Paradoxical worsening of Emergomyces africanus infection in an HIV-infected male on itraconazole and antiretroviral therapy
Bibliographic record
Abstract
Case presentationA 42-year-old male from an urban informal settlement in Cape Town, South Africa, was seen at a tertiary-care hospital for progressively enlarging lesions on his nose.He had initially presented to medical care 6 months earlier with a 3-month history of anorexia, weight loss, nonproductive cough, and nasal congestion.An HIV test was reactive, and his CD4 count was 32 cells/μL.He also had renal insufficiency with a creatinine clearance of 40 mL/min.Two weeks after diagnosis, he was initiated on antiretroviral therapy (ART) consisting of lamivudine (150 mg by mouth twice daily), stavudine (30 mg by mouth twice daily), and efavirenz (600 mg by mouth once daily).One week later, he developed widespread erythematous nodules and plaques on his face and a crusted mass on his nose (Fig 1A).A chest X-ray demonstrated a reticular opacity within the right middle lobe.A skin biopsy of a facial plaque demonstrated a minimal inflammatory response (Fig 1B).Methenamine silver staining revealed small (3-5μm) yeast-like cells with occasional narrow-based budding (Fig 1C).Fungal culture of skin tissue and blood grew Emergomyces africanus (formerly Emmonsia sp.); identification was confirmed by sequencing of the internal transcribed spacer region (ITS).He was treated with intravenous amphotericin B deoxycholate (1 mg/kg) for 14 days.Thereafter, his ART was changed to lamivudine (150 mg by mouth twice daily), zidovudine (300 mg by mouth twice daily), and combination lopinovir/ritonavir (400/100 mg by mouth twice daily), and he was commenced on itraconazole (200 mg capsule orally once daily, to be taken with food) to continue for 1 year pending immune reconstitution.Soon after initiating antifungal therapy, the patient's constitutional and respiratory symptoms abated, and the cutaneous lesions improved over several weeks.However, the nasal lesions never completely resolved despite reported adherence to ART and itraconazole.Approximately 4 months after completing amphotericin B, his nasal lesions worsened over 1 month and he was referred to our tertiary-care centre for further evaluation.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".