Emmonsiosis in South Africa

Today I want to bring your attention to an interesting article in CID about a deadly fungus that affects AIDS patients in South Africa. The article is entitled Clinical Characteristics, Diagnosis, Management, and Outcomes of Disseminated Emmonsiosis: A Retrospective Case Series. This is a fungus you have probably never heard of unless you have a special interest in South Africa and infectious diseases. I do, because of my work in neighboring Maputo, Mozambique.

In 2011, at the Clinical Pathologic conference at Maputo Central Hospital Drs. MAdalena Manjate and Elaine Monteiro presented a case of disseminated histoplasmosis in an AIDS patient. The case was unusual because of the severity of the patient’s skin lesions and disseminated disease, and it stuck in my memory. Then, in 2013, an article about Emmonsia spp was published in the NEJM. That article piqued my interest because of the histoplasmosis case two years before. Histoplasmosis and Emmonsia spp are completely distinct fungi but I had always wondered if something else might have been going on.

As Emmonsia spp has only been only recently described, there are only a handful of articles published about it in the literature. For example, Chris Lippincott from UNC and colleagues published an article last year in EID about three patients with it admitted to Helen Joseph Hospital in Johannesburg. All 3 had AIDS and extremely low CD4 counts.

The new CID article was a multicenter retrospective chart review which identified a number of cases of emmonsiosis in 5 provinces of South Africa. The authors found all cases were disseminated and the vast majority occurred in AIDS patients with very low CD4 counts. The photos of the skin lesions alone are stunning and make it worth glancing at this article even if you don’t take care of patients in South Africa.

This is a pathogen to be aware of if you are taking care of AIDS patients in South Africa and its neighbors, as it seems to be another end-stage killer, going along with TB, cryptococcosis, etc. Research on all aspects of this fungus, from epidemiology to treatment, is lacking, primarily because of the shortage of high quality mycology/pathology laboratories across the continent as well as a weak public health system. More research is needed as a redoubling of our efforts to increase ART coverage for people living with HIV. Perhaps the new WHO guidelines will help in that regard.

Thanks so much for reading! Writing blog posts does take time and we’ll all get much more out of them if they lead to discussion/dialogue. If you found my post useful and wouldn’t mind leaving a comment/sharing on social media, that would be great. Thank so much! Best regards, Phil

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