© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Transplant Infectious Disease, ISSN 1398-2273
Letter to the Editor
A second look at Emmonsia infection can make the difference I. Pelegrın, A. Alastruey-Izquierdo, J. Ayats, M. Cuenca-Estrella, C. Cabellos. A second look at Emmonsia infection can make the difference. Transpl Infect Dis 2014: 00: 000–000 All rights reserved
I. Pelegrın1, A. Alastruey-Izquierdo2, J. Ayats3, M. Cuenca-Estrella2, C. Cabellos1 1
Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain, 2Spanish Mycology Reference Laboratory, National Center for Microbiology, Madrid, Spain, 3Microbiology Department, IDIBELL-Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
Correspondence to: Ivan Pelegrın, Infectious Diseases Service, IDIBELL-Hospital Universitari de Bellvitge, C/ Feixa Llarga s/n. E-08907 L’Hospitalet, Barcelona, Spain Tel: (+34) 932607625 Fax: (+34) 932607637 E-mail: [email protected]
Received 4 February 2014, revised 9 March 2014, accepted for publication 13 March 2014 DOI: 10.1111/tid.12214 Transpl Infect Dis 2014: 0: 1–2
To the Editor In the October 10, 2013 issue of the New England Journal of Medicine, Kenyon et al. (1) reported the finding of a new species of dimorphic fungus that is pathogenic to humans, closely related to Emmonsia pasteuriana. They reported 13 cases of this new Emmonsia infection in human immunodeficiency virusinfected adults in South Africa, most of them presenting with lung and skin lesions. Emmonsia crescens and Emmonsia parva are the agents that cause adiaspiromycosis, and only one human case of E. pasteuriana infection has been described (2). Kenyon et al. (1) noted only 2 reports in the literature of infection with Emmonsia species, other than E. parva and E. crescens, and described them briefly in their discussion. However, in a study published in 2011 in Transplant Infectious Disease, we reported another case of disseminated adiaspiromycosis caused by Emmonsia species (3), which was not cited in the Kenyon article.
We have just performed a new sequence analysis of our isolate, comparing it with the nucleotide sequences of the type strains of Emmonsia species obtained from the updated GenBank database (http://www.ncbi.nih.gov/Genbank/). Our isolate now presents similarities of 99.8% with E. pasteuriana (NCPF 4236), 93.6% with the new species (NCPF 4164), and 92.7% with E. crescens (ATCC 13704). Consequently, our case is the second report of E. pasteuriana infection in humans in the literature, and the first in a transplant patient. When we published our case in 2011, strain types of these species were not available in GenBank, and so they could not be correctly identified at that time. In addition to those reported by Kenyon et al., we have also found 2 more case reports of infection due to Emmonsia species (4, 5), and one of them in a heart transplant patient. After reviewing cases of Emmonsia infection, it seems that Emmonsia species, other than the common
1
Pelegrin et al: Letter: Emmonsia infection
ones, may present as disseminated adiaspiromycosis in immunosuppressed patients. In our view, the total number of cases of Emmonsia infection, other than those caused by E. parva and E. crescens, should be updated to identify populations at risk of developing this rare infection.
Acknowledgements: Conflicts: All authors: no financial support and no conflicts of interest.
References 1. Kenyon C, Bonorchis K, Corcoran C, et al. A dimorphic fungus causing disseminated infection in South Africa. N Engl J Med 2013; 369 (15): 1416–1424. doi:10.1056/NEJMoa1215460.
2
Transplant Infectious Disease 2014:0: 1–2
2. Gori S, Drohuet E, Gueho E, et al. Cutaneous disseminated micosis in a patient with AIDS due to a new dimorphic fungus. J Mycol Med 1998; 8: 57–63. 3. Pelegrın I, Ayats J, Xiol X, et al. Disseminated adiaspiromycosis: case report of a liver transplant patient with human immunodeficiency infection, and literature review. Transpl Infect Dis 2011; 13 (5): 507–514. 4. Stebbins WG, Krishtul A, Bottone EJ, Phelps R, Cohen S. Cutaneous adiaspiromycosis: a distinct dermatologic entity associated with Chrysosporium species. J Am Acad Dermatol 2004; 51: S185–S189. 5. Gan GG, Kamarulzaman A, Goh KY, Ng KP, Na SL, Soo-Hoo TS. Non-sporulating Chrysosporium: an opportunistic fungal infection in a neutropenic patient. Med J Malaysia 2002; 57 (1): 118–122.
Letter to the Editor
A second look at Emmonsia infection can make the difference I. Pelegrın, A. Alastruey-Izquierdo, J. Ayats, M. Cuenca-Estrella, C. Cabellos. A second look at Emmonsia infection can make the difference. Transpl Infect Dis 2014: 00: 000–000 All rights reserved
I. Pelegrın1, A. Alastruey-Izquierdo2, J. Ayats3, M. Cuenca-Estrella2, C. Cabellos1 1
Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain, 2Spanish Mycology Reference Laboratory, National Center for Microbiology, Madrid, Spain, 3Microbiology Department, IDIBELL-Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
Correspondence to: Ivan Pelegrın, Infectious Diseases Service, IDIBELL-Hospital Universitari de Bellvitge, C/ Feixa Llarga s/n. E-08907 L’Hospitalet, Barcelona, Spain Tel: (+34) 932607625 Fax: (+34) 932607637 E-mail: [email protected]
Received 4 February 2014, revised 9 March 2014, accepted for publication 13 March 2014 DOI: 10.1111/tid.12214 Transpl Infect Dis 2014: 0: 1–2
To the Editor In the October 10, 2013 issue of the New England Journal of Medicine, Kenyon et al. (1) reported the finding of a new species of dimorphic fungus that is pathogenic to humans, closely related to Emmonsia pasteuriana. They reported 13 cases of this new Emmonsia infection in human immunodeficiency virusinfected adults in South Africa, most of them presenting with lung and skin lesions. Emmonsia crescens and Emmonsia parva are the agents that cause adiaspiromycosis, and only one human case of E. pasteuriana infection has been described (2). Kenyon et al. (1) noted only 2 reports in the literature of infection with Emmonsia species, other than E. parva and E. crescens, and described them briefly in their discussion. However, in a study published in 2011 in Transplant Infectious Disease, we reported another case of disseminated adiaspiromycosis caused by Emmonsia species (3), which was not cited in the Kenyon article.
We have just performed a new sequence analysis of our isolate, comparing it with the nucleotide sequences of the type strains of Emmonsia species obtained from the updated GenBank database (http://www.ncbi.nih.gov/Genbank/). Our isolate now presents similarities of 99.8% with E. pasteuriana (NCPF 4236), 93.6% with the new species (NCPF 4164), and 92.7% with E. crescens (ATCC 13704). Consequently, our case is the second report of E. pasteuriana infection in humans in the literature, and the first in a transplant patient. When we published our case in 2011, strain types of these species were not available in GenBank, and so they could not be correctly identified at that time. In addition to those reported by Kenyon et al., we have also found 2 more case reports of infection due to Emmonsia species (4, 5), and one of them in a heart transplant patient. After reviewing cases of Emmonsia infection, it seems that Emmonsia species, other than the common
1
Pelegrin et al: Letter: Emmonsia infection
ones, may present as disseminated adiaspiromycosis in immunosuppressed patients. In our view, the total number of cases of Emmonsia infection, other than those caused by E. parva and E. crescens, should be updated to identify populations at risk of developing this rare infection.
Acknowledgements: Conflicts: All authors: no financial support and no conflicts of interest.
References 1. Kenyon C, Bonorchis K, Corcoran C, et al. A dimorphic fungus causing disseminated infection in South Africa. N Engl J Med 2013; 369 (15): 1416–1424. doi:10.1056/NEJMoa1215460.
2
Transplant Infectious Disease 2014:0: 1–2
2. Gori S, Drohuet E, Gueho E, et al. Cutaneous disseminated micosis in a patient with AIDS due to a new dimorphic fungus. J Mycol Med 1998; 8: 57–63. 3. Pelegrın I, Ayats J, Xiol X, et al. Disseminated adiaspiromycosis: case report of a liver transplant patient with human immunodeficiency infection, and literature review. Transpl Infect Dis 2011; 13 (5): 507–514. 4. Stebbins WG, Krishtul A, Bottone EJ, Phelps R, Cohen S. Cutaneous adiaspiromycosis: a distinct dermatologic entity associated with Chrysosporium species. J Am Acad Dermatol 2004; 51: S185–S189. 5. Gan GG, Kamarulzaman A, Goh KY, Ng KP, Na SL, Soo-Hoo TS. Non-sporulating Chrysosporium: an opportunistic fungal infection in a neutropenic patient. Med J Malaysia 2002; 57 (1): 118–122.
