Invasive aspergillosis due to Aspergillus cryptic species: A prospective multicentre study

Area of Science:

• Mycology
• Infectious Diseases
• Clinical Microbiology

Background:

• Aspergillus cryptic species are emerging pathogens causing invasive aspergillosis (IA).
• Accurate identification of these species is difficult in routine clinical settings.
• The MSI application offers a novel tool for detecting and identifying Aspergillus cryptic species.

Purpose of the Study:

• To conduct a multicenter prospective screening of Aspergillus cryptic species-related IA using the MSI application network.
• To analyze the epidemiological, clinical, and mycological characteristics of these infections.
• To compare cryptic IA cases with those caused by Aspergillus fumigatus sensu stricto.

Main Methods:

• Prospective analysis of 369 Aspergillus cryptic isolates from 13 MSI application users over 27 months.
• Species identification confirmed by DNA sequencing.
• Antifungal susceptibility testing performed using EUCAST reference method; 51 Aspergillus fumigatus sensu stricto IA cases analyzed for comparison.

Main Results:

• Fifteen cryptic isolates caused IA, involving eight species, with five cases linked to Aspergillus sublatus.
• These cryptic species exhibited high in vitro resistance to antifungal drugs.
• Pre-exposure to azole drugs was significantly associated with cryptic IA compared to Aspergillus fumigatus sensu stricto (P = .02).

Conclusions:

• Accurate species-level identification of Aspergillus isolates is crucial for understanding and managing cryptic IA.
• The increasing use of antifungal drugs may drive an epidemiological shift towards resistant Aspergillus strains causing IA.
• This study provides critical insights into the clinical and epidemiological landscape of cryptic species-related IA.