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A dimorphic fungus causing disseminated infection in South Africa
Chris Kenyon1, Kim Bonorchis, Craig Corcoran
1Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa. chriskenyon0@gmail.com
Background:
The genus emmonsia contains three species that are associated with human disease. Emmonsia crescens and Emmonsia parva are the agents that cause adiaspiromycosis, and one human case of Emmonsia pasteuriana infection has been described. We report a fungal pathogen within the genus emmonsia that is most closely related to E. pasteuriana in human immunodeficiency virus (HIV)-infected adults in South Africa.
Methods:
Between July 2008 and July 2011, we conducted enhanced surveillance to identify the cause of systemic, dimorphic fungal infections in patients presenting to Groote Schuur Hospital and other hospitals affiliated with the University of Cape Town, Cape Town, South Africa. DNA sequencing was used to identify pathogenic fungi.
Results:
A total of 24 cases of dimorphic fungal infection were diagnosed, 13 of which were caused by an emmonsia species. All 13 patients were HIV-infected, with a median CD4+ T-cell count of 16 cells per cubic millimeter (interquartile range, 10 to 44), and all had evidence of disseminated fungal disease. Three patients died soon after presentation, but the others had a good response to a variety of antifungal agents and antiretroviral therapy. Phylogenetic analysis of five genes (LSU, ITS1-2, and the genes encoding actin, β-tubulin, and intein PRP8) revealed that this fungus belongs in the genus emmonsia and is most closely related to E. pasteuriana.
Conclusions:
The findings suggest that these isolates of an emmonsia species represent a new species of dimorphic fungus that is pathogenic to humans. The species appears to be an important cause of infections in Cape Town.
Insights
A new Emmonsia species, closely related to E. pasteuriana, caused disseminated fungal infections in HIV-infected adults in South Africa. This dimorphic fungus represents a significant emerging pathogen in Cape Town.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Molecular Phylogenetics
Background:
- The genus Emmonsia includes species known to cause human adiaspiromycosis.
- Limited information exists regarding Emmonsia species pathogenic to humans.
- A novel Emmonsia species was identified in HIV-infected adults in South Africa.
Purpose of the Study:
- To identify the causative agent of systemic, dimorphic fungal infections in HIV-infected patients.
- To characterize a novel Emmonsia species based on clinical and molecular data.
Main Methods:
- Enhanced surveillance for systemic fungal infections.
- DNA sequencing for fungal identification.
- Phylogenetic analysis of five genes (LSU, ITS1-2, actin, β-tubulin, intein PRP8).
Main Results:
- Thirteen cases of Emmonsia infection were diagnosed in HIV-infected patients with disseminated disease.
- Patients had low CD4+ T-cell counts (median 16 cells/mm³).
- Phylogenetic analysis confirmed the fungus belongs to the genus Emmonsia and is closely related to E. pasteuriana.
Conclusions:
- The identified Emmonsia isolates represent a new species pathogenic to humans.
- This new species is an important cause of fungal infections in Cape Town.
- Prompt diagnosis and treatment with antifungal and antiretroviral therapy are crucial.
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