National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
University of the Free State, Bloemfontein, South Africa.
J Clin Microbiol. 2020 Feb 24;58(3). doi: 10.1128/JCM.01661-19.
We reevaluated 20 cases of blastomycosis diagnosed in South Africa between 1967 and 2014, with 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 , , and The first group ( = 12) corresponded to the recently described species , and the other ( = 8) is described here as sp. nov. Both species exhibited incomplete conversion to the yeast phase at 37°C and were heterothallic for mating types. All eight 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 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 activity. Over the 5 decades, South African cases of blastomycosis were caused by species that are distinct from Increasing clinical awareness and access to simple rapid diagnostics may improve the diagnosis of blastomycosis in resource-limited countries.
我们重新评估了 1967 年至 2014 年间在南非诊断的 20 例球孢子菌病病例，认为 是致病因子，鉴于新描述的物种和更先进技术的应用。除了组织病理学和/或培养为基础的方法，所有 20 株分离物均进行表型和基因型特征分析，包括 5 个基因的多位点分型和全基因组测序。如临床和实验室标准研究所文件 M27-A3 和 M38-A2 所述进行抗真菌药敏试验。我们合并了实验室和相应的临床病例数据（如有）。5 基因和全基因组序列的形态特征和系统发育分析显示出两个群体，都与 、 、 和 密切相关但又不同。第一个群体（ = 12）对应于最近描述的物种 ，另一个（ = 8）在这里被描述为 sp. nov.。两个物种在 37°C 时不完全转化为酵母相，并且是异型交配型。所有 8 株 分离物都属于α交配型。全基因组测序证实了独特的物种身份以及 基因的完整直系同源物的缺失。肺外（皮肤或骨骼）疾病，可能是由原发性肺部感染的血源性播散引起，比单纯肺部疾病更常见。伏立康唑、泊沙康唑、伊曲康唑、两性霉素 B 和米卡芬净具有最强的 活性。在过去的 50 年中，南非的球孢子菌病病例是由与 不同的物种引起的。提高临床认识和获得简单快速的诊断方法可能会改善资源有限国家的球孢子菌病诊断。
