Sporotrichosis outbreak and mouldy hay in NSW.

BACKGROUND: Sporotrichosis is a subacute/chronic fungal infection caused by Sporothrix schenckii. The fungus thrives on organic matter including hay, wood, moss, soil and plants. Zoonotic transmission has also been reported. Lesions present as superficial skin nodules that become purulent and ulcerate. Lymphocutaneous spread is common. Haematogenous spread is uncommon and case fatality is rare. OBJECTIVE: The aim of this article is to describe an outbreak of sporotrichosis in New South Wales. DISCUSSION: A cluster of six cases was identified in the NSW mid-north coast area in the first half of 2013. Telephone interviews were conducted in an attempt to identify possible exposures. General practitioners were contacted to report on patients with chronic non-healing skin lesions. A batch of mouldy hay supplied by a local farmer was identified as the potential source of exposure. Despite effective treatment with oral antifungals, diagnosis of sporotrichosis is often delayed and prolonged courses of antibiotics are unnecessarily prescribed. Timely detection and management (including referral to a dermatologist or infectious diseases specialist) significantly reduces morbidity. Personal protection is the key to prevention.

Synovial chondromatosis of the elbow in a child.

Synovial chondromatosis is cartilaginous metaplasia of mesenchymal remnants of synovial tissue of the joints. Its main characteristic is the formation of cartilaginous nodules in the synovium and inside the articular space (loose bodies). It usually presents between the third and fifth decades and is rare in children. It presents as a mono-articular pathology affecting large joints such as the knee, hip, and elbow. The main symptoms are pain, swelling, and limitation of movements in the affected joint. Diagnosis is made by panoramic radiographs, computed tomography scan, and mainly magnetic resonance imaging and on surgery. The authors describe of synovial chondromatosis presenting in the elbow of an 11 year-old girl which is unreported to the best of our knowledge.