Human Blastomycosis in South Africa Caused by Blastomyces percursus and Blastomyces emzantsi sp. nov., 1967 to 2014.

Autor:	Maphanga TG; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa tsidisom@nicd.ac.za.; University of the Free State, Bloemfontein, South Africa., Birkhead M; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Muñoz JF; Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA., Allam M; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Zulu TG; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Cuomo CA; Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA., Schwartz IS; University of Alberta, Edmonton, Alberta, Canada., Ismail A; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Naicker SD; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.; University of the Witwatersrand, Johannesburg, South Africa., Mpembe RS; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Corcoran C; Ampath National Laboratory Service, Johannesburg, South Africa., de Hoog S; Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.; Center of Expertise in Mycology of RadboudUMC/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., Kenyon C; Institute of Tropical Medicine, Antwerp, Belgium., Borman AM; UK National Mycology Reference Laboratory, Public Health England, Bristol, United Kingdom., Frean JA; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.; University of the Witwatersrand, Johannesburg, South Africa., Govender NP; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.; University of the Witwatersrand, Johannesburg, South Africa.
Jazyk:	angličtina
Zdroj:	Journal of clinical microbiology [J Clin Microbiol] 2020 Feb 24; Vol. 58 (3). Date of Electronic Publication: 2020 Feb 24 (Print Publication: 2020).
DOI:	10.1128/JCM.01661-19
Abstrakt:	We reevaluated 20 cases of blastomycosis diagnosed in South Africa between 1967 and 2014, with Blastomyces dermatitidis considered to be the etiological agent, in light of newly described species and the use of more advanced technologies. In addition to histopathological and/or culture-based methods, all 20 isolates were phenotypically and genotypically characterized, including multilocus typing of five genes and whole-genome sequencing. Antifungal susceptibility testing was performed as outlined by Clinical and Laboratory Standards Institute documents M27-A3 and M38-A2. We merged laboratory and corresponding clinical case data, where available. Morphological characteristics and phylogenetic analyses of five-gene and whole-genome sequences revealed two groups, both of which were closely related to but distinct from B. dermatitidis , Blastomyces gilchristii , and Blastomyces parvus The first group ( n  = 12) corresponded to the recently described species Blastomyces percursus , and the other ( n  = 8) is described here as Blastomyces emzantsi sp. nov. Both species exhibited incomplete conversion to the yeast phase at 37°C and were heterothallic for mating types. All eight B. emzantsi isolates belonged to the α mating type. Whole-genome sequencing confirmed distinct species identities as well as the absence of a full orthologue of the BAD-1 gene. Extrapulmonary (skin or bone) disease, probably resulting from hematogenous spread from a primary lung infection, was more common than pulmonary disease alone. Voriconazole, posaconazole, itraconazole, amphotericin B, and micafungin had the most potent in vitro activity. Over the 5 decades, South African cases of blastomycosis were caused by species that are distinct from B. dermatitidis Increasing clinical awareness and access to simple rapid diagnostics may improve the diagnosis of blastomycosis in resource-limited countries. (Copyright © 2020 American Society for Microbiology.)
Databáze:	MEDLINE
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