{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:29:00Z","timestamp":1787761740793,"version":"build-2784847793"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Emergomycosis, an emerging dimorphic fungal infection caused by\n                      <jats:italic>Emergomyces<\/jats:italic>\n                      species, primarily affects immunocompromised individuals.\n                      <jats:italic>Emergomyces orientalis<\/jats:italic>\n                      has been reported in China, including rare cases in immunocompetent individuals. Diagnosis remains challenging due to the lack of typical clinical manifestations and radiological features. Co-infection with other pathogens further complicates management, with no prior global reports of concurrent\n                      <jats:italic>E. orientalis<\/jats:italic>\n                      and non-tuberculous mycobacterial (NTM) infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 21-year-old immunocompetent woman with occupational exposure to soil presented with cough, fever, and a mediastinal mass on chest CT. The initial biopsy specimens revealed granulomatous inflammation and yeast-like fungi. Metagenomic next-generation sequencing (mNGS) of endobronchial ultrasound (EBUS)-guided specimens confirmed\n                      <jats:italic>E. orientalis<\/jats:italic>\n                      (40 reads). Liposomal amphotericin B induction therapy initially relieved the symptoms. However, recurrence prompted repeat mNGS, which revealed elevated\n                      <jats:italic>Mycobacterium fortuitum<\/jats:italic>\n                      loads (791 reads). Combined with the patient\u2019s history of soil exposure, a diagnosis of mediastinal\n                      <jats:italic>E. orientalis<\/jats:italic>\n                      with\n                      <jats:italic>M. fortuitum<\/jats:italic>\n                      co-infection was established based on the clinical presentation, the chest CT findings, histopathological observations of yeast-like fungi, the mNGS results, and the therapeutic response. Following confirmation of the co-infection, tailored adjustments to the antimicrobial regimen led to successful clinical management.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      To the best of our knowledge, this is the first study in which\n                      <jats:italic>E. orientalis<\/jats:italic>\n                      and\n                      <jats:italic>M. fortuitum<\/jats:italic>\n                      were documented to coexist in the mediastinum. The dual pathogens were identified through a combination of EBUS-guided biopsy and mNGS. Accurate pathogen identification followed by tailored, pathogen-directed therapy is essential for the effective management of an\n                      <jats:italic>E. orientalis<\/jats:italic>\n                      and\n                      <jats:italic>M. fortuitum<\/jats:italic>\n                      mixed infection.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1778930","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:40:54Z","timestamp":1777009254000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnosis and treatment of a patient with mediastinal infection caused by Emergomyces orientalis and Mycobacterium fortuitum"],"prefix":"10.3389","volume":"16","author":[{"given":"Liang","family":"Guo","sequence":"first","affiliation":[{"name":"Institute of Respiratory Disease, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Luo","sequence":"additional","affiliation":[{"name":"Institute of Respiratory Disease, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menglin","family":"Luo","sequence":"additional","affiliation":[{"name":"Institute of Pharmacy, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingzhou","family":"Zhang","sequence":"additional","affiliation":[{"name":"Institute of Respiratory Disease, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute of Respiratory Disease, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You","family":"Fu","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Wu","sequence":"additional","affiliation":[{"name":"Institute of Respiratory Disease, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Yu","sequence":"additional","affiliation":[{"name":"Institute of Respiratory Disease, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Bai","sequence":"additional","affiliation":[{"name":"Institute of Respiratory Disease, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Xu","sequence":"additional","affiliation":[{"name":"Institute of Respiratory Disease, Xinqiao Hospital, Second Affiliated Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1007\/s10096-019-03771-0","article-title":"Pulmonary non-tuberculous mycobacterial infections: Current state and future management","volume":"39","author":"Chin","year":"2020","journal-title":"Eur. 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