Maphanga Tsidiso G, Britz Erika, Zulu Thokozile G, Mpembe Ruth S, Naicker Serisha D, Schwartz Ilan S, Govender Nelesh P
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.
J Clin Microbiol. 2017 Jun;55(6):1812-1820. doi: 10.1128/JCM.02524-16. Epub 2017 Mar 29.
Disseminated emmonsiosis is an important AIDS-related mycosis in South Africa that is caused by , a newly described and renamed dimorphic fungal pathogen. 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 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 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; = 0.02) or bone marrow (OR, 12.1; 95% CI, 1.2 to 120.2; = 0.03) (versus skin biopsy) was associated with death. susceptibility data support the management of disseminated emmonsiosis with amphotericin B, followed by itraconazole, voriconazole, or posaconazole. Fluconazole was a relatively less potent agent.
播散性埃蒙斯霉菌病是南非一种重要的与艾滋病相关的真菌病，由一种新描述并重新命名的双相真菌病原体引起。抗真菌药敏数据可指导治疗。侵袭性临床分离株的鉴定通过表型和内部转录间隔区测序得以确认。按照临床和实验室标准协会的建议，使用定制的冷冻肉汤微量稀释（BMD）板测定了氟康唑、伏立康唑、伊曲康唑、泊沙康唑、卡泊芬净、阿尼芬净、米卡芬净和氟胞嘧啶的酵母相和霉菌相最低抑菌浓度（MIC）。两性霉素B、伊曲康唑、泊沙康唑和伏立康唑的MIC通过Etest法测定。对50株独特的分离株进行了检测。伊曲康唑酵母相和霉菌相的几何平均（GM）BMD和Etest MIC均为0.01毫克/升。伏立康唑和泊沙康唑的GM BMD MIC在两个阶段均为0.01毫克/升，而GM Etest MIC分别为0.001和0.002毫克/升。氟康唑的GM BMD MIC在两个阶段均为0.18毫克/升。两性霉素B酵母相和霉菌相的GM Etest MIC分别为0.03和0.01毫克/升。棘白菌素类药物和氟胞嘧啶的活性非常有限。有37例患者的治疗和转归数据；在一个包括MIC数据的多变量模型中，仅血培养分离出病原菌（比值比[OR]，8.6；95%置信区间[CI]，1.3至54.4；P = 0.02）或骨髓培养分离出病原菌（OR，12.1；95% CI，1.2至120.2；P = 0.03）（与皮肤活检相比）与死亡相关。药敏数据支持播散性埃蒙斯霉菌病的治疗先用两性霉素B，随后用伊曲康唑、伏立康唑或泊沙康唑。氟康唑是一种相对效力较弱的药物。
