Paradoxical worsening of Emergomyces africanus infection in an HIV-infected male on itraconazole and antiretroviral therapy

Crombie, Kenneth; Spengane, Zandile; Locketz, Michael; Dlamini, Sipho; Lehloenya, Rannakoe; Wasserman, Sean; Maphanga, Tsidiso G.; Govender, Nelesh P.; Kenyon, Chris; Schwartz, Ilan S.

doi:10.1371/journal.pntd.0006173

Cited by 14 publications

(9 citation statements)

References 24 publications

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“…In profoundly immunosuppressed individuals, the host inflammatory response may be minimal to virtually absent, and in such cases, the skin biopsy may appear nearnormal (32). Cases occurring as a manifestation of immune reconstitution inflammatory syndrome (IRIS) exhibit a more pronounced mixed dermal inflammatory infiltrate and even microabscess formation (34).…”

Section: Histopathologymentioning

confidence: 99%

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: Histopathologymentioning

confidence: 99%

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

Samaddar¹,

Sharma²

2021

Front. Med.

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“…Skin lesions with varying morphologies have been observed in individual patients. An unmasking immune reconstitution inflammatory syndrome (IRIS)-like picture has been described among patients whose cutaneous lesions worsen clinically after initiation of antiretroviral treatment [10].…”

Section: Review/discussionmentioning

confidence: 99%

Emergomycosis (<b><i>Emergomyces africanus</i></b>) in Advanced HIV Disease

Govender

Grayson

2019

Dermatopathology

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In 2013, a novel thermally dimorphic fungal pathogen was described to cause disseminated disease among persons living with advanced HIV/AIDS in South Africa. Although the organism was initially described as an Emmonsia-like fungus, it is now known to belong to a new genus of thermally dimorphic fungi and was recently named Emergomyces africanus. There is considerable clinical and histopathological overlap between emergomycosis and histoplasmosis. This review addresses taxonomic, clinical, diagnostic, and therapeutic aspects of Es. africanus disease, a condition which has, to date, only been reported from southern Africa.

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“…[53], Sporothrix schenckii [54], Fusarium spp. [55], or the newly described Emergomyces africanus [56]. To the best of our knowledge, no case of IRIS has been described with any of the Mucorales and phaeohyphomycetes.…”

Section: Fungal-pathogen-associated Iris Characteristicsmentioning

confidence: 99%

“…Cells of the innate immune system, such as monocytes, macrophages, and neutrophils, are of increasing interest in IRIS pathophysiology, since granuloma appears to be frequently found in IRIS lesions [19,41,47]. Indeed, granuloma is the histopathology hallmark in chronic disseminated candidiasis [19] and is commonly found in other fungi-related IRIS [37,41,48,49,56]. An extended description of granuloma in fungi-related IRIS is unavailable, and should be better studied in particular through immune staining to understand which cell types are implicated and their degree of differentiation/activation.…”

Section: Is There a Common Background For Fungal Iris?mentioning

confidence: 99%

Understanding Pathogenesis and Care Challenges of Immune Reconstitution Inflammatory Syndrome in Fungal Infections

Dellière

Guéry

Candon

et al. 2018

JoF

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Immune deficiency of diverse etiology, including human immunodeficiency virus (HIV), antineoplastic agents, immunosuppressive agents used in solid organ recipients, immunomodulatory therapy, and other biologics, all promote invasive fungal infections. Subsequent voluntary or unintended immune recovery may induce an exaggerated inflammatory response defining immune reconstitution inflammatory syndrome (IRIS), which causes significant mortality and morbidity. Fungal-associated IRIS raises several diagnostic and management issues. Mostly studied with Cryptococcus, it has also been described with other major fungi implicated in human invasive fungal infections, such as Pneumocystis, Aspergillus, Candida, and Histoplasma. Furthermore, the understanding of IRIS pathogenesis remains in its infancy. This review summarizes current knowledge regarding the clinical characteristics of IRIS depending on fungal species and existing strategies to predict, prevent, and treat IRIS in this patient population, and tries to propose a common immunological background to fungal IRIS.

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Paradoxical worsening of Emergomyces africanus infection in an HIV-infected male on itraconazole and antiretroviral therapy

Cited by 14 publications

References 24 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

Emergomycosis (<b><i>Emergomyces africanus</i></b>) in Advanced HIV Disease

Understanding Pathogenesis and Care Challenges of Immune Reconstitution Inflammatory Syndrome in Fungal Infections

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