Clinical characteristics, diagnosis, management, and outcomes of disseminated emmonsiosis : a retrospective case series
Faculty of Medicine and Health Sciences
Clinical infectious diseases. - Chicago, Ill.
, p. 1004-1012
University of Antwerp
The first 54 cases are reported of disseminated emmonsiosis, a newly described endemic mycosis in South Africa. Most patients were profoundly immunocompromised. Disease most commonly involved the skin and lungs. Nearly half of all patients died, often undiagnosed.<italic toggle="yes">Methods.aEuro integral We performed a multicenter, retrospective chart review of laboratory-confirmed cases of emmonsiosis diagnosed across South Africa from January 2008 through February 2015. <italic toggle="yes">Results.aEuro integral Fifty-four patients were diagnosed in 5/9 provinces. Fifty-one patients (94%) were human immunodeficiency virus coinfected (median CD4 count 16 cells/A mu L [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). <italic toggle="yes">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. <italic toggle="yes">Conclusions.aEuro integral 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.