Emergomycosis

Abstract

Emergomycosis is an invasive fungal disease caused by dimorphic fungi from the recently described Onyenalean genus, Emergomyces. The disease has been reported from four continents (Europe, Asia, Africa, and North America), although by far the most cases have been reported from South Africa. Nearly all affected patients have been profoundly immunocompromised, typically with a deficiency of cell-mediated immunity such as advanced HIV infection or immunosuppression for organ transplantation. The disease is typically disseminated at diagnosis, involving skin, lungs, and often bloodstream, although other sites may also be affected. In patients with HIV, an unmasking immune reconstitution inflammatory syndrome can occur in the form of new or worsening skin lesions after initiation of antiretroviral therapy. The histopathological picture is identical to histoplasmosis. The diagnosis can be secured by isolating the fungus in culture of biopsied tissue, blood, or other clinical specimens using standard fungal media, or sequencing of broad-range fungal targets (like internal transcribed spacer) from infected tissue. Treatment of severe disease involves induction with amphotericin B followed by itraconazole or newer azole for at least 1 year pending immune reconstitution.