Infected ascites: Distinguishing secondary peritonitis from spontaneous bacterial peritonitis in a cirrhotic patient with classic symptoms.

Introduction: Spontaneous bacterial peritonitis can be differentiated from secondary bacterial peritonitis by the absence of a surgically treatable intra-abdominal source of infection. However, oftentimes this is unapparent and other clinical clues need to be sought after to make the right diagnosis.

Case: A 64-year-old woman was admitted because of three days of worsening diffuse abdominal pain and distention.

Fulminant necrotising fasciitis by community-acquired methicillin-resistant Staphylococcus aureus.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a rare cause of necrotising fasciitis (NF), and is usually not fulminant as in group A Streptococcus (GAS), the archetypal aetiology. We report an unusually fulminant case of NF by CA-MRSA in an immunocompetent patient. A 52-year-old man presented to the emergency department with 1 week of progressive left thigh pain and swelling.

Use of fungal blood cultures in an academic medical center.

We studied the use of fungal blood cultures in our hospital. They added little compared to routine culture results, but clinicians ordered them for sicker patients, when facing diagnostic uncertainty, or after prior candidemia. We need a practical guideline for when to order fungal blood cultures.