How natural disasters change natural patterns: coccidioidomycosis imported to New Orleans.

OBJECTIVE: To identify cases of coccidioidomycosis in the New Orleans area following Hurricane Katrina. METHODS: We performed clinical surveillance across multiple medical disciplines and among three major teaching hospitals in the greater NOLA area in the posthurricane period. Each case involved a detailed history, physical examination, laboratory evaluations, and, in the two fatal cases, a comprehensive postmortem examination. RESULTS: We identified four cases of coccidioidomycosis during the posthurricane period: three with disseminated disease and one with disease limited to the respiratory tract. Two patients were co-infected with HIV and died during hospitalization; one was only diagnosed at autopsy. The two immunocompetent patients responded well to antimicrobial therapy. CONCLUSIONS: A heightened awareness of non-endemic disease is warranted in the practice of postdisaster clinical medicine and public health, as demonstrated by the appearance of coccidioidomycosis in the traditionally nonendemic NOLA area following Hurricane Katrina.

Skin and soft tissue infections.

Primary skin infections (ie, pyodermas) typically are initiated by some breach in the epidermis, resulting in infection by organisms, such as Streptococcus pyogenes and Staphylococcus aureus, that normally colonize the skin. Host-associated factors, such as immunosuppression, vasculopathy, neuropathy, or decreased lymphatic drainage, may predispose to skin infection. The clinical syndromes associated with skin infections are often characteristic and are defined most simplistically by anatomic distribution. Although often mild and self-limited, skin infections can be more aggressive and involve deeper structures, including fascia and muscle. This article discusses skin and soft tissue infections, including impetigo, hair follicle-associated infections (ie, folliculitis, furuncles, and carbuncles) erysipelas, cellulitis, necrotizing fasciitis, pyomyositis, septic bursitis, and tenosynovitis.