Trichosporon asahii is a yeast-like fungus that is emerging as an important cause of invasive infections in tertiary medical centres. A 58-year-old Chinese man with no known medical illnesses presented with liver lacerations and multiple fractures following an alleged 12-foot fall at a construction site. The gravity of his injuries and poor haemodynamic status necessitated an intensive care unit (ICU) admission, during which several febrile episodes were detected and multiple antibiotics were administered. After being in the ICU for at least two weeks, a urease-positive yeast was isolated from the patient's blood. The yeast formed dry, fuzzy and wrinkled white colonies on Sabouraud dextrose agar following prolonged incubation, and produced blastoconidia, true hyphae, pseudohyphae and arthroconidia on slide culture. It was identified biochemically by the ID 32 C kit as T. asahii. The yeast had elevated minimal inhibitory concentration (MIC) values to fluconazole, amphotericin B, flucytosine and all echinocandins tested. In view of this, the patient was treated with voriconazole and was successfully transferred to the general medical ward.
Shewanella spp. are infrequently implicated in human infections but they are emerging pathogens with particular significance in regions with warm climates, such as Southeast Asia. This is a case of a middle-aged diabetic and hypertensive man who presented with worsening congestive heart failure symptoms associated with fever and a painful right leg. His right leg had numerous scabs and was tender, warm and erythematous. He was provisionally diagnosed with decompensated heart failure precipitated by cellulitis and uncontrolled hypertension. His blood grew non-fermentative, oxidase-positive and motile gram-negative bacilli which produced hydrogen sulfide on triple sugar iron agar. When cultured on blood agar, mucoid and weakly β-haemolytic colonies were observed after 48 hours. API 20 NE named the isolate as Shewanella putrefaciens but 16S rRNA sequence analysis identified the organism as Shewanella algae. The patient was treated with a 10-day course of ceftazidime, which resulted in the resolution of the cellulitis.