Screening for invasive fungal disease using non‐culture‐based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa

Schalkwyk, Erika van; Mhlanga, Mabatho; Maphanga, Tsidiso G.; Mpembe, Ruth S.; Shillubane, Amanda; Iyaloo, Samantha; Tsotetsi, Ernest; Pieton, Kim; Karstaedt, Alan; Sahid, Faieza; Menezes, Colin; Tsitsi, Merika; Motau, Ayanda; Wadula, Jeannette; Seetharam, Sharona; Berg, Eunice J. van den; Sriruttan, Charlotte; Govender, Nelesh P.

doi:10.1111/myc.13071

Cited by 7 publications

(12 citation statements)

References 39 publications

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“…There is a possibility that many cases of emergomycosis might have gone missed due to lack of awareness regarding the disease and misidentification of the causative agent. The latter hypothesis is supported by the dramatic increase in the number of cases of disseminated emergomycosis with a relative decline in the number of histoplasmosis cases in South Africa, following the introduction of molecular identification techniques (25,26). All the South African cases were adults with advanced HIV disease (median CD4+ T cell count 16 cells/µL) and had extensive cutaneous involvement (27).…”

Section: Geographical Distributionmentioning

confidence: 96%

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Emergomycosis, an Emerging Systemic Mycosis in Immunocompromised Patients: Current Trends and Future Prospects

Samaddar¹,

Sharma²

2021

Front. Med.

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Recently, the global emergence of emergomycosis, a systemic fungal infection caused by a novel dimorphic fungus Emergomyces species has been observed among immunocompromised individuals. Though initially classified under the genus Emmonsia, a taxonomic revision in 2017 based on DNA sequence analyses placed five Emmonsia-like fungi under a separate genus Emergomyces. These include Emergomyces pasteurianus, Emergomyces africanus, Emergomyces canadensis, Emergomyces orientalis, and Emergomyces europaeus. Emmonsia parva was renamed as Blastomyces parvus, while Emmonsia crescens and Emmonsia sola remained within the genus Emmonsia until a taxonomic revision in 2020 placed both the species under the genus Emergomyces. However, unlike other members of the genus, Emergomyces crescens and Emergomyces sola do not cause disseminated disease. The former causes adiaspiromycosis, a granulomatous pulmonary disease, while the latter has not been associated with human disease. So far, emergomycosis has been mapped across four continents: Asia, Europe, Africa and North America. However, considering the increasing prevalence of HIV/AIDS, it is presumed that the disease must have a worldwide distribution with many cases going undetected. Diagnosis of emergomycosis remains challenging. It should be considered in the differential diagnosis of histoplasmosis as there is considerable clinical and histopathological overlap between the two entities. Sequencing the internal transcribed spacer region of ribosomal DNA is considered as the gold standard for identification, but its application is compromised in resource limited settings. Serological tests are non-specific and demonstrate cross-reactivity with Histoplasma galactomannan antigen. Therefore, an affordable, accessible, and reliable diagnostic test is the need of the hour to enable its diagnosis in endemic regions and also for epidemiological surveillance. Currently, there are no consensus guidelines for the treatment of emergomycosis. The recommended regimen consists of amphotericin B (deoxycholate or liposomal formulation) for 1–2 weeks, followed by oral itraconazole for at least 12 months. This review elaborates the taxonomic, clinical, diagnostic, and therapeutic aspects of emergomycosis. It also enumerates several novel antifungal drugs which might hold promise in the treatment of this condition and therefore, can be potential areas of future studies.

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Section: Geographical Distributionmentioning

confidence: 96%

“…Detection of Es. africanus DNA in 30% of soils samples from the Western Cape Province (7) and in 10% of air samples from Cape Town (26), indicate that the fungus might have an ecological niche. However, to date, it has not been successfully isolated in culture from the environment.…”

Section: Geographical Distributionmentioning

confidence: 99%

Emergomycosis, an Emerging Systemic Mycosis in Immunocompromised Patients: Current Trends and Future Prospects

Samaddar¹,

Sharma²

2021

Front. Med.

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“…1,2 With the advent of antiretroviral therapy (ART), HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome)-related deaths are on a steady decline; however, morbidity secondary to HIV-related infections remains a burden within the African population. [6][7][8][9][10][11] In South Africa, fungal infections remain a substantial disease burden in those living with HIV/AIDS. 10 The disease burden of opportunistic infections, such as histoplasmosis, is yet to be elucidated in KwaZulu-Natal (KZN), a province with over two million people living with HIV/AIDS.…”

Section: Introductionmentioning

confidence: 99%

“…10 The disease burden of opportunistic infections, such as histoplasmosis, is yet to be elucidated in KwaZulu-Natal (KZN), a province with over two million people living with HIV/AIDS. [7][8][9][10][11] Misdiagnosis and diagnostic delays are a reality, and this further compounds morbidity secondary to fungal infection. 10,11 This retrospective study sought to describe the clinicopathological features of H. duboisii infections.…”

Section: Introductionmentioning

confidence: 99%

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Histoplasma capsulatum var. duboisii: A KwaZulu‐Natal, South Africa public sector perspective

2021

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Background: Histoplasma capsulatum var. duboisii (H. duboisii) causes potentially fatal disease in the immunocompromised patient, and the literature on these cases is limited. The study was undertaken to describe the cases of H. duboisii seen in a resource-limited setting.Methods: A 5-year retrospective, laboratory-based histopathologic review of all H. duboisii cases.Results: A total of 24 patients were diagnosed with cutaneous H. duboisii infection.The male-to-female ratio was 1.4. All the patients were human immunodeficiency virus (HIV) positive, and 70.83% (17 of 24 patients) were on antiretroviral therapy.The clinically identified lesions were as follows: plaques, nodular plaques, papules, papulo-pustules, and umbilicated papules. Histopathological appraisal revealed organisms typical of H. duboisii. The commonest epidermal alterations were interface change, parakeratosis, spongiosis, ulceration, acanthosis, hyperkeratosis, transepidermal elimination, and exocytosis in decreasing order. The dermal changes included histiocytic pattern (n = 14), neutrophil-rich (n = 13), non-necrotizing granulomatous inflammation (n = 9), and karyorrhexis (n = 6). Histoplasma was confirmed in 53% (8 of 15 samples) of the tissue samples submitted for routine fungal culture. Conclusion:This study showed the demographics, clinical and histopathology features of H. duboisii infection in a resource-limited setting. Further research on histopathological features of this rare infection is essential to expand on the knowledge base and support findings in this study.

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The current state of clinical mycology in Africa: a European Confederation of Medical Mycology and International Society for Human and Animal Mycology survey

et al. 2022

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Africa, although not unique in this context, is a favourable environment for fungal infections, given the high burden of risk factors. An online survey was developed asking about laboratory infrastructure and antifungal drug availability. We received 40 responses (24•4% response rate) of 164 researchers contacted from 21 African countries. Only five institutions (12•5%) of 40 located in Cameroon, Kenya, Nigeria, Sudan, and Uganda potentially fulfilled the minimum laboratory requirements for European Confederation of Medical Mycology Excellence Centre blue status. Difficulties included low access to susceptibility testing for both yeasts and moulds (available in only 30% of institutions) and Aspergillus spp antigen detection (available in only 47•5% of institutions as an in-house or outsourced test), as well as access to mould-active antifungal drugs such as amphotericin B deoxycholate (available for 52•5% of institutions), itraconazole (52•5%), voriconazole (35•0%), and posaconazole (5•0%). United and targeted efforts are crucial to face the growing challenges in clinical mycology.

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Screening for invasive fungal disease using non‐culture‐based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa

Cited by 7 publications

References 39 publications

Emergomycosis, an Emerging Systemic Mycosis in Immunocompromised Patients: Current Trends and Future Prospects

Emergomycosis, an Emerging Systemic Mycosis in Immunocompromised Patients: Current Trends and Future Prospects

Histoplasma capsulatum var. duboisii: A KwaZulu‐Natal, South Africa public sector perspective

The current state of clinical mycology in Africa: a European Confederation of Medical Mycology and International Society for Human and Animal Mycology survey

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