据报道,非洲和中东国家有芽生菌病,但是,关于这是否与北美已知的由皮肤芽胞杆菌和gilchristii芽胞杆菌引起的疾病相同,已经存在了长达数十年的争论。
我们回顾了来自非洲和中东的已发表的人类和兽类芽生菌病病例。我们提取了病例的流行病学和临床特征,包括疾病部位,诊断,管理,结果,and,如果可用,病例分离株的遗传和抗原分型。此外,我们对来自非洲的9个临床分离株的核酸进行了测序,这些分离株在全球范围内保存为B.dermatitidis;对于5,我们对内部转录间隔区进行了测序,对于其他4个,我们对整个基因组进行了测序。
我们确定了172例独特的胚生菌病患者,包括来自25个非洲国家的159名患者和来自5个中东国家的12名患者,并确定了7例兽医芽生菌病的报告。在人类中,皮肤病占主导地位(n=100/137,73%),其次是肺(n=73/129,57%)和骨关节受累(n=61/128,48%)。不寻常的直接显微镜/组织病理学表现包括组织中的短菌丝碎片(n=23/129,18%)。有34个基因分型的病例分离株,包括4个物种:全毛胚(n=22,65%),来自所有地区的8个国家;emzantsi胚芽(n=9,26%),来自南非;皮氏芽孢杆菌(n=1,3%),来自刚果民主共和国;和B.gilchristi(n=2,6%),来自南非和津巴布韦。
芽生菌病发生在整个非洲和中东,主要由B.percursus和,至少在南非,B.emzantsi,导致疾病的不同临床和病理模式。
Blastomycosis has been reported from countries in Africa and the Middle East, but a decades-long debate has persisted regarding whether this is the same disease known in North America and caused by
Blastomyces dermatitidis and
Blastomyces gilchristii.
We reviewed published cases of human and veterinary blastomycosis from Africa and the Middle East. We abstracted epidemiological and clinical features of cases, including sites of disease, diagnosis, management, outcomes, and, where available, genetic and antigenic typing of case isolates. In addition, we sequenced nucleic acids from 9 clinical isolates from Africa deposited in global collections as B. dermatitidis; for 5, we sequenced the internal transcribed spacer regions, and for the other 4 we sequenced the whole genomes.
We identified 172 unique human patients with blastomycosis, including 159 patients from 25 African countries and 12 patients from 5 Middle Eastern countries, and also identified 7 reports of veterinary blastomycosis. In humans, cutaneous disease predominated (n = 100/137, 73%), followed by pulmonary (n = 73/129, 57%) and osteoarticular involvement (n = 61/128, 48%). Unusual direct microscopy/histopathological presentations included short hyphal fragments in tissues (n = 23/129, 18%). There were 34 genotyped case isolates that comprised 4 species:
Blastomyces percursus (n = 22, 65%), from 8 countries throughout all regions;
Blastomyces emzantsi (n = 9, 26%), from South Africa; B. dermatitidis (n = 1, 3%), from the Democratic Republic of Congo; and B. gilchristii (n = 2, 6%), from South Africa and Zimbabwe.
Blastomycosis occurs throughout Africa and the Middle East and is caused predominantly by B. percursus and, at least in South Africa, B. emzantsi, resulting in distinct clinical and pathological patterns of disease.