Sp Infections Research Articles

Incidences of Aspergillus sp infections in Brazil

The main objective of this research was to analyze the incidence of Aspergillus sp in Brazil, as well as to research the species that cause the most infections and the impacts caused by fungi on Brazilian humanity. This is an exploratory descriptive research from reviews and bibliographic research in scientific articles from the database Scientific Electronic Library Online - Scielo, in the periods 2013 to 2023; Given the above, the need arose to research this subject from the questions: What are the incidences of infections caused by Aspergillus sp in immunosuppressed patients in Brazil? And which fungal species cause more infections? In which Brazilian population? The dissemination of these infections is due to the ingestion of contaminated food, produced without observations as to Good Agricultural Practices (GAP), affecting immunosuppressed patients, senile and hospitalized patients, causing serious neoplasms in humans, by these mycotoxin-emitting fungi, triggering aspergillosis, responsible for major complications in Brazil, and the most affected human organs are the lungs, heart, kidneys, gastrointestinal tract, liver, etc. The A. flavus, A. brasilienses and A. fusarium are the ones that most affect the essential organs and the Brazilian population, especially the lung, which is responsible for serious neoplasms, leading to death in a few days.

EFEKTIVITAS PENAMBAHAN EKSTRAK DAUN PEPAYA (Carica papaya L) UNTUK PENCEGAHAN Saprolegniasis PADA TELUR IKAN MAS PUNTEN (Cyprinus carpio)

Pappaya leaf (Carica papaya L) contains antifungal and antibacterial compounds which can be applied to prevent transmission of Saprolegnia sp infections that attack carp eggs (Cyprinus carpio). The method in this study used several treatments, namely treatment A (control), B (papaya leaf extract 0.75 mg / l), C (papaya leaf extract 1 mg / l), D (papaya leaf extract 1.25 mg / l) and treatment of E (papaya leaf extract 1.5 mg / l). The results showed that there were significantly different treatments for the addition of papaya leaf extract to the hatching rate of carp punten eggs, with treatment C (1 mg / l) being the best treatment in increasing the hatching rate of 89.5%. Furthermore, the addition of papaya leaf extract to the prevalence of Saprolegnia sp fungi showed that treatment C (1 mg / l) was the best treatment in suppressing the prevalence of saprolegnia sp fungi with a prevalence rate of only 10.5%. Then the addition of papaya leaf extract to the goldfish survival rate showed a significant difference between treatments, with treatment C (1 mg / l) being the best treatment in increasing the value of Punten Carp survival arte with a survival rate of 94.68%. Therefore from this study it can be seen that the safe dose in the use of papaya leaf extract is to use a dose of 1 mg / l to suppress the prevalence of saprolegnia sp fungi and increase the hatching rate and increase the survival rate of the Punten Goldfish. Keyword: Saprolegnia sp, Papaya Leaves, Punten Carp

Preparation and In vitro Evaluation of Efficacy and Toxicity of Polysorbate 80-coated Bovine Serum Albumin Nanoparticles containing Amphotericin B.

In this study, bovine serum albumin (BSA) nanoparticles coated with polysorbate- 80 (PS-80) and containing amphotericin B (AmB) were developed using a coacervation method. The nanoparticles were spherical, had a uniform size distribution (polydispersity < 0.25), a small mean size (185 ± 5 nm), a high zeta potential (-38.0 ± 0.7 mV), and a high AmB encapsulation efficiency (93 ± 1%). The AmB release profile was prolonged and diffusion-controlled, resulting in a low degree of AmB aggregation in solution. The physicochemical characteristics of these AmB containing nanoparticles were evaluated by X-ray diffraction, Fourier transform infrared spectroscopy, differential scanning calorimetry, and derivative thermogravimetry and showed that the nanoencapsulation process lead to AmB amorphization while maintaining its chemical integrity. In a hemolysis assay, AmB-loaded PS-80-coated BSA nanoparticles demonstrated an absence of cytotoxicity toward erythrocytes, whereas pure and commercial AmB were highly hemolytic. In an assay to assess antifungal activity against Cryptococcus neoformans, AmB-charged PS-80-coated BSA nanoparticles were effective, however, due to the prolonged AmB release from the nanoparticles, the MIC was higher than for pure or commercial AmB. PS-80-coated BSA nanoparticles are potential carriers for the delivery of AmB for the treatment of Cryptococcus sp infections.

Identification of rickettsial immunoreactive proteins using a proximity ligation assay Western blotting and the traditional immunoproteomic approach.

The closely related species Rickettsia conorii and R. africae are both etiological agents of rickettsiosis, a tick-borne serious infective disease. The laboratory diagnosis is based on serology, but remains not enough specific to provide the diagnosis at the species level. Here, we attempted to identify specific proteins that would enable the discrimination of R. africae sp from R. conorii sp infections. We screened 22 R. africae- and 24 R. conorii-infected sera at different course of infection using a traditional immunoproteomic approach. In parallel, we focused on the technical development of a "relatively new technique" named a proximity ligation assay coupled to two-dimensional Western blotting. The top range markers of R. africae early infection were rpoA, atpD, and acnA, ORF0029, R. africae active infection were rOmpB β-peptide, OmpA, groEL and ORF1174, early R. conorii infection was prsA, RC0031, pepA, R. conorii active infection were ftsZ, cycM and rpoA. They are candidates for serodiagnosis of rickettsioses.

Life-Threatening Pneumopathy and U urealyticum in a STAT3-Deficient Hyper-IgE Syndrome Patient

A deficiency in signal transducer and activator of transcription 3 (STAT3) is responsible for autosomal dominant hyperimmunoglobulin E syndrome, an immunodeficiency syndrome causing Staphylococcus aureus, Streptococcus pneumonia, Haemophilus influenzae, and, rarely, Pseudomonas aeruginosa and Aspergillus sp infections. Currently, intracellular pathogens are not targeted in the management of severe infections. The pathophysiologic mechanism of hyperimmunoglobulin E syndrome immunodeficiency has recently been linked to a disorder in the T helper 17 pathway and disruption of the interleukin -23/interleukin-17 axis. We report an unusual case of severe pleuropneumopathy by Ureaplasma urealyticum in a teenage girl with STAT3-deficient hyperimmunoglobulin E syndrome (STAT3 HIES). A previous case of severe lung infection by Mycoplasma pneumoniae has already been described in a STAT3-deficient patient, but U urealyticum has never been reported in patients with STAT3 HIES. After a review of the literature, it seems that the specific immunodeficiency pathway of STAT3 HIES exposes STAT3 HIES patients to Ureaplasma lung infections because the pathophysiology of STAT3 HIES and Ureaplasma is based on STAT3 and T helper 17 cells.

Situação da tuberculose em ovinos consorciados com bovinos leiteiros na região sudoeste maranhense

RESUMO: Objetivando conhecer a situação da tuberculose ovina no Maranhão, avaliaram-se 343 ovinos da região sudoeste do estado, 247 fêmeas e 96 machos, com idade acima de 6 meses, por meio do teste cervical comparativo (TCC), com inoculação de tuberculinas na região cervical direita. Cranialmente, injetou-se derivado proteico purificado (PPD) aviário; e caudalmente, PPD bovino, em doses individuais de 0,1 mL. Todos os animais apresentaram resultado negativo para tuberculose, entretanto, 65 ovinos apresentaram reação à tuberculina bovina superior à aviária. Para investigar a possibilidade de baixa sensibilização ou anergia em animais com tuberculose avançada, foi necropsiado um ovino caquético, idade acima de quatro anos, com resultado negativo ao TCC, porém, com reação à tuberculina aviária e linfonodos aumentados com consistência endurecida. Os resultados indicaram infecções por C. pseudotuberculosis, Actinomyces pyogenes, Staphylococcus aureus e Mycobacterium sp. A cultura e o isolamento resultaram em Pseudomonas aeruginosas e Bacillus sp. Não foram visualizadas estruturas bacterianas compatíveis com bacilo álcool ácido resistente (BAAR). Os resultados confirmam ausência de animais reagentes ao M. bovis, pressupondo inexistência da tuberculose em ovinos na região estudada.

Nationwide Trends in Bacterial Meningitis before the Introduction of 13-Valent Pneumococcal Conjugate Vaccine-Burkina Faso, 2011-2013.

BackgroundFollowing introduction of Haemophilus influenzae type b vaccine in 2006 and serogroup A meningococcal conjugate vaccine in 2010, Streptococcus pneumoniae (Sp) became the leading cause of bacterial meningitis in Burkina Faso. We describe bacterial meningitis epidemiology, focusing on pneumococcal meningitis, before 13-valent pneumococcal conjugate vaccine (PCV13) introduction in the pediatric routine immunization program in October 2013.MethodsNationwide population-based meningitis surveillance collects case-level demographic and clinical information and cerebrospinal fluid (CSF) laboratory results. Sp infections are confirmed by culture, real-time polymerase chain reaction (rt-PCR), or latex agglutination, and CSF serotyped using real-time and conventional PCR. We calculated incidence rates in cases per 100,000 persons, adjusting for age and proportion of cases with CSF tested at national reference laboratories, and case fatality ratios (CFR).ResultsDuring 2011–2013, 1,528 pneumococcal meningitis cases were reported. Average annual adjusted incidence rates were 26.9 (<1 year), 5.4 (1–4 years), 7.2 (5–14 years), and 3.0 (≥15 years). Overall CFR was 23% and highest among children aged <1 year (32%) and adults ≥30 years (30%). Of 1,528 cases, 1,036 (68%) were serotyped: 71% were PCV13-associated serotypes, 14% were non-PCV13-associated serotypes, and 15% were non-typeable by PCR. Serotypes 1 (45%) and 12F/12A/12B/44/46 (8%) were most common. Among children aged <1 year, serotypes 5 (15%), 6A/6B (13%) and 1 (12%) predominated.ConclusionsIn Burkina Faso, the highest morbidity and mortality due to pneumococcal meningitis occurred among children aged <1 year. The majority of cases were due to PCV13-associated serotypes; introduction of PCV13 should substantially decrease this burden.

Robust Th17 response to intranasal group A streptococcal infection requires IL-6 produced by CD301b+CD11b+CD103- migratory dendritic cells (MUC2P.937)

Abstract Intranasal (i.n.) Group A Streptococcal (Streptococcus pyogenes - Sp) infections generate a vigorous Th17 response. We tested the hypothesis that a specific dendritic cell (DC) subset in the nasal associated lymphoid tissue and cervical lymph nodes (CLN), preferential sites of colonization and lymphatic drainage site for i.n. Sp, are responsible for this skewing of the T cell response. The hypothesis was tested by tracking polyclonal Sp peptide:MHCII-specific CD4+ T cells mice lacking specific DC subsets. We found that Sp peptide:MHCII-specific Th17 formation depended on an IL-6 producing CD301b+ CD11b+ CD103- migratory DC population in the CLN. The results contrast with other findings implicating CD11b+ CD103+ DC in Th17 induction in the intestinal mucosa. Therefore, different DC subsets are responsible for Th17 generation through different mucosal surfaces.

Endocarditis by Kocuria rosea in an immunocompetent child

Kocuria rosea belongs to genus Kocuria (Micrococcaceae family, suborder Micrococcineae, order Actinomycetales) that includes about 11 species of bacteria. Usually, Kocuria sp are commensal organisms that colonize oropharynx, skin and mucous membrane; Kocuria sp infections have been described in the last decade commonly affecting immunocompromised patients, using intravenous catheter or peritoneal dialysis. These patients had mainly bacteremia/recurrent sepsis. We hereby describe the case of a 10-year-old girl, immunocompetent, who had endocarditis/sepsis by K. rosea which was identified in five different blood cultures by Vitek 2 ID-GPC card (BioMérieux, France). Negative HIV serology, blood count within normal range of leukocytes/neutrophils and lymphocytes, normal fractions of the complement, normal level of immunoglobulins for the age; lymphocyte immunophenotyping was also within the expected values. Thymus image was normal at chest MRI. No catheters were required. Identification of K. rosea was essential to this case, allowing the differentiation of coagulase-negative staphylococci and use of an effective antibiotic treatment. Careful laboratory analysis of Gram-positive blood-born infections may reveal more cases of Kocuria sp infections in immunocompetent patients, which may collaborate for a better understanding, prevention and early treatment of these infections in pediatrics.

ABSTRACT 427

Background and aims: Streptococcus pneumoniae (SP or pneumococcus) causes many childhood diseases and is a significant cause of morbidity and mortality in children worldwide. Invasive pneumococcal disease could result in death or permanent disabilities despite treatment with systemic antibiotics. Aims: To investigate the pattern of morbidity and mortality associated with severe SP infection and pediatric intensive care unit (PICU) admission. Methods: A retrospective study between 2002 and 2013 of all children in the PICU with a laboratory isolation of SP. Results: There were 20 (1.2%) PICU patients with SP isolations [blood culture (n=6 patients), CSF (n=1) and pleural/pulmonary specimens (n=13)]. 90% of SP were sensitive to penicillin, and all SP specimens were sensitive to cefotaxime and vancomycin. SP infections were associated with high PICU mortality of 25% (or 5% of total PICU mortality), high rates of need for mechanical ventilatory (65%), inotropic supports (35%) and dialysis (15%), and an odds of PICU deaths of 5.96 (p=0.0008). Older children had significantly higher prevalence of premorbid conditions such as malignancy, mental retardation/cerebral palsy (MRCP)+/-seizure disorders, chromosomal or genetic disorders (p=0.003) than children < 5 years of age. Serotypes were available for some of these specimens which included 19A, 19F, 6B, 3 and 6C. There were 4 deaths with multi-organ system failure and hemolytic uremic syndrome (two 19A, and two serotype 3). Conclusions: Severe SP infections are associated with significant morbidity and mortality despite treatment with systemic antibiotics and ICU support. The expanded coverage of newer polyvalent pneumococcal vaccines can probably prevent infections by serotypes 19A, 6B and 3.

Vitamin E boosts resistance to Streptococcus pneumoniae infection in aged mice by inhibiting hepoxilin A3‐mediated neutrophil recruitment across the lung epithelium (392.4)

Streptococcus pneumoniae (Sp) infections in the elderly are a significant health and economic burden. We showed that vitamin E (VE) supplementation reverses the age‐associated decline in resistance to Sp in mice. To identify mechanisms of VE‐mediated protection, young and old (2 and 22 mo, respectively) mice were fed a control (30 PPM VE) or supplemented (500 PPM VE) diet for 1 mo and then intratracheally challenged with Sp. Aged mice fed the control diet suffered excessive pulmonary inflammation relative to young mice, with almost two‐fold higher levels of neutrophil infiltration (PMNs; p= 0.0157), a feature associated with pulmonary damage and poor disease outcome. VE supplementation reduced pulmonary inflammation in old mice to levels found in young mice. VE also inhibited Sp‐induced PMN egress across polarized lung epithelial monolayers. PMN trans‐epithelial migration in response to Sp infection requires 12‐lipoxygenase‐ (12‐LO‐) dependent production of the eicosanoid hepoxilin A3 (HXA3) but VE had no effect on 12‐LO levels or activity. Rather, VE decreased the responsiveness of PMNs to HXA3. These results indicate that VE dramatically reduces age‐associated susceptibility to Sp in a murine infection model and identify HXA3 responsiveness as a key target for VE‐mediated reduction of PMN migration in aged mice.Grant Funding Source: Supported by Tufts Collaborates, ASPEN ‘13 Abbott Nutrition Grant and USDA Contract #58‐1950‐0‐014

P085: Surveillance of drug-resistant Salmonella sp and Shigella sp infections in Rwanda

Salmonella sp. and Shigella sp infections are public health threat worldwide, particularly in Sub-Saharan Africa including in Rwanda. This study was done to identify Salmonella sp. and Shigella sp. currently circulating in Rwanda and determine their drug susceptibility pattern.

Streptococci–Human Papilloma Virus Interaction With Ethanol Exposure Leads to Keratinocyte Damage

Ethanol, human papilloma virus (HPV), and poor oral hygiene are risk factors that have been attributed to oral carcinogenesis. Streptococci sp and HPV infections are common in the head and neck, often associated with sexual activity. Although HPV is linked to head and neck squamous cell carcinoma, it is unclear whether there is a similar role for Streptococci sp. This cell study examines whether Streptococci sp and HPV-16 with exposure to ethyl alcohol (ETOH) can act as cofactors in the malignant transformation of oral keratinocytes. ETOH (0.1%-20% vol/vol) was used to investigate Streptococci sp attachment with immortalized E6-expressing HPV/HOK-16B cells, human oral buccal keratinocytes, and foreskin keratinocytes. Streptococci sp (Streptococci mutans [LT11]) and various strains of acetaldehyde (AA) producer and nonproducer Streptococcus salivarius (110-1, 109-2, 101-7, and 107-1) and a lactic acid producer bacterium, Lactobacillus rhamnosus (24-1 and 25-2), were examined for interactions with keratinocytes by use of a green dye (percent of cells with colonies after 24 hours). Carcinogens, AA, malondialdehyde, DNA damage, and proliferation (5'-bromo-2-deoxyuridine) among keratinocytes were also quantified. AA and malondialdehyde production from permissible Streptococci sp significantly increased with attachment to keratinocytes, whereas L rhamnosus did not significantly attach to keratinocytes. This attachment was associated with enhanced levels of AA adduct formation, proliferation (5'-bromo-2-deoxyuridine incorporation), and enhanced migration through integrin-coated basement membrane by HPV oral keratinocytes, which are characteristics of a malignant phenotype. These cell studies suggest that oral Streptococci sp and HPV (HPV-16) cooperate to transform oral keratinocytes after low-level ETOH (1%) exposure. These results appear to suggest a significant clinical interaction, but further validation is warranted.

Immunity to secondary bacterial pneumonia caused by Streptococcus pneumoniae following Influenza A infection (108.10)

Abstract IAV is highly contagious and responsible for both seasonal and pandemic flu. However, mortality associated with IAV is mainly due to secondary bacterial infections. The bacterial and host factors that mediate lethality, as well as the protective immune mechanisms against co-infections, are largely unknown. By sequentially infecting mice with IAV and Sp (IAV/Sp), we show that IAV-infected mice are highly susceptible to secondary Sp infections (&amp;lt;10 CFU). Mice lacking IL-12, Type 1 IFN receptors, or both were just as susceptible to an IAV/Sp infection, suggesting these inflammatory cytokines are not involved in lethality. IAV-specific CD8 T cells from IAV/Sp co-infected mice had increased PD-1 expression, a marker associated with dysfunctional/exhausted CD8 T cells. When we immunized mice with different strains of IAV or Sp and challenged them with IAV/Sp co-infection, IAV-immunized mice were fully protected against an IAV/Sp infection. Immunization with one IAV strain provided cross-protection against a co-infection challenge with a different serotype strain of IAV. Immunization with Sp prolonged survival of co-infected mice, and was IL-12 dependent. We conclude that 1) Early inflammatory cytokines are not responsible for death caused by IAV/Sp co-infections, 2) Secondary Sp infections do not affect the magnitude but the quality of IAV-specific CD8 T cell responses, and 3) cross-protective immunity against IAV/Sp co-infections can be induced by immunization with IAV or Sp.

Extended-spectrum β-lactamase-producing Salmonella enterica serovar Oranienburg (CTX-M-2 group) in a pediatric hospital in Tucumán, Argentina

Salmonella sp infections have been reported over recent years in hospitals in Argentina and other countries due to multiresistant strains. The aim of this study was to characterize the extended-spectrum beta-lactamases in third-generation cephalosporin-resistant strains of Salmonella enterica serovar Oranienburg. We studied 60 strains isolated from children with gastroenteritis and/or extraintestinal complications. The antibiotic susceptibility patterns of the isolates were analyzed and the beta-lactamases were characterized using phenotyping and genotyping methods. All the strains were resistant to ampicillin, cefotaxime, cefepime and aztreonam and partially susceptible to ceftazidime, thus corresponding well with the resistance phenotype conferred by CTX-M-type beta-lactamases. An isoelectric point enzyme (pI = 7.9) was detected in all of the strains, and this was confirmed by PCR as a member of the CTX-M-2 group. This is the first report of Salmonella enterica serovar Oranienburg producing beta-lactamases of the CTX-M-2 group in a pediatric hospital in Tucumán, Argentina.

Prevalence of bacterial infections in nomadic fulani herdsmen of Ebonyi State, Nigeria

Over the years, nomadic Fulani herdsmen have established different settlement camps outside the traditional villages of their indigenous host communities in Ebonyi State. With increasing concerns about the health condition of the nomads, this study was undertaken to investigate the prevalence and distribution of bacterial infection amongst the spatially distributed population of the nomadic Fulani the state. A total of 1218 willing nomads were examined for bacteria infections between June 2006 and August 2007. Urine, stool and blood samples were collected from the herdsmen and their children using standard bacteriological techniques. Out of the 1218 samples taken from 7 bush encampments, 677(55.6%) had various bacterial infections. Results showed that Enterococci sp (30.3%) and Neisseria sp (23.3%) infections were predominant when compared to Enterobacter sp (20.0%), Staphylococci sp (14.2%) and Acinetobacter sp (0.3%) infections of the population. The implications of these findings are discussed.Keywords: Bacteria infection, nomadic Fulani, herdsmen, cattle, Nigeria

Increased Susceptibility for Superinfection with Streptococcus pneumoniae during Influenza Virus Infection Is Not Caused by TLR7-Mediated Lymphopenia

Influenza A virus (IAV) causes respiratory tract infections leading to recurring epidemics with high rates of morbidity and mortality. In the past century IAV induced several world-wide pandemics, the most aggressive occurring in 1918 with a death toll of 20–50 million cases. However, infection with IAV alone is rarely fatal. Instead, death associated with IAV is usually mediated by superinfection with bacteria, mainly Streptococcus pneumoniae. The reasons for this increased susceptibility to bacterial superinfection have not been fully elucidated. We previously demonstrated that triggering of TLR7 causes immune incompetence in mice by induction of lymphopenia. IAV is recognized by TLR7 and infections can lead to lymphopenia. Since lymphocytes are critical to protect from S. pneumoniae it has long been speculated that IAV-induced lymphopenia might mediate increased susceptibility to superinfection. Here we show that sub-lethal pre-infections of mice with IAV-PR8/A/34 strongly increased their mortality in non-lethal SP infections, surprisingly despite the absence of detectable lymphopenia. In contrast to SP-infection alone co-infected animals were unable to control the exponential growth of SP. However, lymphopenia forced by TLR7-triggering or antibody-mediated neutropenia did not increase SP-susceptibility or compromise the ability to control SP growth. Thus, the immune-incompetence caused by transient lympho- or leukopenia is not sufficient to inhibit potent antibacterial responses of the host and mechanisms distinct from leukodepletion must account for increased bacterial superinfection during viral defence.

Leuconostoc sp in cancer patients: a descriptive study

The species of Leuconostoc are uncommon opportunistic pathogens, which can be isolated in critically ill patients, immunocompromised hosts and in nosocomial infections. They are mostly isolated in bacteremia associated to intravascular devices and to the use of total parenteral nutrition. Nevertheless, other infections due to Leuconostoc sp have been described among which, meningitis, bloodstream infections, urinary tract infections and peritonitis have been reported. In this article we describe a series of cancer patients with Leuconostoc sp infections and their associated clinical conditions, and a literature review is presented.

Microbiologic Workload and Clinical Significance ofStreptococcus pneumoniaeIsolated during One Week in Spain

Most studies reporting Streptococcus pneumoniae (Sp) infections select either specific populations/diseases, or refer to a single or a low number of institutions. A nationwide point-prevalence study including 147 hospitals from which we collected all the isolates of Sp reported in a single week (February 16-22, 2004). Workload and clinical data were studied, and susceptibility testing and serotyping of all isolates were performed. The participating institutions had an estimated catchment population of 37,534,750 inhabitants. During the study week, microbiology laboratories received 224,956 samples of which 34,647 were positive and 360 had S. pneumoniae. Overall, 69% of the isolates were from adults (> or = 15 years). Most of the isolates (89%) were considered clinically significant. Infection was community-acquired in 88% of infections and monomicrobial in 79%. We calculated that S. pneumoniae was isolated 38 times per 100,000 inhabitants/year and it was present in 1% of all samples with one or more bacterial isolates. We also calculated that pneumococcal disease (invasive and noninvasive) was present in 34 patients per 100,000 inhabitants/year. Penicillin resistance (I+R) was 42%, and erythromycin resistance was 35%. The most frequent serotypes were 3, 19F, and 19A. Considering only invasive isolates, the estimated coverage of the 7-valent vaccine was 61% in children and 41% in adults, and the estimated coverage of the 23-valent vaccine in adults was 79%. A nationwide point-prevalence study is an efficient tool for surveying pneumococcal infection in a large population.

A deeply invasive Phoma species infection in a renal transplant recipient

Phoma sp, a fungus routinely isolated from the soil and a known plant pathogen, was found to be the cause of an aggressive, deep compartment hand infection in a renal transplant recipient. Previous reports have described minimally invasive Phoma sp infections with isolates recovered from the skin or subcutaneous tissue. This case, however, is the first reported in which Phoma sp was found to be both aggressive and deeply invasive. Histologic sections obtained from the synovium of the fourth and fifth dorsal hand compartments revealed invasive hyphal elements. Detailed examination with Grocott-Gomori methenamine-silver staining revealed branching filaments and pycnidia. A Phoma sp was isolated from culture after 2 weeks of incubation. Antifungal agent sensitivity testing found the organism to be sensitive to amphotericin B but resistant to both fluconazole and 5-flucytosine. Treatment required surgical debridement and the use of prolonged systemic amphotericin B therapy in order to effect cure. This is a unique case of a deeply invasive Phoma sp infection, indicating that such processes are not strictly indolent as previously reported.