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Vinayagamoorthy K, Gangavaram DR, Skiada A, Prakash H. Emergomycosis, an Emerging Thermally Dimorphic Fungal Infection: A Systematic Review. J Fungi (Basel) 2023; 9:1039. [PMID: 37888295 PMCID: PMC10607913 DOI: 10.3390/jof9101039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Emergomycosis is an endemic mycosis caused by the Emergomyces species. Infections due to this agent have been reported globally. Hence, the present systematic review on Emergomyces infections was conducted to study the disease epidemiology, underlying diseases and risk factors, causative agents, and treatment and outcome. The MEDLINE, Scopus, Embase, and Web of Science databases were searched systematically with appropriate keywords from January 1990 to October 2022. A total of 77 cases of emergomycosis were included in the analysis. Emergomycosis was most commonly seen in patients with human immunodeficiency virus (HIV) infection (n = 61, 79.2%) and HIV-uninfected patients with or without other comorbidities (n = 16, 20.8%). The underlying disease and risk factors significantly associated with emergomycosis in the HIV-infected patients were CD4+ T-cell counts less than 100 cells/mm3 (n = 55, 90.2%), anaemia (n = 30, 49.2%), and thrombocytopenia (n = 17, 27.9%), whereas in the HIV-uninfected patients, treatment with immunosuppressive drugs (n = 10, 62.5%), renal disease (n = 8, 50%), transplant recipients (n = 6, 37.5%), and diabetes mellitus (n = 4, 25%) were the significant risk factors associated with emergomycosis. Emergomyces africanus (n = 55, 71.4%) is the most common causative agent, followed by E. pasteurianus (n = 9, 11.7%) and E. canadensis (n = 5, 6.5%). E. africanus was most often isolated from HIV-infected patients (n = 54, 98.2%), whereas E. pasteurianus was most common in HIV-uninfected patients (n = 5, 55.6%). The all-cause mortality rate of the total cohort is 42.9%. No significant variation in the mortality rate is observed between the HIV-infected patients (n = 28, 36.4%) and the HIV-uninfected patients (n = 5, 6.5%). In conclusion, with an increase in the immunosuppressed population across the globe in addition to HIV infection, the case burden of emergomycosis may increase in the future. Hence, clinicians and mycologists should be vigilant and clinically suspicious of emergomycosis, which helps in early diagnosis and initiation of antifungal treatment to prevent disease mortality.
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Affiliation(s)
| | - Dinesh Reddy Gangavaram
- Department of Dermatology, Venereology and Leprosy, PES Institute of Medical Sciences & Research, Kuppam 517425, Andhra Pradesh, India;
| | - Anna Skiada
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Hariprasath Prakash
- Department of Microbiology, PES Institute of Medical Sciences & Research, Kuppam 517425, Andhra Pradesh, India
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Pierce J, Sayeed S, Doern CD, Bryson AL. Emergomyces pasteurianus in Man Returning to the United States from Liberia and Review of the Literature. Emerg Infect Dis 2023; 29:635-639. [PMID: 36823688 PMCID: PMC9973675 DOI: 10.3201/eid2903.221683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
A 65-year-old man with HIV sought treatment for fever, weight loss, and productive cough after returning to the United States from Liberia. Fungal cultures grew Emergomyces pasteurianus, and the patient's health improved after beginning voriconazole. We describe the clinical case and review the literature, treatment, and susceptibilities for E. pasteurianus.
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He D, Quan M, Zhong H, Chen Z, Wang X, He F, Qu J, Zhou T, Lv X, Zong Z. Emergomyces orientalis Emergomycosis Diagnosed by Metagenomic Next-Generation Sequencing. Emerg Infect Dis 2021; 27:2740-2742. [PMID: 34546163 PMCID: PMC8462323 DOI: 10.3201/eid2710.210769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Emergomyces is a newly described dimorphic fungus genus; it may cause fatal infections in immunocompromised patients, but diagnosis is often delayed. We report a case of disseminated emergomycosis caused by the novel species Emergomyces orientalis in a kidney transplant recipient from Tibet. Infection was diagnosed early by metagenomic next-generation sequencing.
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Samaddar A, Sharma A. Emergomycosis, an Emerging Systemic Mycosis in Immunocompromised Patients: Current Trends and Future Prospects. Front Med (Lausanne) 2021; 8:670731. [PMID: 33968970 PMCID: PMC8104006 DOI: 10.3389/fmed.2021.670731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
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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Affiliation(s)
- Arghadip Samaddar
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
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Gnat S, Łagowski D, Nowakiewicz A, Dyląg M. A global view on fungal infections in humans and animals: infections caused by dimorphic fungi and dermatophytoses. J Appl Microbiol 2021; 131:2688-2704. [PMID: 33754409 DOI: 10.1111/jam.15084] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/18/2021] [Indexed: 12/28/2022]
Abstract
Fungal infections are still underappreciated and their prevalence is underestimated, which renders them a serious public health problem. Realistic discussions about their distribution, symptoms, and control can improve management and diagnosis and contribute to refinement of preventive actions using currently available tools. This article represents an overview of dermatophytes and endemic fungi that cause infections in humans and animals. In addition, the impact of climate change on the fungal spread is discussed. The endemic fungal infections characterized in this article include coccidioidomycosis, histoplasmosis, blastomycosis, lobomycosis, emergomycosis and sporotrichosis. Moreover the geographic distribution of these fungi, which are known to be climate sensitive and/or limited to endemic tropical and subtropical areas, is highlighted. In turn, dermatophytes cause superficial fungal infections of skin, hairs and nails, which are the most prevalent mycoses worldwide with a high economic burden. Therefore, the possibility of causing zoonoses and reverse zoonoses by dermatophytes is highly important. In conclusion, the article illustrates the current issues of the epidemiology and distribution of fungal diseases, emphasizing the lack of public programmes for prevention and control of these types of infection.
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Affiliation(s)
- S Gnat
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - D Łagowski
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - A Nowakiewicz
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - M Dyląg
- Faculty of Biological Sciences, Department of Mycology and Genetics, Institute of Genetics and Microbiology, University of Wroclaw, Wroclaw, Poland
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Ashraf N, Kubat RC, Poplin V, Adenis AA, Denning DW, Wright L, McCotter O, Schwartz IS, Jackson BR, Chiller T, Bahr NC. Re-drawing the Maps for Endemic Mycoses. Mycopathologia 2020; 185:843-865. [PMID: 32040709 PMCID: PMC7416457 DOI: 10.1007/s11046-020-00431-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/24/2020] [Indexed: 01/19/2023]
Abstract
Endemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.
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Affiliation(s)
- Nida Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Ryan C Kubat
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Victoria Poplin
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Antoine A Adenis
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - David W Denning
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura Wright
- Geographic Research Analysis and Services Program, Division of Toxicology and Human Health Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Orion McCotter
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brendan R Jackson
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA.
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Disseminated Emergomyces pasteurianus Infection in India: A Case Report and a Review. Mycopathologia 2019; 185:193-200. [PMID: 31659677 DOI: 10.1007/s11046-019-00387-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/21/2019] [Indexed: 12/28/2022]
Abstract
We report here a case of disseminated Emergomyces pasteurianus infection from India in a patient with AIDS. The patient presented with weight loss, dyspnoea and multiple non-tender skin lesions over face, neck and chest over 3 months. The case was diagnosed by microscopy, histopathology of sample and isolation of fungus from skin lesion, breast nodule, bone marrow and sputum. The identification of the isolates was confirmed by sequencing internal transcribed spacer region of rDNA, beta-tubulin, actin and intein PRP8. The patient responded well to intravenous amphotericin B deoxycholate followed by itraconazole therapy.
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Sun L, Wan Z, Li R, Yu J. In vitro activities of nine antifungal agents against rare pathogenic fungi. J Med Microbiol 2019; 68:1664-1670. [PMID: 31553302 DOI: 10.1099/jmm.0.001083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose. To assess in vitro activities of nine antifungal agents (amphotericin B, fluconazole, voriconazole, itraconazole, posaconazole, caspofungin, micafungin, terbinafine and 5-flucytosine) against 93 strains of rare pathogenic fungi and the combined effects of drug combinations against several multidrug-resistant fungi.Methodology. The broth microdilution method M38-A3 and M27-A4 from the Clinical and Laboratory Standards Institute and the checkerboard method were performed in this study.Results. Low MICs for fluconazole were observed in moulds including Tritirachium oryzae, Exophiala attenuata and yeasts. MICs for amphotericin B>2 µg ml-1 were found among Aspergillus nidulans, Fusarium napiforme, Trichoderma longibrachiatum, Tritirachium oryzae, Cunninghamella bertholletiae, Cunninghamella phaeospora, Conidiobolus coronatus, Exophiala attenuata, Ochroconis mirabilis and Rhinocladiella basitona. Multidrug resistance was observed in Microascus spp., Lomentospora prolificans and Pythium insidiosum.Conclusion. Our study illustrated in vitro drug susceptibilities of some rare pathogenic fungi, which provide data to guide clinical treatment of fungal infections.
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Affiliation(s)
- Lingyue Sun
- Department of Dermatology and Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
| | - Zhe Wan
- Department of Dermatology and Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
| | - Jin Yu
- Department of Dermatology and Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
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Gast KB, van der Hoeven A, de Boer MGJ, van Esser JWJ, Kuijper EJ, Verweij JJ, van Keulen PHJ, van der Beek MT. Two cases of Emergomyces pasteurianus infection in immunocompromised patients in the Netherlands. Med Mycol Case Rep 2019; 24:5-8. [PMID: 30733915 PMCID: PMC6357787 DOI: 10.1016/j.mmcr.2019.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/31/2018] [Accepted: 01/11/2019] [Indexed: 11/26/2022] Open
Abstract
We report two cases of Emergomyces pasteurianus infection in the Netherlands. Both patients were immunocompromised and had pulmonary symptoms. The first patient died due to a pulmonary infection with Es. pasteurianus, concomitant listeriosis, Pseudomonas aeruginosa sepsis and invasive pulmonary aspergillosis. The second patient had pulmonary and subcutaneous lesions, and recovered completely after treatment with posaconazole for 14 months. In both cases, diagnosis of Es. pasteurianus was made with internal transcribed spacer rRNA PCR and culture.
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Affiliation(s)
- Karin B Gast
- Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Alieke van der Hoeven
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaco J Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | - Martha T van der Beek
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
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Phylogeny, ecology and taxonomy of systemic pathogens and their relatives in Ajellomycetaceae (Onygenales): Blastomyces, Emergomyces, Emmonsia, Emmonsiellopsis. FUNGAL DIVERS 2018. [DOI: 10.1007/s13225-018-0403-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kappagoda S, Adams JY, Luo R, Banaei N, Concepcion W, Ho DY. Fatal Emmonsia sp. Infection and Fungemia after Orthotopic Liver Transplantation. Emerg Infect Dis 2018; 23:346-349. [PMID: 28098544 PMCID: PMC5324819 DOI: 10.3201/eid2302.160799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report a fatal case of disseminated Emmonsia sp. infection in a 55-year-old man who received an orthotopic liver transplant. The patient had pneumonia and fungemia, and multisystem organ failure developed. As human habitats and the number of immunocompromised patients increase, physicians must be aware of this emerging fungal infection.
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Emergomyces: a New Genus of Dimorphic Fungal Pathogens Causing Disseminated Disease among Immunocompromised Persons Globally. CURRENT FUNGAL INFECTION REPORTS 2018. [DOI: 10.1007/s12281-018-0308-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Schwartz IS, McLoud JD, Berman D, Botha A, Lerm B, Colebunders R, Levetin E, Kenyon C. Molecular detection of airborne Emergomyces africanus, a thermally dimorphic fungal pathogen, in Cape Town, South Africa. PLoS Negl Trop Dis 2018; 12:e0006174. [PMID: 29357352 PMCID: PMC5800596 DOI: 10.1371/journal.pntd.0006174] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/06/2018] [Accepted: 12/18/2017] [Indexed: 12/28/2022] Open
Abstract
Emergomyces africanus is a thermally dimorphic fungus that causes a systemic mycosis in immunocompromised persons in South Africa. Infection is presumed to follow inhalation of airborne propagules. We developed a quantitative PCR protocol able to detect as few as 5 Es. africanus propagules per day. Samples were collected in Cape Town, South Africa over 50 weeks by a Burkard spore trap with an alternate orifice. We detected Es. africanus in air samples from 34 days (10%) distributed over 11 weeks. These results suggest environmental exposure to airborne Es. africanus propagules occurs more commonly in endemic areas than previously appreciated.
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Affiliation(s)
- Ilan S. Schwartz
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Josh D. McLoud
- Biological Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Dilys Berman
- University of Cape Town, Cape Town, Western Cape, South Africa
| | - Alfred Botha
- Department of Microbiology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Barbra Lerm
- Department of Microbiology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | | | - Estelle Levetin
- Biological Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Antifungal Susceptibility of Emerging Dimorphic Pathogens in the Family Ajellomycetaceae. Antimicrob Agents Chemother 2017; 62:AAC.01886-17. [PMID: 29084748 DOI: 10.1128/aac.01886-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 10/23/2017] [Indexed: 11/20/2022] Open
Abstract
The in vitro susceptibilities of 24 molecularly identified dimorphic fungi belonging to the genera Adiaspiromyces, Blastomyces, and Emergomyces within the family Ajellomycetaceae were tested against 8 standard antifungal agents using CLSI document M38-A2. Amphotericin B and posaconazole had the lowest geometric mean MICs (<0.05 μg/ml) followed by itraconazole (<0.07 μg/ml), voriconazole (<0.15 μg/ml), and isavuconazole (<0.42 μg/ml) while fluconazole was not active. Micafungin demonstrated good in vitro antifungal activity against Emergomyces (geometric mean minimum effective concentration [GM MEC] 0.1 μg/ml) and Blastomyces (GM MEC <0.017 μg/ml).
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Wang RJ, Miller RF, Huang L. Approach to Fungal Infections in Human Immunodeficiency Virus-Infected Individuals: Pneumocystis and Beyond. Clin Chest Med 2017; 38:465-477. [PMID: 28797489 DOI: 10.1016/j.ccm.2017.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Many fungi cause pulmonary disease in patients with human immunodeficiency virus (HIV) infection. Pathogens include Pneumocystis jirovecii, Cryptococcus neoformans, Aspergillus spp, Histoplasma capsulatum, Coccidioides spp, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Talaromyces marneffei, and Emmonsia spp. Because symptoms are frequently nonspecific, a high index of suspicion for fungal infection is required for diagnosis. Clinical manifestations of fungal infection in HIV-infected patients frequently depend on the degree of immunosuppression and the CD4+ helper T cell count. Establishing definitive diagnosis is important because treatments differ. Primary and secondary prophylaxes depend on CD4+ helper T cell counts, geographic location, and local prevalence of disease.
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Affiliation(s)
- Richard J Wang
- Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Robert F Miller
- Research Department of Infection and Population Health, Institute of Global Health, University College London, Gower Street, London WC1E 6BT, UK; Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
| | - Laurence Huang
- Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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Maphanga TG, Britz E, Zulu TG, Mpembe RS, Naicker SD, Schwartz IS, Govender NP. In Vitro Antifungal Susceptibility of Yeast and Mold Phases of Isolates of Dimorphic Fungal Pathogen Emergomyces africanus (Formerly Emmonsia sp.) from HIV-Infected South African Patients. J Clin Microbiol 2017; 55:1812-1820. [PMID: 28356416 PMCID: PMC5442537 DOI: 10.1128/jcm.02524-16] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/20/2017] [Indexed: 11/20/2022] Open
Abstract
Disseminated emmonsiosis is an important AIDS-related mycosis in South Africa that is caused by Emergomycesafricanus, a newly described and renamed dimorphic fungal pathogen. In vitro antifungal 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 unique E. africanus isolates 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 limited in vitro activity. 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 vitro susceptibility data support the management of disseminated emmonsiosis with amphotericin B, followed by itraconazole, voriconazole, or posaconazole. Fluconazole was a relatively less potent agent.
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Affiliation(s)
- Tsidiso G Maphanga
- 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 Free State, Bloemfontein, South Africa
| | - Erika Britz
- 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
| | - Thokozile G Zulu
- 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
| | - Ruth S Mpembe
- 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
| | - Serisha D Naicker
- 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
| | - Ilan S Schwartz
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nelesh P Govender
- 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
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19
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Dukik K, Muñoz JF, Jiang Y, Feng P, Sigler L, Stielow JB, Freeke J, Jamalian A, van den Ende BG, McEwen JG, Clay OK, Schwartz IS, Govender NP, Maphanga TG, Cuomo CA, Moreno L, Kenyon C, Borman AM, de Hoog S. Novel taxa of thermally dimorphic systemic pathogens in the Ajellomycetaceae (Onygenales). Mycoses 2017; 60:296-309. [PMID: 28176377 PMCID: PMC5775888 DOI: 10.1111/myc.12601] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 12/11/2022]
Abstract
Recent discoveries of novel systemic fungal pathogens with thermally dimorphic yeast-like phases have challenged the current taxonomy of the Ajellomycetaceae, a family currently comprising the genera Blastomyces, Emmonsia, Emmonsiellopsis, Helicocarpus, Histoplasma, Lacazia and Paracoccidioides. Our morphological, phylogenetic and phylogenomic analyses demonstrated species relationships and their specific phenotypes, clarified generic boundaries and provided the first annotated genome assemblies to support the description of two new species. A new genus, Emergomyces, accommodates Emmonsia pasteuriana as type species, and the new species Emergomyces africanus, the aetiological agent of case series of disseminated infections in South Africa. Both species produce small yeast cells that bud at a narrow base at 37°C and lack adiaspores, classically associated with the genus Emmonsia. Another novel dimorphic pathogen, producing broad-based budding cells at 37°C and occurring outside North America, proved to belong to the genus Blastomyces, and is described as Blastomyces percursus.
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Affiliation(s)
- Karolina Dukik
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands
| | - Jose F. Muñoz
- Broad Institute of MIT and Harvard, Cambridge, MA, U.S.A
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
- Institute of Biology, Universidad de Antioquia, Medellín, Colombia
| | - Yanping Jiang
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Guiyang, China
| | - Peiying Feng
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lynne Sigler
- University of Alberta Microfungus Collection and Herbarium and Biological Sciences, Edmonton, Alberta, Canada
| | - J. Benjamin Stielow
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Thermo Fisher Scientific, Landsmeer, The Netherlands
| | - Joanna Freeke
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Thermo Fisher Scientific, Landsmeer, The Netherlands
| | - Azadeh Jamalian
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Thermo Fisher Scientific, Landsmeer, The Netherlands
| | | | - Juan G. McEwen
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
- School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Oliver K. Clay
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Ilan S. Schwartz
- Epidemiology for Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nelesh P. Govender
- University of Cape Town, Cape Town, South Africa
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | | | | | - Leandro Moreno
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands
- Basic Pathology Department, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Chris Kenyon
- University of Cape Town, Cape Town, South Africa
- Sexually Transmitted Infection Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands
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20
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Wang P, Kenyon C, de Hoog S, Guo L, Fan H, Liu H, Li Z, Sheng R, Yang Y, Jiang Y, Zhang L, Xu Y. A novel dimorphic pathogen,Emergomyces orientalis(Onygenales), agent of disseminated infection. Mycoses 2017; 60:310-319. [DOI: 10.1111/myc.12583] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/17/2016] [Accepted: 10/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Peng Wang
- Division of Clinical Microbiology; P.U.M.C.H.; Beijing China
| | - Chris Kenyon
- Sexually Transmitted Infection Unit; Institute of Tropical Medicine; Antwerp Belgium
| | - Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre; Utrecht The Netherlands
| | - Lina Guo
- Division of Clinical Microbiology; P.U.M.C.H.; Beijing China
| | - Hongwei Fan
- Division of Internal Medicine; P.U.M.C.H.; Beijing China
| | - Hongrui Liu
- Division of Pathology; P.U.M.C.H.; Beijing China
| | - Zhongwei Li
- Division of Bioinformatics; Academy of Military Medical Science; Beijing Institute of Radiation Medicine; Beijing China
| | - Ruiyuan Sheng
- Division of Internal Medicine; P.U.M.C.H.; Beijing China
| | - Ying Yang
- Division of Fungi; Academy of Military Medical Science; Beijing Institute of Radiation Medicine; Beijing China
| | - Yanping Jiang
- CBS-KNAW Fungal Biodiversity Centre; Utrecht The Netherlands
- Department of Dermatology; The Affiliated Hospital; Guizhou Medical University; Guiyang China
| | - Li Zhang
- Division of Clinical Microbiology; P.U.M.C.H.; Beijing China
| | - Yingchun Xu
- Division of Clinical Microbiology; P.U.M.C.H.; Beijing China
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21
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Sharma S, Gupta P, Gupta N, Lal A, Behera D, Rajwanshi A. Pulmonary infections in immunocompromised patients: the role of image-guided fine needle aspiration cytology. Cytopathology 2016; 28:46-54. [DOI: 10.1111/cyt.12359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 01/15/2023]
Affiliation(s)
- S. Sharma
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - P. Gupta
- Department of Radiodiagnosis; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - N. Gupta
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - A. Lal
- Department of Radiodiagnosis; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - D. Behera
- Department of Pulmonary Medicine; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - A. Rajwanshi
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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22
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Abstract
Infections with geographically constrained dimorphic fungi cause the endemic mycoses, which include blastomycosis, coccidioidomycosis, emmonsiosis, histoplasmosis, paracoccidioidomycosis, sporotrichosis, and penicilliosis. In the last 5 years, our understanding of the epidemiology, diagnostics, and to a lesser extent management of these diseases has advanced. Specifically, the application of molecular techniques for genotyping fungal pathogens has resulted in the recognition of cryptic species within several genera, including Blastomyces, and Paracoccidioides; the reclassification of Penicillium marneffei, the agent of penicilliosis, to the genus Talaromyces; and the global emergence of dimorphic fungi of the genus Emmonsia, cause disease in immunocompromised persons. New and refined diagnostic tests are available based on the detection of circulating antigens and antibodies, mass spectrometry, and targeted gene amplification. In contrast, the development of new therapeutic options remains stalled, although isavuconazole may hold promise. Finally, advances have been made in the prospect of viable vaccines for preventing animal and human disease.
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Affiliation(s)
- Ilan S. Schwartz
- Departments of Internal Medicine and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba Canada
- Epidemiology for Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Chris Kenyon
- Sexually Transmitted Infection Unit, Institute of Tropical Medicine, Antwerp, Belgium
- University of Cape Town, Cape Town, Western Cape South Africa
| | - George R. Thompson
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, CA USA
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23
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Malik R, Capoor MR, Vanidassane I, Gogna A, Singh A, Sen B, Rudramurthy SM, Honnavar P, Gupta S, Chakrabarti A. Disseminated Emmonsia pasteuriana infection in India: a case report and a review. Mycoses 2015; 59:127-32. [PMID: 26647904 DOI: 10.1111/myc.12437] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/29/2022]
Abstract
We report here the first case of disseminated Emmonsia pasteuriana infection in a patient with AIDS in India. The patient presented with weight loss, dyspnoea, left-sided chest pain and multiple non-tender skin lesions over face and body for 3 months. Disseminated emmonsiosis was diagnosed on microscopic examination and fungal culture of skin biopsy and needle aspirate of lung consolidation. It was confirmed by sequencing internal transcribed spacer region of rDNA, beta tubulin, actin, and intein PRP8. The patient responded to amphotericin B and itraconazole therapy.
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Affiliation(s)
- Rupali Malik
- Department of Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Malini R Capoor
- Department of Microbiology, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Ilavarasi Vanidassane
- Department of Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Arun Gogna
- Department of Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Avninder Singh
- National Institute of Pathology, Safdarjung Hospital, New Delhi, India
| | - Biswajit Sen
- National Institute of Pathology, Safdarjung Hospital, New Delhi, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Prasanna Honnavar
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunita Gupta
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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24
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Schwartz IS, Kenyon C, Feng P, Govender NP, Dukik K, Sigler L, Jiang Y, Stielow JB, Muñoz JF, Cuomo CA, Botha A, Stchigel AM, de Hoog GS. 50 Years of Emmonsia Disease in Humans: The Dramatic Emergence of a Cluster of Novel Fungal Pathogens. PLoS Pathog 2015; 11:e1005198. [PMID: 26584311 PMCID: PMC4652914 DOI: 10.1371/journal.ppat.1005198] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ilan S. Schwartz
- International Health Unit, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chris Kenyon
- Sexually Transmitted Infection Unit, Institute of Tropical Medicine, Antwerp, Belgium
- University of Cape Town, Cape Town, Western Cape, South Africa
| | - Peiying Feng
- Department of Dermatology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Nelesh P. Govender
- University of Cape Town, Cape Town, Western Cape, South Africa
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Karolina Dukik
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Lynne Sigler
- University of Alberta Microfungus Collection and Herbarium, Devonian Botanic Garden, Edmonton, Alberta, Canada
| | - Yanping Jiang
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Guiyang, China
| | | | - José F. Muñoz
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
- Institute of Biology, Universidad de Antioquia, Medellín, Colombia
| | - Christina A. Cuomo
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Alfred Botha
- Department of Microbiology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Alberto M. Stchigel
- Mycology Unit, Medical School & Pere Virgili Institute for Health Research, Universitat Rovira i Virgili, Reus, Spain
| | - G. Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- * E-mail:
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