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Volume 4, Issue 4

Cryptic aspergillosis: a rare entity and a diagnostic challenge Open Access

Abstract

Cryptic aspergillosis, caused by cryptic species of , is increasingly reported in humans and causes significant morbidity and mortality in immunocompromised individuals. The main aim of this study was to describe the occurrence of this entity at a large tertiary care centre and analyse the challenges in identifying them in a routine diagnostic laboratory.

This was a retrospective case review of all patients diagnosed with cryptic species from April 2019 to February 2020. The isolates were identified using conventional microbiological techniques, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI- TOF MS), 28S rRNA and internal transcribed spacer (ITS) sequencing.

The species identified were and . Identification by MALDI- TOF MS and sequencing was concordant for all except , with MALDI- TOF MS misidentifying it as . All isolates showed low minimum inhibitory concentrations (MICs) for the panel of antifungal drugs.

Aspergillosis caused by cryptic species presents a diagnostic challenge. This study confirms the importance of molecular methods for accurate identification.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): AFST (antifungal susceptibility testing) , cryptic species , ITS sequencing , MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry) and MEC (minimum effective concentration)
© 2022 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. The Microbiology Society waived the open access fees for this article.
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2022-04-19
2024-04-24
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References

  1. Denning DW Clinical manifestations and diagnosis of chronic pulmonary aspergillosis. UpToDate; 2022 https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-chronic-pulmonary-aspergillosis
  2. Pasqualotto AC, Denning DW. Post-operative aspergillosis. Clin Microbiol Infect 2006; 12:1060–1076 [View Article] [PubMed]
     [Google Scholar]
  3. Obradovic-Tomasev M, Popovic A, Vuckovic N, Jovanovic M. Mixed fungal infection (Aspergillus, mucor, and Candida) of severe hand injury. Case Rep Infect Dis 2014; 2014:954186 [View Article] [PubMed]
     [Google Scholar]
  4. Gautier M, Normand A-C, Ranque S. Previously unknown species of Aspergillus . Clin Microbiol Infect 2016; 22:662–669 [View Article] [PubMed]
     [Google Scholar]
  5. Samson RA, Visagie CM, Houbraken J, Hong S-B, Hubka V et al. Phylogeny, identification and nomenclature of the genus Aspergillus . Stud Mycol 2014; 78:141–173 [View Article] [PubMed]
     [Google Scholar]
  6. Paris CA, Wagner FS, Wagner WH. Cryptic species, species delimitation, and taxonomic practice in the homosporous ferns. American Fern Journal 1989; 79:46 [View Article]
     [Google Scholar]
  7. Nagarajan C, Thayanidhi P, Kindo AJ, Ramaraj V, Mohanty S et al. Fungal rhinosinusitis: report of uncommon Aspergillus species as etiological agents. IJCRI 2014; 5:13 [View Article]
     [Google Scholar]
  8. Perlin DS, Rautemaa-Richardson R, Alastruey-Izquierdo A. The global problem of antifungal resistance: prevalence, mechanisms, and management. Lancet Infect Dis 2017; 17:e383–e392 [View Article] [PubMed]
     [Google Scholar]
  9. Taheri Rizi Z, Abastabar M, Fakhim H, Ilkit M, Ahangarkani F et al. Antifungal activity of a novel triazole, efinaconazole and nine comparators against 354 molecularly identified Aspergillus isolates. Mycopathologia 2020; 185:357–365 [View Article] [PubMed]
     [Google Scholar]
  10. CLSI Reference method for Broth Dilution Filamentous Fungi Antifungal Susceptibility Test 3rd ed CLSI standard M38. Wayne, PA: Clinical and Laboratory Standards Institute; 2017 https://clsi.org/standards/products/microbiology/documents/m38/
  11. Won EJ, Shin JH, Kim SH, Choi MJ, Byun SA et al. Antifungal susceptibilities to amphotericin B, triazoles and echinocandins of 77 clinical isolates of cryptic Aspergillus species in multicenter surveillance in Korea. Med Mycol 2018; 56:501–505 [View Article] [PubMed]
     [Google Scholar]
  12. Yang X, Chen W, Liang T, Tan J, Liu W et al. A 20-year antifungal susceptibility surveillance (from 1999 to 2019) for Aspergillus spp. and proposed epidemiological cutoff values for Aspergillus fumigatus and Aspergillus flavus: a study in a tertiary hospital in China. Front Microbiol 2021; 12:680884 [View Article] [PubMed]
     [Google Scholar]
  13. Homa M, Manikandan P, Szekeres A, Kiss N, Kocsubé S et al. Characterization of Aspergillus tamarii strains from human keratomycoses: molecular identification, antifungal susceptibility patterns and cyclopiazonic acid producing abilities. Front Microbiol 2019; 10:2249 [View Article] [PubMed]
     [Google Scholar]
  14. Gürcan S, Tikveşli M, Ustündağ S, Ener B. A case report on Aspergillus lentulus pneumonia. Balkan Med J 2013; 30:429–431 [View Article] [PubMed]
     [Google Scholar]
  15. Alastruey-Izquierdo A, Alcazar-Fuoli L, Cuenca-Estrella M. Antifungal susceptibility profile of cryptic species of Aspergillus . Mycopathologia 2014; 178:427–433 [View Article] [PubMed]
     [Google Scholar]
  16. Masih A, Singh PK, Kathuria S, Agarwal K, Meis JF et al. Identification by molecular methods and matrix-assisted laser desorption ionization-time of flight mass spectrometry and antifungal susceptibility profiles of clinically significant rare Aspergillus species in a referral chest hospital in Delhi, India. J Clin Microbiol 2016; 54:2354–2364 [View Article] [PubMed]
     [Google Scholar]
  17. Negri CE, Gonçalves SS, Xafranski H, Bergamasco MD, Aquino VR et al. Cryptic and rare Aspergillus species in Brazil: prevalence in clinical samples and in vitro susceptibility to triazoles. J Clin Microbiol 2014; 52:3633–3640 [View Article] [PubMed]
     [Google Scholar]
  18. Nedel WL, Pasqualotto AC. Treatment of infections by cryptic Aspergillus species. Mycopathologia 2014; 178:441–445 [View Article] [PubMed]
     [Google Scholar]
  19. Guenter S, Gorkiewicz G, Halwachs B, Kashofer K, Thueringer A et al. Impact of ITS-based sequencing on antifungal treatment of patients with suspected invasive fungal infections. J Fungi (Basel) 2020; 6:E43 [View Article] [PubMed]
     [Google Scholar]
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Cryptic aspergillosis: a rare entity and a diagnostic challenge
Access Microbiology 4, 000344 (2022); https://doi.org/10.1099/acmi.0.000344
/content/journal/acmi/10.1099/acmi.0.000344
/content/journal/acmi/10.1099/acmi.0.000344
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