Abstract
The use of molecular tools has led to the description of new cryptic species among different Aspergillus species complexes. Their frequency in the clinical setting has been reported to be between 10 and 15 %. The susceptibility to azoles and amphotericin B of many of these species is low, and some of them, such as Aspergillus calidoustus or Aspergillus lentulus, are considered multi-resistant. The changing epidemiology, the frequency of cryptic species, and the different susceptibility profiles make antifungal susceptibility testing an important tool to identify the optimal antifungal agent to treat the infections caused by these species.
Similar content being viewed by others
References
Alastruey-Izquierdo A, Mellado E, Pelaez T, Peman J, Zapico S, Alvarez M, et al. Population-based survey of filamentous fungi and antifungal resistance in Spain (FILPOP Study). Antimicrob Agents Chemother. 2013;57(7):3380–7. doi:10.1128/AAC.00383-13.
Marr KA, Patterson T, Denning D. Aspergillosis. Pathogenesis, clinical manifestations, and therapy. Infect Dis Clin North Am. 2002;16(4):875–94, vi.
Lass-Florl C. The changing face of epidemiology of invasive fungal disease in Europe. Mycoses. 2009;52(3):197–205.
Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34(7):909–17. doi:10.1086/339202.
Balajee SA, Gribskov JL, Hanley E, Nickle D, Marr KA. Aspergillus lentulus sp. nov., a new sibling species of A. fumigatus. Eukaryot Cell. 2005;4(3):625–32. doi:10.1128/EC.4.3.625-632.2005.
Varga J, Houbraken J, Van Der Lee HA, Verweij PE, Samson RA. Aspergillus calidoustus sp. nov., causative agent of human infections previously assigned to Aspergillus ustus. Eukaryot Cell. 2008;7(4):630–8. doi:10.1128/EC.00425-07.
Balajee SA, Gribskov J, Brandt M, Ito J, Fothergill A, Marr KA. Mistaken identity: Neosartorya pseudofischeri and its anamorph masquerading as Aspergillus fumigatus. J Clin Microbiol. 2005;43(12):5996–9. doi:10.1128/JCM.43.12.5996-5999.2005.
Varga J, Kocsube S, Toth B, Frisvad JC, Perrone G, Susca A, et al. Aspergillus brasiliensis sp. nov., a biseriate black Aspergillus species with world-wide distribution. Int J Syst Evol Microbiol. 2007;57(Pt 8):1925–32. doi:10.1099/ijs.0.65021-0.
Balajee SA, Borman AM, Brandt ME, Cano J, Cuenca-Estrella M, Dannaoui E, et al. Sequence-based identification of Aspergillus, Fusarium, and mucorales species in the clinical mycology laboratory: where are we and where should we go from here? J Clin Microbiol. 2009;47(4):877–84. doi:10.1128/JCM.01685-08.
Schoch CL, Seifert KA, Huhndorf S, Robert V, Spouge JL, Levesque CA, et al. Nuclear ribosomal internal transcribed spacer (ITS) region as a universal DNA barcode marker for Fungi. Proc Natl Acad Sci USA. 2012;109(16):6241–6. doi:10.1073/pnas.1117018109.
Alastruey-Izquierdo A, Mellado E, Cuenca-Estrella M. Current section and species complex concepts in Aspergillus: recommendations for routine daily practice. Ann NY Acad Sci. 2012;1273:18–24. doi:10.1111/j.1749-6632.2012.06822.x.
Balajee SA, Kano R, Baddley JW, Moser SA, Marr KA, Alexander BD, et al. Molecular identification of Aspergillus species collected for the transplant-associated infection surveillance network. J Clin Microbiol. 2009;47(10):3138–41. doi:10.1128/JCM.01070-09.
Balajee SA, Weaver M, Imhof A, Gribskov J, Marr KA. Aspergillus fumigatus variant with decreased susceptibility to multiple antifungals. Antimicrob Agents Chemother. 2004;48(4):1197–203.
Zbinden A, Imhof A, Wilhelm MJ, Ruschitzka F, Wild P, Bloemberg GV, et al. Fatal outcome after heart transplantation caused by Aspergillus lentulus. Transpl Infect Dis. 2012;14(5):E60–3. doi:10.1111/j.1399-3062.2012.00779.x.
Subcommittee on Antifungal Susceptibility Testing of the EECfAST. EUCAST technical note on the method for the determination of broth dilution minimum inhibitory concentrations of antifungal agents for conidia-forming moulds. Clin Microbiol Infect. 2008;14(10):982–4. doi:10.1111/j.1469-0691.2008.02086.x.
Clinical Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard-2nd edition. CLSI document M38-A. Wayne, Pennsylvania, USA: Clinical Laboratory Standards Institute; 2002.
Chryssanthou E, Cuenca-Estrella M. Comparison of the EUCAST-AFST broth dilution method with the CLSI reference broth dilution method (M38-A) for susceptibility testing of posaconazole and voriconazole against Aspergillus spp. Clin Microbiol Infect. 2006;12(9):901–4. doi:10.1111/j.1469-0691.2006.01419.x.
Koutroutsos K, Arabatzis M, Bougatsos G, Xanthaki A, Toutouza M, Velegraki A. Neosartorya hiratsukae peritonitis through continuous ambulatory peritoneal dialysis. J Med Microbiol. 2010;59(Pt 7):862–5. doi:10.1099/jmm.0.019133-0.
Guarro J, Kallas EG, Godoy P, Karenina A, Gene J, Stchigel A, et al. Cerebral aspergillosis caused by Neosartorya hiratsukae, Brazil. Emerg Infect Dis. 2002;8(9):989–91. doi:10.3201/eid0809.020073.
Alcazar-Fuoli L, Mellado E, Alastruey-Izquierdo A, Cuenca-Estrella M, Rodriguez-Tudela JL. Aspergillus section Fumigati: antifungal susceptibility patterns and sequence-based identification. Antimicrob Agents Chemother. 2008;52(4):1244–51. doi:10.1128/AAC.00942-07.
Arabatzis M, Kambouris M, Kyprianou M, Chrysaki A, Foustoukou M, Kanellopoulou M, et al. Polyphasic identification and susceptibility to seven antifungals of 102 Aspergillus isolates recovered from immunocompromised hosts in Greece. Antimicrob Agents Chemother. 2011;55(6):3025–30. doi:10.1128/AAC.01491-10.
Summerbell RC, de Repentigny L, Chartrand C, St Germain G. Graft-related endocarditis caused by Neosartorya fischeri var. spinosa. J Clin Microbiol. 1992;30(6):1580–2.
Coriglione G, Stella G, Gafa L, Spata G, Oliveri S, Padhye AA, et al. Neosartorya fischeri var fischeri (Wehmer) Malloch and Cain 1972 (anamorph: Aspergillus fischerianus Samson and Gams 1985) as a cause of mycotic keratitis. Eur J Epidemiol. 1990;6(4):382–5.
Matsumoto N, Shiraga H, Takahashi K, Kikuchi K, Ito K. Successful treatment of Aspergillus peritonitis in a peritoneal dialysis patient. Pediatr Nephrol. 2002;17(4):243–5. doi:10.1007/s00467-002-0821-6.
Jarv H, Lehtmaa J, Summerbell RC, Hoekstra ES, Samson RA, Naaber P. Isolation of Neosartorya pseudofischeri from blood: first hint of pulmonary Aspergillosis. J Clin Microbiol. 2004;42(2):925–8.
Vinh DC, Shea YR, Jones PA, Freeman AF, Zelazny A, Holland SM. Chronic invasive aspergillosis caused by Aspergillus viridinutans. Emerg Infect Dis. 2009;15(8):1292–4. doi:10.3201/eid1508.090251.
Pelaez T, Alvarez-Perez S, Mellado E, Serrano D, Valerio M, Blanco JL, et al. Invasive aspergillosis caused by cryptic Aspergillus species: a report of two consecutive episodes in a patient with leukaemia. J Med Microbiol. 2013;62(Pt 3):474–8. doi:10.1099/jmm.0.044867-0.
Coelho D, Silva S, Vale-Silva L, Gomes H, Pinto E, Sarmento A, et al. Aspergillus viridinutans: an agent of adult chronic invasive aspergillosis. Med Mycol. 2011;49(7):755–9. doi:10.3109/13693786.2011.556672.
Shivaprakash MR, Jain N, Gupta S, Baghela A, Gupta A, Chakrabarti A. Allergic fungal rhinosinusitis caused by Neosartorya hiratsukae from India. Med Mycol. 2009;47(3):317–20. doi:10.1080/13693780802562977.
Balajee SA, Nickle D, Varga J, Marr KA. Molecular studies reveal frequent misidentification of Aspergillus fumigatus by morphotyping. Eukaryot Cell. 2006;5(10):1705–12. doi:10.1128/EC.00162-06.
Posteraro B, Mattei R, Trivella F, Maffei A, Torre A, De Carolis E, et al. Uncommon Neosartorya udagawae fungus as a causative agent of severe corneal infection. J Clin Microbiol. 2011;49(6):2357–60. doi:10.1128/JCM.00134-11.
Vinh DC, Shea YR, Sugui JA, Parrilla-Castellar ER, Freeman AF, Campbell JW, et al. Invasive aspergillosis due to Neosartorya udagawae. Clin Infect Dis. 2009;49(1):102–11. doi:10.1086/599345.
Hendrickx M, Beguin H, Detandt M. Genetic re-identification and antifungal susceptibility testing of Aspergillus section Nigri strains of the BCCM/IHEM collection. Mycoses. 2012;55(2):148–55. doi:10.1111/j.1439-0507.2011.02049.x.
Howard SJ, Harrison E, Bowyer P, Varga J, Denning DW. Cryptic species and azole resistance in the Aspergillus niger complex. Antimicrob Agents Chemother. 2011;55(10):4802–9. doi:10.1128/AAC.00304-11.
Alcazar-Fuoli L, Mellado E, Alastruey-Izquierdo A, Cuenca-Estrella M, Rodriguez-Tudela JL. Species identification and antifungal susceptibility patterns of species belonging to Aspergillus section Nigri. Antimicrob Agents Chemother. 2009;53(10):4514–7. doi:10.1128/AAC.00585-09.
Szigeti G, Kocsube S, Doczi I, Bereczki L, Vagvolgyi C, Varga J. Molecular identification and antifungal susceptibilities of black Aspergillus isolates from otomycosis cases in Hungary. Mycopathologia. 2012;174(2):143–7. doi:10.1007/s11046-012-9529-8.
Balajee SA, Lindsley MD, Iqbal N, Ito J, Pappas PG, Brandt ME. Nonsporulating clinical isolate identified as Petromyces alliaceus (anamorph Aspergillus alliaceus) by morphological and sequence-based methods. J Clin Microbiol. 2007;45(8):2701–3. doi:10.1128/JCM.00642-07.
Ozhak-Baysan B, Alastruey-Izquierdo A, Saba R, Ogunc D, Ongut G, Timuragaoglu A, et al. Aspergillus alliaceus and Aspergillus flavus co-infection in an acute myeloid leukemia patient. Med Mycol. 2010;48(7):995–9. doi:10.3109/13693781003749418.
Carrizosa J, Levison ME, Lawrence T, Kaye D. Cure of Aspergillus ustus endocarditis on a prosthetic valve. Arch Intern Med. 1974;133(3):486–90.
Iwen PC, Rupp ME, Bishop MR, Rinaldi MG, Sutton DA, Tarantolo S, et al. Disseminated aspergillosis caused by Aspergillus ustus in a patient following allogeneic peripheral stem cell transplantation. J Clin Microbiol. 1998;36(12):3713–7.
Panackal AA, Imhof A, Hanley EW, Marr KA. Aspergillus ustus infections among transplant recipients. Emerg Infect Dis. 2006;12(3):403–8. doi:10.3201/eid1205.050670.
Verweij PE, van den Bergh MF, Rath PM, de Pauw BE, Voss A, Meis JF. Invasive aspergillosis caused by Aspergillus ustus: case report and review. J Clin Microbiol. 1999;37(5):1606–9.
Egli A, Fuller J, Humar A, Lien D, Weinkauf J, Nador R, et al. Emergence of Aspergillus calidoustus infection in the era of posttransplantation azole prophylaxis. Transplantation. 2012;94(4):403–10. doi:10.1097/TP.0b013e31825992f0.
Alastruey-Izquierdo A, Cuesta I, Houbraken J, Cuenca-Estrella M, Monzon A, Rodriguez-Tudela JL. In vitro activity of nine antifungal agents against clinical isolates of Aspergillus calidoustus. Med Mycol. 2010;48(1):97–102. doi:10.3109/13693780902803040.
Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis. 2008;47(4):503–9. doi:10.1086/590004.
Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis. 2006;43(1):25–31. doi:10.1086/504810.
Acknowledgments
Ana Alastruey-Izquierdo has a research contract from Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015) Instituto de Salud Carlos III—co-financed by European Development Regional Fund “A way to achieve Europe” ERDF, Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015) and the Fondo de Investigaciónes Sanitarias MPY1369/13. Laura Alcazar-Fuoli is funded by Fondo de Investigación Sanitaria with a Miguel Servet fellowship (CP11/00026).
Conflicts of interest
M. C. E. has received grant support from Astellas Pharma, BioMerieux, Gilead Sciences, Merck Sharp and Dohme, Pfizer, Schering Plough, Soria Melguizo SA, Ferrer International the European Union, the ALBAN program, the Spanish Agency for International Cooperation, the Spanish Ministry of Culture and Education, The Spanish Health Research Fund, The Instituto de Salud Carlos III, The Ramon Areces Foundation, and The Mutua Madrilena Foundation. He has been an advisor/consultant to the Panamerican Health Organization, Gilead Sciences, Merck Sharp and Dohme, Pfizer, and Schering Plough. He has been paid for talks on behalf of Gilead Sciences, Merck Sharp and Dohme, Pfizer, and Schering Plough. Other authors: nothing to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alastruey-Izquierdo, A., Alcazar-Fuoli, L. & Cuenca-Estrella, M. Antifungal Susceptibility Profile of Cryptic Species of Aspergillus . Mycopathologia 178, 427–433 (2014). https://doi.org/10.1007/s11046-014-9775-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11046-014-9775-z