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Six patients received salvage treatment with posaconazole oral suspension (800 mg/day in divided doses) for severe forms of histoplasmosis. One patient had pulmonary disease and 5 had disseminated disease. Previous antifungal therapy consisted of amphotericin B, itraconazole, fluconazole, or voriconazole. Posaconazole treatment duration for individual patients ranged from 6 weeks to 34 weeks. All patients had successful clinical outcomes with significant clinical improvements noted during the first month of therapy. Although the number of patients evaluated in this case series is small, the findings are encouraging and provide preliminary evidence that posaconazole may be a useful salvage treatment option for histoplasmosis involving a variety of infected tissues and organs.

A case of neonatal osteomyelitis in a baby with Down's syndrome is described. The causative organism was a non-encapsulated Haemophilus influenzae biotype I, which was isolated from pus at the site of infection. This organism has not previously been reported as a cause of neonatal osteomyelitis.

A cohort of 66 patients on maintenance haemodialysis was examined for serological (anti-HCV) and virological (HCV-RNA) evidence of infection with hepatitis C virus (HCV). Nine (13.6%) were anti-HCV positive, all of whom had detectable HCV-RNA in their serum. Statistical analysis of various risk factors (including length of time on haemodialysis, history of blood transfusion, history of renal transplantation and of previous hepatitis B infection) showed that only the length of time on haemodialysis was significantly associated with the acquisition of HCV infection. Genotypic analysis showed that five patients were infected with genotype 1 and a further two were infected with genotype 4. The latter finding is of significance because strains of genotype 4 are extremely uncommon in Western Europe. These results demonstrate that intra-unit transmission of HCV-infection took place in a group of patients on maintenance haemodialysis.

Liver abscess formation due to Fusobacterium nucleatum is rare. We describe an HIV-I antibody positive man, with normal surrogate markers of cell-mediated immunity, who presented with F. nucleatum bacteraemia and liver abscess formation. He was found to have IgG2 subclass deficiency. This case illustrates the clinical importance of altered B-cell function in patients who are at an early stage of HIV disease.

A case of septicaemia caused by Pediococcus pentosaceus is described. The role played by pediococci, and other vancomycin-resistant Gram-positive cocci, in disease states is examined. We suggest that in immunocompromised patients these organisms act as opportunist pathogens. This would appear to be the first reported case of P. pentosaceus septicaemia.

The treatment of an infected vascular graft invariably requires an extra-anatomic bypass through a non-infected tissue plane, as simple drainage with antibiotics is rarely successful. We report a case in which an established infection of a prosthetic vascular graft with Salmonella dublin was successfully treated with simple drainage and a prolonged course of oral ciprofloxacin.