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Aspergillus terreus: an emerging amphotericin B-resistant opportunistic mold in patients with hematologic

Ray Y Hachem1, Dimitrios P Kontoyiannis, Maha R Boktour

  • 1Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston 77030, USA. rhachem@mdanderson.org

Cancer
|September 21, 2004
PubMed
Abstract

Insights

Invasive aspergillosis (IA) caused by Aspergillus terreus and Aspergillus fumigatus have similar poor outcomes in immunocompromised patients. Aspergillus terreus IA was more frequently nosocomial and showed reduced susceptibility to amphotericin B.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Invasive aspergillosis (IA) is a significant cause of mortality in immunocompromised individuals.
  • Aspergillus terreus is the second most common cause of IA at The University of Texas M. D. Anderson Cancer Center, after Aspergillus fumigatus.
  • This study compares risk factors and outcomes of IA caused by A. terreus versus A. fumigatus.

Purpose of the Study:

  • To compare the risk factors and clinical outcomes of invasive aspergillosis (IA) caused by Aspergillus terreus and Aspergillus fumigatus.
  • To evaluate the antifungal susceptibility patterns of A. terreus and A. fumigatus isolates.
  • To assess patient response to antifungal therapies.

Main Methods:

  • Retrospective review of medical records for 300 patients with Aspergillus infection (1995-2001).
  • Specific analysis of 32 patients with A. terreus IA and 33 patients with A. fumigatus IA.
  • In vitro antifungal susceptibility testing, including minimal inhibitory concentrations (MICs).

Main Results:

  • Patient groups with A. terreus and A. fumigatus IA were comparable in age, gender, and underlying disease (leukemia most common).
  • A trend towards higher neutropenia frequency was observed in the A. terreus group.
  • IA caused by A. terreus was significantly more frequent in nosocomial infections (P=0.03) and showed higher resistance to amphotericin B (MIC90, 4.0 µg/mL).

Conclusions:

  • Despite decreased in vitro susceptibility to amphotericin B, A. terreus and A. fumigatus IA showed comparably poor responses to amphotericin B.
  • Both IA types demonstrated somewhat improved responses to posaconazole.
  • A. terreus IA was more frequently associated with nosocomial acquisition.

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