Disseminated Emmonsia pasteuriana infection in India: a case report and a review

Abstract

We report here the first case of disseminated Emmonsia pasteuriana infection in a patient with AIDS in India. The patient presented with weight loss, dyspnoea, left-sided chest pain and multiple non-tender skin lesions over face and body for 3 months. Disseminated emmonsiosis was diagnosed on microscopic examination and fungal culture of skin biopsy and needle aspirate of lung consolidation. It was confirmed by sequencing internal transcribed spacer region of rDNA, beta tubulin, actin, and intein PRP8. The patient responded to amphotericin B and itraconazole therapy.

Antifungal Susceptibility of Emerging Dimorphic Pathogens in the Family Ajellomycetaceae

“…For Adiaspiromyces crescens, our results confirm the previous findings of low MICs when the mold phase was tested, with MIC values of 0.06, 0.25, 0.06, and 64 g/ml for amphotericin B, itraconazole, voriconazole, and fluconazole, respectively (5). Furthermore, the low MIC ranges of amphotericin B and azoles and high MIC range of fluconazole for Emergomyces pasteurianus and Emergomyces africanus were in agreement with previous findings (9,10). In addition, the GM MIC, MIC 50 , and MIC 90 of Emergomyces africanus are in agreement with results described for 50 E. africanus strains, except for fluconazole and with slightly higher values for echinocandins (8).…”

“…This is the first comparative in vitro susceptibility study of five newly described taxa of dimorphic pathogens, Emergomyces orientalis, Emergomyces canadensis, B. percursus, B. helicus, and B. silverae, and of B. parvus and B. gilchristii. In vitro susceptibility studies of Adiaspiromyces crescens, Emergomyces africanus, Emergomyces pasteurianus, and Blastomyces dermatitidis have been performed previously (5,(8)(9)(10). For Adiaspiromyces crescens, our results confirm the previous findings of low MICs when the mold phase was tested, with MIC values of 0.06, 0.25, 0.06, and 64 g/ml for amphotericin B, itraconazole, voriconazole, and fluconazole, respectively (5).…”

“…Emergomyces species differ from the other species within the same family by producing budding yeasts (less than 5 m) in vivo rather than adiaspores and often disseminate with secondary cutaneous manifestation, referred to as emergomycosis (8). Two species have been tested for antifungal susceptibility: Emergomyces africanus, the causative agent of an outbreak in South Africa (8,9), and Emergomyces pasteurianus (10). Emergomyces infections have been treated mostly with amphotericin B, itraconazole, or fluconazole (4, 11; S. Sanche, A. Wong, L. Sigler, S. Angel, and S. Peterson, presented at Focus on Fungal Infections, Miami, FL, 2005, abstract 87) but no clinical trial has been conducted to date.…”

In Vitro Antifungal Susceptibility of Yeast and Mold Phases of Isolates of Dimorphic Fungal Pathogen Emergomycesafricanus (Formerly Emmonsia sp.) from HIV-Infected South African Patients

“…The first case of E. pasteurianus was described in an Italian patient with AIDS (8). Thereafter, several reports followed from Spain, China, India, and more recently, a single case from South Africa (2,(9)(10)(11)(12). E. orientalis has been reported only from a single immunocompetent Chinese patient (7).…”

Approach to Fungal Infections in Human Immunodeficiency Virus–Infected Individuals

“…E. pasteuriana does not cause adiaspiromycosis but, in case reports from Italy, Spain, China, and India, is described to cause disseminated fungal disease in patients with cell-mediated immunodeficiency from HIV infection, medical immunosuppression, or both. 80–85 In 2013, a new species of an as yet unnamed Emmonsia species of fungus was described in HIV-infected patients in South Africa. 86 In a case series of 54 patients, 51 were HIV-infected, one was medically immunosuppressed following renal transplantation, and two had no apparent cause for immunodeficiency.…”