Coccidioidomycosis is a fungal infection caused by Coccidioides species. The disease has wide clinical presentation and a distinct geographical distribution. We describe two cases of coccidioidomycosis in returned Australian travellers who presented to Nambour Hospital. Knowledge of the international geographical distribution of endemic fungal infections and their clinical manifestations can assist in earlier diagnosis and appropriate management.

Introduction: Pruritus is one of the well-recognized major skin derangements in patients with advanced renal failure and are usually  without visible skin lesions. Only few studies have addressed this issue in Nepalese population. Objective:.The present study aims to identify the prevalence and associated factors of uremic pruritus in chronic dialysis patients in western Nepal. Methodology:A prospective observational study was conducted to include all chronic dialysis patients with uremic pruritus at the Manipal Teaching Hospital, Pokhara, Nepal over a period of one year (June 2018 and May 2019). Results: During the study period, a total of 59 patients were included in the study with mean age of 55.8±15.8years,of which 37 (63%) patients developed uremic pruritus. Statistically significant relationship betweenpresence of pruritus and  pruritus severity with frequency of itching grade and sleep disturbance score among elderly (p=0.001) were observed The serum urea can predict uremic pruritus among elderly patients with a good diagnostic value.  The multivariate analysis showed male gender, hypertension, elevated serum albumin and random blood sugarwere independent predictors of pruritus in patients undergoing chronic dialysis. Conclusions: Our findings demonstrate that higher proportion ofpatients undergoing chronic dialysis werediagnosed with uremic pruritus (63%) and occurrence of pruritus had association with frequency of itching grade and sleep disturbance score .The serum levels of urea may predict the occurrence of pruritus among elderly patients.Furthermore, a large multicenter study is warranted with longer follow up which may provide robust information on the burden of pruritus and its associated factors to guide appropriate management among elderly.

Background Onychomycosis is extremely rare in neonates, infrequently reported in children and is considered to be exclusively a disease of adults. Case presentation We, herein report a case of fingernail onychomycosis in a 28-day-old, healthy, male neonate. The child presented with a history of yellowish discoloration of the fingernail of the left hand for one week. The etiological agent was demonstrated both by microscopic examination and culture of nail clippings. The isolate grown on culture was identified as Candida albicans by phenotypic characteristics and by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antifungal sensitivity testing was performed by broth dilution method as per the Clinical & Laboratory Standards Institute guidelines. An oral swab culture of the child also yielded C. albicans with the same antibiogram as the nail isolate. The case was diagnosed as distal and lateral subungual candida onychomycosis of severity index score 22 (severe) and was treated with syrup fluconazole 6 mg/kg body weight/week and 5% amorolfine nail lacquer once/week for three months. After three months of therapy, the patient completely recovered with the development of a healthy nail plate. Conclusions The case is presented due to its rarity in neonates which, we suppose is the first case report of onychomycosis from Nepal in a 28-day-old neonate. Oral colonization with pathogenic yeasts and finger suckling could be risk factors for neonatal onychomycosis.

Introduction: The etiology of dermatoses involving genital areas could be venereal or on-venereal.  These disorders are responsible for mental distress and guilt which can be minimized by appropriate diagnosis and information to the patients. Objectives: To assess the clinical pattern and prevalence of various non venereal genital dermatoses in a referral center. Materials and Methods:  This was a hospital-based descriptive study involving patients with non-venereal diseases visiting outpatient clinics of Department of Dermatology. After informed consent, all the parameters were recorded in a proforma and analyzed. Results: Total of 70 patients with non-venereal genital dermatoses were included. Mean age of the patients was 33 years. Majority were male, married and had history of irregular use of contraceptives. Duration of symptoms ranged from one to 36 months with mean of four months. Total 19 types of non-venereal skin diseases were noted with major complaint of itching in genitalia in 22 (31.4%). Primary site of involvement/complaint was vulva in 19 (27.1%), scrotum in 17 (24.3%), groin in 18 (25.7%) and penile area in 14 (20.0%).  The most common final dermatological diagnosis in majority was fungal infections and neurodermatitis in 12.9% each. Extramarital relationship was reported by 37 out of 70 patients (52.9%), while 31 patients correlated their symptoms with sexual exposure. Conclusions: Itching was the most common presenting complaint with infective etiology. The current study highlighted the relevance of addressing non-venereal genital dermatoses in order to avoid the general misconception that all genital lesions are sexually transmitted.

Background: Peripheral ulcerative keratitis (PUK) is a disorder consisting of a crescent-shaped destructive inflammation of the perilimbal corneal stroma. Case: We present a case of PUK following acute bacterial conjunctivitis in a 60-year-old lady with a history of on-and-off joint pain for two years. After admission to the hospital, she underwent conjunctival resection and was given topical and oral steroids. She was prescribed hydroxychloroquine after confirming the diagnosis of rheumatoid arthritis with a positive RA factor. Conclusion: This report highlights the role of infection as a triggering agent in the induction of PUK in an otherwise quiescent cornea. Keywords: conjunctivitis; peripheral ulcerative keratitis; rheumatoid arthritis DOI: 10.3126/nepjoph.v2i1.3709 Nep J Oph 2010;2(1) 71-73