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A dimorphic fungus causing disseminated infection in South Africa

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dc.contributor.author Kenyon, C. en_US
dc.contributor.author Bonorchis, K. en_US
dc.contributor.author Corcoran, C. en_US
dc.contributor.author Meintjes, G. en_US
dc.contributor.author Locketz, M. en_US
dc.contributor.author Lehloenya, R. en_US
dc.contributor.author Vismer, H. F. en_US
dc.contributor.author Naicker, P. en_US
dc.contributor.author Prozesky, H. en_US
dc.contributor.author van Wyk, M. en_US
dc.contributor.author Bamford, C. en_US
dc.contributor.author du Plooy, M. en_US
dc.contributor.author Imrie, G. en_US
dc.contributor.author Dlamini, S. en_US
dc.contributor.author Borman, A. M. en_US
dc.contributor.author Colebunders, R. en_US
dc.contributor.author Yansouni, C. P. en_US
dc.contributor.author Mendelson, M. en_US
dc.contributor.author Govender, N. P. en_US
dc.date.accessioned 2014-09-25T13:39:22Z
dc.date.available 2014-09-25T13:39:22Z
dc.date.issued 2013 en_US
dc.identifier.issn 0028-4793 en_US
dc.identifier.doi http://dx.doi.org/10.1056/NEJMoa1215460 en_US
dc.identifier.other ITG-C1A; ITG-C16A; DCS; U-STINF; U-HIVCLI; JIF; DOI; Abstract; UPD56 en_US
dc.identifier.uri http://hdl.handle.net/10390/7593
dc.description.abstract Background The genus emmonsia contains three species that are associated with human disease. Emmonsia crescens and Emmonsia parva are the agents that cause adiaspiromycosis, and one human case of Emmonsia pasteuriana infection has been described. We report a fungal pathogen within the genus emmonsia that is most closely related to E. pasteuriana in human immunodeficiency virus (HIV)-infected adults in South Africa. Methods Between July 2008 and July 2011, we conducted enhanced surveillance to identify the cause of systemic, dimorphic fungal infections in patients presenting to Groote Schuur Hospital and other hospitals affiliated with the University of Cape Town, Cape Town, South Africa. DNA sequencing was used to identify pathogenic fungi. Results A total of 24 cases of dimorphic fungal infection were diagnosed, 13 of which were caused by an emmonsia species. All 13 patients were HIV-infected, with a median CD4+ T-cell count of 16 cells per cubic millimeter (interquartile range, 10 to 44), and all had evidence of disseminated fungal disease. Three patients died soon after presentation, but the others had a good response to a variety of antifungal agents and antiretroviral therapy. Phylogenetic analysis of five genes (LSU, ITS1-2, and the genes encoding actin, beta-tubulin, and intein PRP8) revealed that this fungus belongs in the genus emmonsia and is most closely related to E. pasteuriana. Conclusions The findings suggest that these isolates of an emmonsia species represent a new species of dimorphic fungus that is pathogenic to humans. The species appears to be an important cause of infections in Cape Town. en_US
dc.language English en_US
dc.subject Fungi en_US
dc.subject Mycoses en_US
dc.subject Emmonsia pasteuriana en_US
dc.subject Co-infections en_US
dc.subject Viral diseases en_US
dc.subject HIV en_US
dc.subject AIDS en_US
dc.subject Surveillance en_US
dc.subject Case reports en_US
dc.subject Identification en_US
dc.subject DNA sequence analysis en_US
dc.subject Phylogenetics en_US
dc.subject Dimorphism en_US
dc.subject South Africa en_US
dc.subject Africa, Southern en_US
dc.title A dimorphic fungus causing disseminated infection in South Africa en_US
dc.type Article en_US
dc.citation.issue 15 en_US
dc.citation.jtitle New England Journal of Medicine en_US
dc.citation.volume 369 en_US
dc.citation.pages 1416-1424 en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/24106934 en_US
dc.citation.jabbreviation N Engl J Med en_US


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