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Clinical characteristics, diagnosis, management and outcomes of disseminated emmonsiosis: a retrospective case series.
Clin Infect Dis. 2015 Jun 9;
Authors: Schwartz IS, Govender NP, Corcoran C, Dlamini S, Prozesky H, Burton R, Mendelson M, Taljaard J, Lehloenya R, Calligaro G, Colebunders R, Kenyon C
Abstract
OBJECTIVE: 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: 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 HIV co-infected (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 diagnose the majority of patients.
PMID: 26060283 [PubMed - as supplied by publisher]