important factor due to the diverse and increasing foreign-born population in the United States.Disclosures All authors: No reported disclosures.

Neisseria, of the family Neisseriacea, are gram-negative, nonmotile, and non–spore-forming bacteria. The pathogens Neisseria gonorrhoeae and Neisseria meningitidis have been extensively studied and have long been recognized as human-specific pathogenic bacteria. Other members of the Neisseria genus, are nonpathogenic and are normal inhabitants of the upper respiratory tract. However, recent reports suggest that these normally nonpathogenic bacteria have the potential to produce infection. Cases of Neisseria species causing bacteremia, endocarditis, and pneumonia have been documented, as well as infection in immune-compromised hosts. Currently, there is a paucity of data regarding Neisseria species infection in patients with cancer. We report a case series of nongonococcal and nonmeningococcal Neisseria infection in patients with underlying malignancy to add to this limited body of knowledge and to provide further evidence of the opportunistic potential of these species in immune-compromised hosts.

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