Sebastien Imbert1,2, Sophie Cassaing3, Christine Bonnal4, Anne-Cecile Normand1, Frederic Gabriel5, Damien Costa6, Marion Blaize1,2, Laurence Lachaud7, Lilia Hasseine8, Lise Kristensen9, Juliette Guitard10, Christine Schuttler11, Helene Raberin12, Sophie Brun13, Marijke Hendrickx14, Renaud Piarroux1,15, Arnaud Fekkar1,2. 1. AP-HP, Groupe Hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France. 2. Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, F-75013, Paris, France. 3. Centre Hospitalier Universitaire de Toulouse, Service de Parasitologie Mycologie, F-31059, Toulouse, France. 4. AP-HP, Hôpital Bichat-Claude Bernard, Service de Parasitologie Mycologie, F-75018, Paris, France. 5. Centre Hospitalier Universitaire de Bordeaux, Service de Parasitologie Mycologie, F-33000, Bordeaux, France. 6. Centre Hospitalier Universitaire de Rouen, Service de Parasitologie Mycologie, F-76000, Rouen, France. 7. Centre Hospitalier Universitaire de Montpellier, Service de Parasitologie Mycologie, F-34000, Montpellier, France. 8. Centre Hospitalier Universitaire de Nice, Service de Parasitologie Mycologie, F-06000, Nice, France. 9. Aarhus University Hospital, Department of Clinical Microbiology, DK-8200, Aarhus N, Denmark. 10. AP-HP, Hôpital Saint-Antoine, Service de Parasitologie Mycologie, F-75012, Paris, France. 11. Laboratoire Biogroup-LCD, F-92300, Levallois, France. 12. Centre Hospitalier Universitaire de Saint Etienne, Service de Parasitologie Mycologie, F-42100, Saint Etienne, France. 13. AP-HP, Hôpital Avicenne, Service de Parasitologie Mycologie, F-93000, Bobigny, France. 14. Service of Mycology and Aerobiology, BCCM/IHEM Fungal collection, Scientific Institute of Public Health, B-1050, Brussels, Belgium. 15. Sorbonne Université, Inserm, Institut Pierre Louis d'Epidemiologie et de Santé Publique, F-75013, Paris, France.
Abstract
OBJECTIVES: Aspergillus cryptic species are increasingly recognized causes of Aspergillus diseases, including life-threatening invasive aspergillosis (IA). However, as their accurate identification remains challenging in a routine practice, few is known from a clinical and epidemiological perspective. Recently, the MSI application has emerged as a powerful tool for the detection and identification of Aspergillus cryptic species. We aimed to use to the network of users of the MSI application to conduct a multicenter prospective screening of Aspergillus cryptic species related IA and analyze their epidemiological, clinical and mycological characteristics. METHODS: Over a 27-month period, the clinical involvement of 369 Aspergillus cryptic isolates, from 13 French and Danish MSI application users, was prospectively analyzed. Species identification was confirmed by DNA-sequencing and antifungal susceptibility testing was performed using EUCAST reference method. Fifty-one A. fumigatus sensu stricto invasive cases were also analyzed. RESULTS: Fifteen cryptic isolates were responsible of IA. Eight species were involved, including 5 cases related to the species A. sublatus. These species showed high rate of in vitro low susceptibility to antifungal drugs. In comparison with A. fumigatus sensu stricto invasive cases, pre-exposure to azole drugs was significantly associated with cryptic IA (p = 0.02). DISCUSSION: This study brings new insights in cryptic species related IA and underlines the importance to identify accurately at the species level these Aspergillus isolates. The increasing use of antifungal drugs might lead in the future to an epidemiologic shift with an emergence of resistant isolates involved in IA. This article is protected by copyright. All rights reserved.
OBJECTIVES:Aspergillus cryptic species are increasingly recognized causes of Aspergillus diseases, including life-threatening invasive aspergillosis (IA). However, as their accurate identification remains challenging in a routine practice, few is known from a clinical and epidemiological perspective. Recently, the MSI application has emerged as a powerful tool for the detection and identification of Aspergillus cryptic species. We aimed to use to the network of users of the MSI application to conduct a multicenter prospective screening of Aspergillus cryptic species related IA and analyze their epidemiological, clinical and mycological characteristics. METHODS: Over a 27-month period, the clinical involvement of 369 Aspergillus cryptic isolates, from 13 French and Danish MSI application users, was prospectively analyzed. Species identification was confirmed by DNA-sequencing and antifungal susceptibility testing was performed using EUCAST reference method. Fifty-one A. fumigatus sensu stricto invasive cases were also analyzed. RESULTS: Fifteen cryptic isolates were responsible of IA. Eight species were involved, including 5 cases related to the species A. sublatus. These species showed high rate of in vitro low susceptibility to antifungal drugs. In comparison with A. fumigatus sensu stricto invasive cases, pre-exposure to azole drugs was significantly associated with cryptic IA (p = 0.02). DISCUSSION: This study brings new insights in cryptic species related IA and underlines the importance to identify accurately at the species level these Aspergillus isolates. The increasing use of antifungal drugs might lead in the future to an epidemiologic shift with an emergence of resistant isolates involved in IA. This article is protected by copyright. All rights reserved.
Authors: Xihua Lian; Amy Scott-Thomas; John G Lewis; Madhav Bhatia; Sean A MacPherson; Yiming Zeng; Stephen T Chambers Journal: Int J Mol Sci Date: 2022-05-16 Impact factor: 6.208