Rift Valley Fever Potential, Arabian Peninsula

2 episodes of surgical debridement during the first month. The lesions began to improve in the second month of medical therapy, when skin grafting was performed. The patient remained well and was discharged after almost 3 months. Medications were continued for a total period of 6 months. The patient has been well for >2 years. P. insidiosum in tissues resembles agents of zygomycosis morphologically but, unlike the latter, rarely stains with hematoxylin and eosin. Various immunostainings also help identify the organism (4). With the exception of the facial-cranial form of the disease in the United States (5), most cases in Thailand occur in patients with chronic hemolytic anemia; thalassemia-hemoglobinopathy is the most common underlying disease. Major clinical manifestations include ocular and craniofacial infections in healthy children, arteritis usually originating from lower extremities, and chronic subcutaneous abscesses. Treatment options reported to be successful include supersaturated potassium iodide for the chronic cutaneous form (2), a combination of terbinafine and itraconazole in a single case of an acute, severe ocular, subcutaneous infection (6), and therapeutic vaccination for severe infections involving major arteries (7,8) in conjunction with surgery. The first case suggested that, with chronic pythiosis involving the aorta, effective management is difficult. In the second case, the laboratory was familiar with P. insidiosum isolation procedures; therefore, a quick diagnosis was made and early treatment was instituted. This early form of cutaneous pythiosis is rarely diagnosed properly by most clinical and pathologic laboratories. Human cases probably occur worldwide (9) but are underrecognized and thus, misdiagnosed (5). More research into the pathogenesis, diagnosis, and new treatment modalities is urgently needed. Acknowledgments We thank Leonel Mendoza for performing immunodiffusion and providing the therapeutic immunogens and Brian Poligone for a critical review of the manuscript.