During March 2016–January 2019, Burkholderia cepacia complex (BCC) infection developed in 13 persons who inject drugs (PWID) in Kowloon West Region, Hong Kong, China. Seven cases were infective spondylitis, 2 endocarditis, 2 septic arthritis, 1 intramuscular abscess and bacteremia, and 1 necrotizing fasciitis. Pulsed-field gel electrophoresis revealed that the isolates from 9 patients were clonally related. This clone caused major illness, and 11 of the 13 patients required surgical treatment. Clinicians should be aware of this pathogen and the appropriate broad-spectrum antimicrobial drugs to empirically prescribe for PWID with this life-threatening infection. Close collaboration among public health authorities, outreach social workers, and methadone clinics is essential for timely prevention and control of outbreaks in the PWID population.

Introduction: We report a local human case of Thelazia callipaeda eye infection in a 49-year-old lady with history of fly contact in Hong Kong. Case description: A 49-year-old lady presented with right eye foreign body sensation for one month. She recalled a fly being stuck onto her right upper eyelashes with mascara when she went hiking in a forest trail in Hong Kong. On assessment there were a lot of giant papillae on palpebral conjunctiva. Three living worms crawling on conjunctiva were discovered and removed in total. The worms were identified as Thelazia callipaeda by morphology and molecular sequencing. After removal, her symptoms resolved completely. Conclusion: Human thelaziasis is probably under-reported in many countries. The presence of giant papillary conjunctivitis in non-contact lens wearers should alert clinicians to the possibility of thelaziasis in patients with compatible exposure history in endemic regions. Ophthalmologists should increase their awareness towards this uncommon disease and should not wrongly attributed the symptoms to allergic conjunctivitis.

Background: Improvements in fungal species identification in the clinical laboratory has seen an increased recognition of cryptic Aspergillus species as a cause of invasive aspergillosis. Case: An 18-year-old male presented to hospital after a 1-month history of nasal congestion and facial headache. He had no significant medical history. An initial CT sinuses showed evidence of chronic sinusitis. He was discharged with oral amoxicillinclavulanate and prednisolone with a plan for outpatient management. Shortly thereafter he developed CNIII and CNIV palsy and was admitted to hospital with an MRI brain showing an expansile mass centred on the clivus extending into the posterior and pituitary fossa. A surgical procedure and sinus tissue biopsy was taken which demonstrated fungal hyphae. IV liposomal amphotericin B and posaconazole were commenced. Suede-like beige colonies were noted on the Sabouraud agar plate from culture of intraoperative specimens. Internal transcribed spacer (ITS) region sequencing (577 bp) identified it as Aspergillus felis. Despite antifungal therapy, his CNS infection progressed, and he died 2 weeks from admission to hospital. Conclusion: Aspergillus felis is a member of the A. viridinutans complex. It was named after the first host in which clinical disease was described. This is the first documented death in a human from A. felis infection.