Emergomyces orientalis Emergomycosis Diagnosed by Metagenomic Next-Generation Sequencing

Abstract

Emergomyces is a newly described dimorphic fungus genus; it may cause fatal infections in immunocompromised patients, but diagnosis is often delayed. We report a case of disseminated emergomycosis caused by the novel species Emergomyces orientalis in a kidney transplant recipient from Tibet. Infection was diagnosed early by metagenomic next-generation sequencing.

Keywords: China; Emergomyces; Emergomyces orientalis; Tibet; disseminated emergomycosis; fungi; immunocompromised; metagenomic next-generation sequencing; respiratory infections; transplant patients.

Figure

Emergomyces orientalis infection in a kidney transplant patient from Tibet. A) Pulmonary consolidation with the air bronchogram sign shown on a computed tomography scan. B) Microbes stained with Grocott-Gomori's methenamine silver in the bronchoalveolar lavage fluid sample (original magnification ×1,000). C) Pathological image of 1 yeast cell shown by electron microscopy in a necrotizing granuloma from paraffin-embedded pulmonary tissue (original magnification ×16,000). D) Tiny, slightly raised white colonies on Sabouraud agar on day 20 at 25°C (left) and grayish yellow furrowed colonies on blood agar on day 30 at 35°C (right) isolated from bronchoalveolar lavage fluid samples. E) Specific secondary α-shaped conidiophore shown with fluorescent calcium staining (original magnification ×1,000). F) Ultrasound revealed a soft tissue abscess in the patient’s right subcostalis.