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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A dimorphic fungus causing disseminated infection in South Africa
New England Journal of Medicine, Volume 369, No. 15, Year 2013
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Description
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. Copyright © 2013 Massachusetts Medical Society.
Authors & Co-Authors
Kenyon, Chris Richard
South Africa, Observatory
Groote Schuur Hospital
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Bonorchis, Kim
South Africa, Johannesburg
National Health Laboratory Service
Corcoran, Craig
South Africa, Observatory
Groote Schuur Hospital
Meintjes, Graeme Ayton
South Africa, Observatory
Groote Schuur Hospital
South Africa, Tygerberg
Tygerberg Hospital
United Kingdom, London
Imperial College London
Locketz, Michael
South Africa, Cape Town
University of Cape Town
Lehloenya, Rannakoe J.
South Africa, Observatory
Groote Schuur Hospital
Vismer, Hester Francis
South Africa, Tygerberg
South African Medical Research Council
Naicker, Preneshni R.
South Africa, Tygerberg
Tygerberg Hospital
Prozesky, Hans (Hw)
South Africa, Tygerberg
Tygerberg Hospital
Wyk, Marelizevan
South Africa, Johannesburg
National Institute for Communicable Diseases
Bamford, Colleen M.
South Africa, Observatory
Groote Schuur Hospital
Du Plooy, Moira
South Africa, Centurion
Ampath National Reference Laboratory
Imrie, Gail
South Africa, Tygerberg
South African Medical Research Council
Dlamini, Sipho Kenneth
South Africa, Observatory
Groote Schuur Hospital
Borman, Andrew M.
United Kingdom, London
Public Health England
Colebunders, Robert Leon
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Yansouni, Cedric P.
Canada, Montreal
Centre Universitaire de Santé Mcgill
Mendelson, Marc
South Africa, Observatory
Groote Schuur Hospital
Govender, Nelesh P.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Statistics
Citations: 119
Authors: 19
Affiliations: 12
Identifiers
Doi:
10.1056/NEJMoa1215460
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Genetics And Genomics
Health System And Policy
Infectious Diseases
Study Locations
South Africa