{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T23:22:55Z","timestamp":1784330575537,"version":"3.55.0"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2017,8,25]],"date-time":"2017-08-25T00:00:00Z","timestamp":1503619200000},"content-version":"vor","delay-in-days":236,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Skin lesions are common in advanced HIV infection and are sometimes caused by serious diseases like systemic mycoses (SM). AIDS-related SM endemic to Western Cape, South Africa, include emergomycosis (formerly disseminated emmonsiosis), histoplasmosis, and sporotrichosis. We previously reported that 95% of patients with AIDS-related emergomycosis had skin lesions, although these were frequently overlooked or misdiagnosed clinically. Prospective studies are needed to characterize skin lesions of SM in South Africa and to help distinguish these from common HIV-related dermatoses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We prospectively enrolled HIV-infected adult patients living in Western Cape, South Africa, with CD4 counts \u2264100 cells\/\u03bcL and widespread skin lesions present \u22646 months that were deemed clinically compatible with SM. We obtained skin biopsies for histopathology and fungal culture and collected epidemiological and clinical data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 34 patients enrolled and in whom a diagnosis could be made, 25 had proven SM: 14 had emergomycosis, and 3 each had histoplasmosis and sporotrichosis; for 5 additional patients, the fungal species could not be identified. Antiretroviral therapy (ART) had been initiated in the preceding 4 weeks for 11\/25 (44%) patients with SM (vs no patients without SM). Plaques and scale crust occurred more frequently in patients with SM (96% vs 25%, P = .0002; and 67% vs 13%, P = .01, respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Recent ART initiation and presence of plaques or scale crust should make clinicians consider SM in patients with advanced HIV infection in this geographic area. Clinical overlap between SM and other dermatoses makes early skin biopsy critical for timely diagnosis and treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofx186","type":"journal-article","created":{"date-parts":[[2017,8,25]],"date-time":"2017-08-25T07:49:57Z","timestamp":1503647397000},"source":"Crossref","is-referenced-by-count":54,"title":["AIDS-Related Endemic Mycoses in Western Cape, South Africa, and Clinical Mimics: A Cross-Sectional Study of Adults With Advanced HIV and Recent-Onset, Widespread Skin Lesions"],"prefix":"10.1093","volume":"4","author":[{"given":"Ilan S","family":"Schwartz","sequence":"first","affiliation":[{"name":"Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa"},{"name":"Sexually Transmitted Infections Unit, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rannakoe","family":"Lehloenya","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskya","family":"Claasens","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, Stellenbosch University, Cape Town, South Africa"},{"name":"Immunodeficiency Clinic, Karl Bremer Hospital, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zandile","family":"Spengane","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Prozesky","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie","family":"Burton","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, Western Cape, South Africa"},{"name":"Southern African Medical Unit, M\u00e9decins Sans Fronti\u00e8res, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arifa","family":"Parker","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Wasserman","sequence":"additional","affiliation":[{"name":"Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme","family":"Meintjes","sequence":"additional","affiliation":[{"name":"Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Mendelson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jantjie","family":"Taljaard","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann W","family":"Schneider","sequence":"additional","affiliation":[{"name":"National Health Laboratory Service, Tygerberg Branch, Cape Town, Western Cape, South Africa"},{"name":"Division of Anatomical Pathology, Department of Pathology, Stellenbosch University, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Beylis","sequence":"additional","affiliation":[{"name":"National Health Laboratory Service, Groote Schuur Branch, Cape Town, Western Cape, South Africa"},{"name":"Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Maloba","sequence":"additional","affiliation":[{"name":"National Health Laboratory Service, Tygerberg Branch, Cape Town, Western Cape, South Africa"},{"name":"Division of Microbiology, Department of Pathology, Stellenbosch University, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelesh P","family":"Govender","sequence":"additional","affiliation":[{"name":"National Institute for Communicable Diseases \u2013 Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Health Laboratory Service, Sandringham, Gauteng, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Colebunders","sequence":"additional","affiliation":[{"name":"Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sipho","family":"Dlamini","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,8,25]]},"reference":[{"key":"2020081005182491400_CIT0001","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1001\/archderm.1989.01670150047004","article-title":"Prevalence and clinical spectrum of skin disease in patients infected with human immunodeficiency 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