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Published on: July 31, 2019
A 9-Year Experience of Aspergillus Infections from Isfahan, Iran
Mostafa Chadeganipour1, Rasoul Mohammadi1,2
1Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Purpose:
Aspergillosis is an important fungal disease affecting millions of individuals worldwide. The genus of Aspergillus consist of various complexes, causing a wide spectrum of diseases from superficial infections in immunocompetent hosts to life-threatening disseminated infections among immunocompromised patients. This study aimed to identify Aspergillus species by phenotypic (total isolates) and molecular tests (35 isolates), obtained from patients in Isfahan (the third-largest city of Iran) between 2010 and 2018, and determine the susceptibility of 35 clinical isolates to itraconazole (ITR), amphotericin-B (AMB), and voriconazole (VOR).
Patients And Methods:
Based on clinical signs, a total of 2385 suspected cases were included in this retrospective study from January 2010 to December 2018. Direct microscopic examination with potassium hydroxide, sabouraud dextrose agar with chloramphenicol, and czapekdox agar media was applied to identify etiologic agents. Thirty-five Aspergillus species collected from January 2016 to December 2018 were identified by PCR-sequencing of ITS1-5.8SrDNA-ITS2 region, and their susceptibility to ITR, AMB, and VOR was determined using E-test.
Results:
Based on direct microscopy and positive culture, 132 out of 2385 suspected cases had Aspergillus infection (5.5%). Fifty-four patients were male, and 78 patients were female. Patients in the age groups of 41-50 and 21-30 years had the highest and lowest frequencies, respectively. Aspergillus flavus/oryzae (n=54), A. fumigatus (n=24), A. niger (n=15), and A. terreus (n=12) were the most prevalent Aspergillus species, respectively. Among 35 Aspergillus species, the MIC ranges of AMB, ITR, and VOR for A. flavus/oryzae, A. niger, and A. terreus were (0.5-4 μg/mL; 0.5-16 μg/mL; 0.25-8 μg/mL), (1 μg/mL, 1 μg/mL, 1 μg/mL), and (4-4 μg/mL, 0.5-1 μg/mL, 0.5-1 μg/mL), respectively.
Conclusion:
Aspergillus infections have a wide spectrum of clinical manifestations and often occur in immunocompromised patients. Accurate identification at the species level is essential since the emergence of cryptic species is connected to different patterns of AFST that affect patient treatment outcomes. Azole-resistant Aspergillus spp. is a global concern, and the detection of the route of resistance is pivotal to prevent and control infection.
Insights
This study identified Aspergillus species in Iran, finding Aspergillus flavus/oryzae most common. Accurate species identification is crucial for treating aspergillosis and managing antifungal resistance.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Aspergillosis, caused by *Aspergillus* species, is a significant global health concern.
- Infections range from superficial to life-threatening disseminated forms, particularly in immunocompromised individuals.
- Accurate species identification is vital due to varying clinical manifestations and antifungal susceptibility patterns.
Purpose of the Study:
- To identify *Aspergillus* species from clinical samples in Isfahan, Iran, using phenotypic and molecular methods.
- To determine the antifungal susceptibility of identified *Aspergillus* isolates to itraconazole, amphotericin-B, and voriconazole.
Main Methods:
- Retrospective analysis of 2385 suspected cases from 2010-2018.
- Phenotypic identification using direct microscopy and culture on specific media.
- Molecular identification of 35 isolates via PCR-sequencing of the ITS1-5.8SrDNA-ITS2 region.
- Antifungal susceptibility testing using E-test.
Main Results:
- *Aspergillus* infection was confirmed in 5.5% (132/2385) of suspected cases.
- *Aspergillus flavus/oryzae* (n=54) was the most prevalent species, followed by *A. fumigatus* (n=24), *A. niger* (n=15), and *A. terreus* (n=12).
- Variable Minimum Inhibitory Concentration (MIC) ranges were observed for amphotericin-B, itraconazole, and voriconazole across different species.
Conclusions:
- *Aspergillus* infections present diverse clinical forms and necessitate precise species-level identification.
- Emergence of cryptic species linked to antifungal resistance patterns impacts treatment outcomes.
- Addressing azole-resistant *Aspergillus* species is a global priority, requiring effective detection and control strategies.
