Microbiology
A dimorphic mold Emergomyces africanus, Emergomyces canadensis, E. pasteurianus, and E. orientalis, Emmonsia crescens, E. parva.
Related to Blastomyces.
Epidemiologic Risks
Emergomyces africanus in Africa, Emergomyces orientalis in Asia.
Emergomyces canadensis N. America.
E. crescens is found worldwide, E. parva is in North and South America, Eastern Europe, Australia, and Asia.
E. pasteuriana, reported from Europe, Asia and Africa.
Most cases are in South Africa. The fungus is worldwide, a rat (and many other mammals) pathogen, that causes Adiaspiromycosis.
In humans usually from inhalation, then it can disseminate.
Syndromes
Occasionally pneumonia and systemic disease.
A disseminated illness in S. Africa. It can look like a widespread folliculitis (PubMed). Also a case out of India (PubMed).
Treatment
"Recently, the susceptibility of an isolate of E. crescens to various antifungal agents was determined (5). The mic's (in μg/ml) of amphotericin B, itraconazole, voriconazole, caspofungin, fluconazole, and 5-fluorocytosine were 0.06, 0.12 to 0.25, 0.06, 0.5, 64, and 8, respectively, with no significant differences in susceptibilities between the aleurioconidia and adiaspores. Only amphotericin B was fungicidal (PubMed)".
In one case series, amphotericin treatment was most associated with survival (PubMed).
Avoid fluconazole and echinocandins.
Notes
It can cause a positive urine Histoplasma antigen.
Last Update: 01/18/20.