Management of a Trichophyton tonsurans outbreak in a day-care center

Trichophyton tonsurans is the leading cause of tinea capitis in the United Kingdom (UK) as well as causing tinea corporis. This organism has been linked to several outbreaks in the UK and abroad, and such outbreaks may be prolonged since T. tonsurans can be difficult to control. There remains an incomplete consensus in the literature on the optimal management of such outbreaks of this infection. Following notification that a child with T. tonsurans was identified at a day-care center in the UK, initial investigations identified nine cases of fungal infection involving children and staff over the previous 7 months. We report on the management of an outbreak of T. tonsurans tinea capitis and tinea corporis among children and staff in a day-care center. An outbreak control team with representatives from dermatology, microbiology, day-care center management, and the Health Protection Agency initiated case ascertainment by scalp inspection and brushing of all children and staff at the nursery. Two complete rounds of screening were required before the outbreak was declared over. Infection control measures included antifungal shampoo use, exclusion of identified cases for a short period, removal of shared items from the center, and enhanced decontamination of fomites. The outbreak, which lasted longer than 12 months, involved 12 children and 7 staff members. Of these, 12 cases were confirmed by positive fungal culture. T. tonsurans is difficult to manage, especially in childcare settings, but case ascertainment, appropriate treatment with oral agents, and sustained infection control measures can be effective in controlling such outbreaks.

Rare species of actinomyces as causative pathogens in breast abscess

Actinomyces species are commensal flora usually found in the oropharynx, gastrointestinal tract, and female genital tract. Primary actinomycosis of the breast is an unusual condition, where the most commonly isolated pathogen has been Actinomyces israelii. In recent years, other Actinomyces strains have been found associated with breast disease. We present the first reported cases of breast infection caused by the rare species, Actinomyces turicensis and Actinomyces radingae. Both infections displayed chronicity and abscess formation. In the first case, the infection was refractory to recurrent aspirations and initial antibiotic therapy. In the second case, aspiration and prolonged antibiotic therapy was required to overcome the chronic infection.

Cutaneous Salmonella infection

Pustular dermatitis caused by Salmonella stanley developed on the arm of a veterinary surgeon after the delivery of a dead bovine calf. The vet did not develop any systemic symptoms and made a full recovery. This is the only report of cutaneous infection caused by this organism.

Nocardiosis in an immunocompromised patient--an unusual presentation

A case of disseminated nocardiosis in a 39-year-old immunosuppressed patient is described. This presented clinically as a septicaemia with meningitis, and the true diagnosis was delayed following an apparent initial response to broad-spectrum antibiotics. The need for increased awareness of unusual infections in immunosuppressed patients who may have had repeated and sometimes invasive diagnostic techniques is discussed.