Pythium aphanidermatum is a fungus-like plant pathogen which has never been reported as a cause of human infection. We report a case of P. aphanidermatum invasive wound infection in a 21-year-old male injured during combat operations in Afghanistan.

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An occurrence of Vibrio cholerae non-O1/O139 gastroenteritis in the U.S. Gulf Coast is reported here. Genomic analysis revealed that the isolate lacked known virulence factors associated with the clinical outcome of a V. cholerae infection but did contain putative genomic islands and other accessory virulence factors. Many of these factors are widespread among environmental strains of V. cholerae, suggesting that there might be additional virulence factors in non-O1/O139 V. cholerae yet to be determined. Phylogenetic analysis revealed that the isolate belonged to a phyletic lineage of environmental V. cholerae isolates associated with sporadic cases of gastroenteritis in the Western Hemisphere, suggesting a need to monitor non-O1/O139 V. cholerae in the interest of public health. Vibrio spp. are natural inhabitants of marine and estuarine environments, and they cause human infections that most commonly present as gastroenteritis or wound infections and/or septicemia (1, 2). The infection is generally acquired through the consumption of contaminated food or water or by the direct invasion of wounds (3). Vibrio cholerae is the causative agent of cholera, the severe watery diarrheal disease that has the potential to become pandemic. Based on variable somatic (outer membrane) O-antigen composition, more than 200 serogroups of V. cholerae have been recognized to date (4). Of them, toxigenic strains of V. cholerae typically belong to serogroups O1 or O139 and are rare in the United States (5). All other serogroups, notably the non-O1/O139 serogroup, are frequently isolated from environmental sources and have been associated with sporadic cases of gastroenteritis or extraintestinal infections. Although none has caused a pandemic yet (6), these serogroups have reportedly caused epidemics of cholera through the acquisition of genes carried on mobile elements (e.g., O antigens, vibrio pathogenicity island 1 [VPI-1], VPI-2, cholera toxin phage [CTX], and heatstable enterotoxin [NAG-ST]). Human illnesses caused by environmental V. cholerae non-O1/O139 serogroups are reported regularly (7). Over the past few decades, environmental studies have shown that nontoxigenic V. cholerae strains inhabit estuarine waters along the Atlantic and Gulf coasts (8-14). They are most commonly isolated from environmental sources, such as brackish water, oysters, and sewage, and have been reported in many countries, such as Bangladesh, Brazil, Guam, Great Britain, and the United States, even when cholera outbreaks had not been recorded for decades in those countries (2).In the United States, the consumption of raw or undercooked seafood is the leading cause of non-O1/O139 V. cholerae-associated gastroenteritis, with isolated cases reported (8,15). Outbreaks of intestinal illness caused by non-O1/O139 V. cholerae have been reported more commonly than would be expected (16)(17)(18). Since 2000, an average of 44 cases has been reported each year (http:// www.cdc.gov/nationalsurveillance/cholera-vibrio-surveillance .html). The majority of infectio...

Third generation cephalosporins are commonly used in the treatment of leptospirosis. The efficacy of first generation cephalosporins has been less well-studied. Susceptibility testing of 13 Leptospira strains (11 serovars) to cefazolin and cephalexin was conducted using broth microdilution. Median minimal inhibitory concentration (MIC) for cefazolin and cephalexin ranged from < 0.016 to 2 μg/mL (MIC90 = 0.5 μg/mL) and from 1 to 8 μg/mL (MIC90 = 8 μg/mL), respectively. Efficacy of cefazolin and cephalexin in an acute lethal hamster model of leptospirosis was studied. Survival rates for cefazolin were 80%, 100%, and 100%, and survival rates for cephalexin were 50%, 80%, and 100% (treated with 5, 25, and 50 mg/kg per day for 5 days, respectively). Each treatment group showed improved survival compared with no treatment (P < 0.01), and none of the therapies, regardless of dose, was statistically significantly different than doxycycline. These results support a potential role for first generation cephalosporins as alternative therapies for leptospirosis.

Pneumocystis pneumonia is an increasingly recognized threat in non-HIV immunosuppressed patients and is associated with worse outcomes compared to HIV-infected patients. The preferred first line treatment is trimethoprim-sulfamethoxazole; however, second line treatments for those intolerant of this regimen have been primarily studied in patients with acquired immunodeficiency syndrome (AIDS). We report a case of Pneumocystis pneumonia in a 75-year-old man with chronic lymphocytic leukemia (CLL) and a history of sulfa allergy successfully treated with clindamycin-primaquine.