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Clin Infect Dis. 2015 Sep 15;61(6):1004-12. doi: 10.1093/cid/civ439. Epub 2015 Jun 9.

Clinical Characteristics, Diagnosis, Management, and Outcomes of Disseminated Emmonsiosis: A Retrospective Case Series.

Author information

1
Departments of Medical Microbiology and Internal Medicine, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Canada Department of Epidemiology and Social Medicine, Faculty of Health Sciences, University of Antwerp, Belgium.
2
National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, National Health Laboratory Service, Sandringham Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
3
Ampath National Laboratory Services, Centurion.
4
Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town.
5
Division of Infectious Diseases, Department of Medicine, Stellenbosch University.
6
Division of Dermatology, Department of Medicine, University of Cape Town.
7
UCT Lung Institute, University of Cape Town, South Africa.
8
Department of Epidemiology and Social Medicine, Faculty of Health Sciences, University of Antwerp, Belgium Clinical Sciences Unit, Institute of Tropical Medicine, Antwerp, Belgium.
9
Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town Clinical Sciences Unit, Institute of Tropical Medicine, Antwerp, Belgium.

Abstract

BACKGROUND:

We describe the geographic distribution, clinical characteristics, and management of patients with disease caused by Emmonsia sp., a novel dimorphic fungal pathogen recently described in South Africa.

METHODS:

We performed a multicenter, retrospective chart review of laboratory-confirmed cases of emmonsiosis diagnosed across South Africa from January 2008 through February 2015.

RESULTS:

Fifty-four patients were diagnosed in 5/9 provinces. Fifty-one patients (94%) were human immunodeficiency virus coinfected (median CD4 count 16 cells/µL [interquartile range, 6-40]). In 12 (24%) of these, antiretroviral therapy had been initiated in the preceding 2 months. All patients had disseminated disease, most commonly involving skin (n = 50/52, 96%) and lung (n = 42/48, 88%). Yeasts were visualized on histopathologic examination of skin (n = 34/37), respiratory tissue (n = 2/4), brain (n = 1/1), liver (n = 1/2), and bone marrow (n = 1/15). Emmonsia sp. was cultured from skin biopsy (n = 20/28), mycobacterial/fungal and aerobic blood culture (n = 15/25 and n = 9/37, respectively), bone marrow (n = 12/14), lung (n = 1/1), lymph node (n = 1/1), and brain (n = 1/1). Twenty-four of 34 patients (71%) treated with amphotericin B deoxycholate, 4/12 (33%) treated with a triazole alone, and none of 8 (0%) who received no antifungals survived. Twenty-six patients (48%) died, half undiagnosed.

CONCLUSIONS:

Disseminated emmonsiosis is more widespread in South Africa and carries a higher case fatality rate than previously appreciated. Cutaneous involvement is near universal, and skin biopsy can be used to diagnose the majority of patients.

KEYWORDS:

AIDS-related mycosis; Emmonsia sp.; dimorphic fungi; emmonsiosis; endemic mycosis

PMID:
26060283
DOI:
10.1093/cid/civ439
[Indexed for MEDLINE]

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