Although infective endocarditis is frequently associated with splinter hemorrhages, and has been reported in patients with histoplasmosis, it is unlikely to have occurred in this patient. In histoplasma endocarditis the left-sided valves are more commonly affected, and approximately half of the patients have prior valvular Selleck Ivacaftor disease. Echocardiography usually shows extensive valvular lesions, and the disease is unlikely to respond promptly to medical treatment alone.[11] In this case, TEE revealed

no vegetations or valvular abnormalities, and all symptoms and signs resolved promptly with medical treatment alone. In addition, the patient had no other disease or condition associated with splinter hemorrhages. We thus hypothesize that

splinter hemorrhages can be a manifestation of disseminated histoplasmosis itself. Diagnosis of histoplasmosis relies on culture, histopathology, serologic tests, and antigen detection,[12] although culture is considered the gold standard for confirmation. Because histoplasmosis is not endemic in Israel, our laboratory does not have sufficient experience with identification by culture, and we rely on the use of PCR to confirm the final diagnosis. Moreover Selleckchem Pexidartinib serologic tests are known to be unreliable, especially in disseminated disease,[13] and culture yield is probably low in travelers,[12] emphasizing the need for faster and newer diagnostic strategies. Sinomenine Histoplasmosis is uncommon among returning travelers, and mostly presents as a pulmonary disease. When histoplasmosis is encountered among travelers,

it is commonly associated with cave exploration and appears in outbreaks associated with a common source.[14-18] However this is not always the case, and sometimes an environmental source of the infection is not found. Clinicians should therefore be aware of this uncommon infection and its various clinical manifestations in patients with the appropriate travel history. The authors state they have no conflicts of interest. “
“Rabies is an irreversible, fatal disease most frequently characterized by acute encephalitis that causes approximately 55,000 deaths annually in Africa and Asia. Disease occurs when rabies virus, a Lyssavirus, is transmitted to a human via the saliva of an infected mammalian carnivore or bat, usually a dog, if it comes in contact with mucous membranes or enters the body via a bite, scratch, or lick on broken skin. Animal reservoirs for rabies exist in all continental areas worldwide. Deaths are presumed to be underreported in areas with poor access to medical facilities. Children are considered to be at a higher risk than adults.1,2 Although the risk of contracting rabies in developed countries is generally low, those who travel to areas with high epizootic endemicity are at increased risk of exposure and death.