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Hordeolum is a common staphylococcal abscess that is characterized by a localized red, swollen, acutely tender area on the upper or lower lid Internal hordeolum is a meibomian gland abscess that points onto the conjunctival surface of the lid; external hordeolum or sty is smaller and on the margin Warm compresses are helpful Incision may be indicated if resolution does not begin within 48 hours An antibiotic ointment (bacitracin or erythromycin) applied to the eyelid every 3 hours may be beneficial during the acute stage Internal hordeolum may lead to generalized cellulitis of the lid

daily In critically ill patients who are not responding to conventional antifungal treatment, there may be a role for the addition of caspofungin to amphotericin B or voriconazole therapy, although randomized trials are lacking Based on promising results in neutropenic patients with invasive pulmonary aspergillosis, surgical resection warrants further study The mortality rate of pulmonary or disseminated disease in the immunocompromised patient remains well above 50%, particularly in patients with refractory neutropenia This high mortality rate often leads clinicians to institute prophylactic therapy around the time of bone marrow transplantation with agents such as itraconazole

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Bart-Delabesse E et al Detection of Aspergillus galactomannan antigenemia to determine biological and clinical implications of beta-lactam treatments J Clin Microbiol 2005 Oct;43(10):5214 20 [PMID: 16207986] Hope WW et al Laboratory diagnosis of invasive aspergillosis Lancet Infect Dis 2005 Oct;5(10):609 22 [PMID: 16183515] Singh N et al Aspergillus infections in transplant recipients Clin Microbiol Rev 2005 Jan;18(1):44 69 [PMID: 15653818]

Blastomycosis occurs most often in men infected during occupational or recreational activities out of doors and in a geographically limited area of the south central and midwestern United States and Canada Disease usually occurs in immunocompetent individuals Pulmonary infection is most common and may be asymptomatic When dissemination takes place, lesions are most frequently seen in the skin, bones, and urogenital system Cough, moderate fever, dyspnea, and chest pain are common These may resolve or progress, with bloody and purulent sputum production, pleurisy, fever, chills, loss of weight, and prostration Radiologic studies, either chest radiographs or CT scans, usually reveal pulmonary infiltrates and enlarged regional lymph nodes, though less commonly than in histoplasmosis or coccidioidomycosis Raised, verrucous cutaneous lesions that have an abrupt downward sloping border are usually present in disseminated blastomycosis Bones often the ribs and vertebrae are frequently involved Lesions appear to be both destructive and proliferative on radiography Epididymitis, prostatitis, and other involvement of the male urogenital system may occur Central nervous system involvement is uncommon Although they do not appear to be at greater risk for acquisition of disease, infection in HIV-infected persons may progress rapidly, with dissemination common Laboratory findings usually include leukocytosis and anemia, though these are not specific The organism is found in clinical specimens, such as expectorated sputum or tissue, as a thick-walled cell 5 20 mcm in diameter that may have a single broad-based bud It grows readily on culture Serologic tests are not well standardized A urinary antigen test is available, but it has some cross reactivity with Histoplasma; consequently, its usefulness in diagnosis and in assessing response to therapy is unclear Itraconazole, 100 200 mg/d orally for at least 2 3 months, is the therapy of choice for nonmeningeal disease, with a response rate of over 80% Amphotericin B, 03 06 mg/kg/d intravenously for a total dose of 15 25 g, is given for treatment failures or cases with central nervous system involvement Clinical follow-up for relapse should be made regularly for several years so that therapy may be resumed or another drug instituted.

Kauffman CA et al Endemic mycoses: Blastomycosis, histoplasmosis, and sporotrichosis Infect Dis Clin North Am 2006 Sep; 20(3):645 62 [PMID: 16984873]

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