title: In VitroAntifungal Susceptibility of Yeast and Mold Phases of Isolates of Dimorphic Fungal Pathogen Emergomyces africanus (Formerly Emmonsia sp.) from HIV-Infected South African Patients.
abstract: Disseminated emmonsiosis is an important AIDS-related mycosis in South Africa that is caused byEmergomycesafricanus, a newly described and renamed dimorphic fungal pathogen.In vitroantifungal susceptibility data can guide management. Identification of invasive clinical isolates was confirmed phenotypically and by sequencing of the internal transcribed spacer region. Yeast and mold phase MICs of fluconazole, voriconazole, itraconazole, posaconazole, caspofungin, anidulafungin, micafungin, and flucytosine were determined with custom-made frozen broth microdilution (BMD) panels in accordance with Clinical and Laboratory Standards Institute recommendations. MICs of amphotericin B, itraconazole, posaconazole, and voriconazole were determined by Etest. Fifty uniqueE. africanusisolates were tested. The yeast and mold phase geometric mean (GM) BMD and Etest MICs of itraconazole were 0.01 mg/liter. The voriconazole and posaconazole GM BMD MICs were 0.01 mg/liter for both phases, while the GM Etest MICs were 0.001 and 0.002 mg/liter, respectively. The fluconazole GM BMD MICs were 0.18 mg/liter for both phases. The GM Etest MICs of amphotericin B, for the yeast and mold phases were 0.03 and 0.01 mg/liter. The echinocandins and flucytosine had very limitedin vitroactivity. Treatment and outcome data were available for 37 patients; in a multivariable model including MIC data, only isolation from blood (odds ratio [OR], 8.6; 95% confidence interval [CI], 1.3 to 54.4;P= 0.02) or bone marrow (OR, 12.1; 95% CI, 1.2 to 120.2;P= 0.03) (versus skin biopsy) was associated with death.In vitrosusceptibility data support the management of disseminated emmonsiosis with amphotericin B, followed by itraconazole, voriconazole, or posaconazole. Fluconazole was a relatively less potent agent.
authors.affiliation: National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa tsidisom@nicd.ac.za.|Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
authors.forename: Tsidiso G
authors.initials: TG
authors.lastname: Maphanga
authors.affiliation: National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Erika
authors.initials: E
authors.lastname: Britz
authors.affiliation: National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Thokozile G
authors.initials: TG
authors.lastname: Zulu
authors.affiliation: National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Mpembe
authors.affiliation: National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa.|Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Serisha D
authors.initials: SD
authors.lastname: Naicker
authors.affiliation: Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.|Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ilan S
authors.initials: IS
authors.lastname: Schwartz
authors.affiliation: National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa.|Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Nelesh P
authors.identifier: 0000-0001-7869-9462
authors.initials: NP
authors.lastname: Govender
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology*; D002912:Chrysosporium / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009181:Mycoses / Q000382:microbiology*; D017422:Sequence Analysis, DNA; D013019:South Africa
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer
keywords: antifungal susceptibility testing; dimorphic fungus; disseminated emmonsiosis; emergomycosis; novel; opportunistic infection