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

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

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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use*
  • Biopsy
  • Chrysosporium / isolation & purification*
  • Female
  • Humans
  • Male
  • Mycoses / diagnosis*
  • Mycoses / drug therapy
  • Mycoses / epidemiology*
  • Mycoses / microbiology
  • Prevalence
  • Retrospective Studies
  • Skin / microbiology*
  • Skin / pathology*
  • South Africa / epidemiology
  • Survival Analysis
  • Treatment Outcome

Substances

  • Antifungal Agents