Introduction: Pulmonary fungus ball is a rare complication in pre-existing pulmonary cavitary lesions, due to some chronic pulmonary diseases including tuberculosis, lung abscess and sarcoidosis. Fungus ball is mostly caused by aspergillus. In many patients, fungus ball is asymptomatic, but in a significant number of them it can develop cough and hemoptysis, which may be massive and fatal. The cornerstone of assessment is chest imaging, along with sputum culture or aspergillus antibody in patient's serum. The purpose of this report is increment in attention to this complication in patients with previous pulmonary tuberculosis (TB). Case Presentation: The patient was a 23-year-old woman with chief complaint of fever, cough and hemoptysis, who was hospitalized in the Infectious Diseases Ward of Farshchian Sina hospital in March 2016. She had a history of anti-TB therapy from two years before. Sputum and bronchoalveolar lavage (BAL) were negative for cytology and Mycobacterium tuberculosis, but cultures of both samples were positive for Aspergillus niger. Her lung contrast-enhanced computerized tomography (CECT) scan revealed the presence of a fungus ball inside the upper lobe cavity of right lung. After lobectomy, fungal mass was confirmed by histopathology. Conclusion: In patients with pulmonary complaints (especially hemoptysis) and history of cavitary pulmonary tuberculosis, the differential diagnosis of community-acquired pneumonia, lung abscess, reactivation of tuberculosis and lung cancer as well as fungal infections should be considered.

Background and Objective: Empirical antibiotic therapy of communityand hospital-acquired infections without the knowledge of the common causes and resistance patterns of the infections can lead to the enhancement of antibiotic resistance. Regarding this, the aim of this study was to determine the etiologic agents and antibiotic resistance pattern of community-and hospital-acquired infections. Materials and Methods: This descriptive-analytical study was conducted on hospitalized patients with positive microbial cultures in two hospitals of Hamadan city, Iran, during 2012-2015. The participants were assigned into two groups of community-and hospital-acquired infections after their examination in terms of clinical manifestations. In addition to the common pathogens and their resistance patterns, the patients were examined for the type of interventions and underlying diseases. The data were analyzed in SPSS software (version 20) using the statistical tests. Results: Out of the 818 documented infections, 108 (13.2%) and 710 (86.8%) cases were community-and hospital-acquired infections, respectively. The majority of the positive cultures were respectively observed in the tracheal (62.7%), urinary (23.7%), and blood (9%) samples. Furthermore, the most frequent medical interventions included peripheral venous catheter (71.9%), suction (64.3%), ventilator (59.6%), and urinary catheter (16.5%). The most common etiologic agents of nosocomial infections were Escherichia coli (19.3%), Pseudomonas aeruginosa (18.9%), and Acinetobacter baumannii (16.6%). Regarding the communityacquired infections, the most common etiologic agents included E. coli (19.4%), coagulase-negative staphylococci (18.5%), and Pseudomonas aeruginosa (14.8%). The highest reported resistance among nosocomial infections was related to oxacillin and ciprofloxacin. On the other hand, community-acquired infection showed the highest resistance to vancomycin and ciprofloxacin. Conclusion: As the findings indicated, Gram-negative bacteria are more common in both community-and hospital-acquired infections. In addition, the results were indicative of the enhancement of antibiotic resistance over time.