{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:18:58Z","timestamp":1788913138371,"version":"build-2803163510"},"reference-count":58,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T00:00:00Z","timestamp":1664323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43TW011255"],"award-info":[{"award-number":["D43TW011255"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Emergomycosis, histoplasmosis, sporotrichosis and blastomycosis are endemic to southern Africa; the first two are AIDS-related mycoses. We described laboratory-diagnosed cases of endemic and imported mycoses in South Africa over a decade and discuss available diagnostic tools, reasons for the current under-estimation of cases and future strategies to improve case ascertainment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We analysed electronic pathology laboratory data from all public laboratories and one large private laboratory in South Africa from 2010\u20132020. Diagnostic specimens processed at the national mycology reference laboratory were also included. We classified cases as proven, probable and possible based on the method of identification.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We identified 682 cases, of which 307 were proven, 279 were probable and 96 were possible. Of 307 culture-confirmed cases, 168 were identified by phenotypic methods plus sequencing, 128 by phenotypic methods alone and 11 by direct PCR. Of 279 probable cases, 176 had yeasts observed on histology, 100 had a positive <jats:italic>Histoplasma<\/jats:italic> antigen test and 3 a positive pan-dimorphic PCR test. All 96 possible cases had compatible clinical syndrome with inflammatory infiltrates on skin tissue histology. A majority of cases had an unspecified endemic mycosis (207\/682, 30.4%), followed by sporotrichosis (170\/682, 24.9%), emergomycosis (154\/682, 22.6%), histoplasmosis (133\/682, 19.5%), blastomycosis (14\/682, 2.1%) and talaromycosis (4\/682, 0.6%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study reports a relatively low number of cases over a decade considering an estimated large population at risk, suggesting that a substantial fraction of cases may remain undiagnosed. There is a need to increase awareness among healthcare workers and to develop rapid point-of-care diagnostic tools and make these widely accessible.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010737","type":"journal-article","created":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T18:24:09Z","timestamp":1664389449000},"page":"e0010737","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":19,"title":["Endemic mycoses in South Africa, 2010\u20132020: A decade-long description of laboratory-diagnosed cases and prospects for the future"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6014-5725","authenticated-orcid":true,"given":"Rutendo E.","family":"Mapengo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsidiso G.","family":"Maphanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne","family":"Grayson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelesh P.","family":"Govender","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,28]]},"reference":[{"issue":"5","key":"pntd.0010737.ref001","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/myc.12601","article-title":"Novel taxa of thermally dimorphic systemic pathogens in the Ajellomycetaceae (Onygenales)","volume":"60","author":"K Dukik","year":"2017","journal-title":"Mycoses"},{"issue":"7","key":"pntd.0010737.ref002","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1093\/cid\/ciaa1100","article-title":"Blastomycosis in Africa and the Middle East: a comprehensive review of reported cases and reanalysis of historical isolates based on molecular data","volume":"73","author":"IS Schwartz","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"9","key":"pntd.0010737.ref003","doi-asserted-by":"crossref","first-page":"e1007977","DOI":"10.1371\/journal.ppat.1007977","article-title":"Emergomyces: The global rise of new dimorphic fungal pathogens","volume":"15","author":"IS Schwartz","year":"2019","journal-title":"PLoS Pathog"},{"issue":"1","key":"pntd.0010737.ref004","doi-asserted-by":"crossref","first-page":"e0006468","DOI":"10.1371\/journal.pntd.0006174","article-title":"Molecular detection of airborne Emergomyces africanus, a thermally dimorphic fungal pathogen, in Cape Town, South Africa","volume":"12","author":"IS Schwartz","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"8","key":"pntd.0010737.ref005","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1093\/mmy\/myaa018","article-title":"Deep fungal infections diagnosed by histology in Uganda: A 70-year retrospective study","volume":"58","author":"R Kwizera","year":"2020","journal-title":"Med Mycol"},{"issue":"3","key":"pntd.0010737.ref006","doi-asserted-by":"crossref","first-page":"80","DOI":"10.3390\/jof5030080","article-title":"Getting histoplasmosis on the map of international recommendations for patients with advanced hiv disease","volume":"5","author":"F Bongomin","year":"2019","journal-title":"J Fungi"},{"key":"pntd.0010737.ref007","unstructured":"Global HIV & AIDS statistics\u2014Fact sheet. 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