Objective: To describe an outbreak of influenza A in an oncology unit, highlighting infection control methods implemented, and examining reasons health care workers (HCWs) present to work with influenza-like illness (ILI). Methods: Confirmed cases were defined by the presence of ILI and a positive nasopharyngeal polymerase chain reaction swab for influenza A H3. Probable cases were defined as exposed HCWs with ILI who were unavailable for polymerase chain reaction testing. Infection prevention measures included closing the ward for new admissions, oseltamivir prophylaxis for all exposed groups, and dismissal from work of HCWs with ILI until resolution of symptoms. An anonymous survey of the cases in our HCWs was conducted to better elucidate reasons behind presenteeism. Results: Over the course of 8 days (November 16, 2017, to November 22, 2017), influenza was diagnosed in 7 of 10 inpatients on the oncology ward, 16 HCWs (14 confirmed, 2 probable), and 2 visitors. The suspected index case was an HCW. Of the surveyed HCWs, 64% presented to work despite feeling ill (ie, presenteeism). The most common reason was "sense of duty as a health care worker." Conclusions: This nosocomial outbreak of influenza highlights the challenges of protecting inpatients from viral respiratory tract infections. HCWs and patient visitors with ILI should avoid work or visiting until resolution of peak respiratory symptoms and adhere to strict respiratory etiquette. (C) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Nodular Skin Lesions in an Immunocompromised Patient(See page 1079 for the Photo Quiz.)Diagnosis: Disseminated amebiasis (Acanthamoeba species).Our patient was an immunocompromised individual who died after developing a progressive meningoencephalitis with associated brain lesions (Figure 1) and concurrent nodular skin lesions (Figure 2).Histopathology from the cutaneous lesions revealed numerous cysts and trophozoites (Figure 3), which were pathologically consistent with free-living amoebae (either Balamuthia species or Acanthamoeba species).Indirect immunofluorescence testing was performed by the Centers for Disease Control and Prevention (CDC), and was positive for Acanthamoeba species and negative for Balamuthia mandrillaris.Cultures of the cerebrospinal fluid (CSF) were without growth; however, after the pathology findings from the skin biopsy, remaining CSF was sent to the CDC and found to be positive by polymerase chain reaction (PCR) for Acanthamoeba species.These findings are consistent with a diagnosis of disseminated acanthamebiasis.The most common clinical presentation of Acanthamoeba species is a nonopportunistic keratitis, usually in contact lens wearers.Other human infections with this free-living amoeba are rare and include sinus infections, skin manifestations, and central nervous system (CNS) involvement, most often granulomatous amoebic encephalitis (GAE).Typically, these syndromes affect the immunocompromised host, often patients with human immunodeficiency