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Aspergillus lentulus: An Under-recognized Cause of Antifungal Drug-Resistant Aspergillosis

Saman Nematollahi1, Nitipong Permpalung1,2, Sean X Zhang3

  • 1Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Open Forum Infectious Diseases
|September 1, 2021
PubMed

Insights

Aspergillus lentulus causes drug-resistant infections and is often misidentified as Aspergillus fumigatus in clinical labs. This highlights the need for accurate species identification to ensure effective antifungal treatment.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Aspergillus lentulus is a fungal species phenotypically similar to Aspergillus fumigatus.
  • It is known to be resistant to azole antifungal drugs.
  • A. lentulus has been identified as a cause of azole-breakthrough infections.

Purpose of the Study:

  • To highlight the challenge of distinguishing Aspergillus lentulus from Aspergillus fumigatus in clinical settings.
  • To report recent cases of infections caused by Aspergillus lentulus.
  • To review the clinical significance and identification of Aspergillus lentulus.

Main Methods:

  • Phenotypic identification of fungal isolates.
  • Review of clinical case data.
  • Literature review on Aspergillus lentulus.

Main Results:

  • Clinical laboratories may misidentify Aspergillus lentulus as Aspergillus fumigatus due to phenotypic similarities.
  • Four recent cases of Aspergillus lentulus infections are presented.
  • In vitro resistance to azoles is consistent with clinical observations.

Conclusions:

  • Accurate identification of Aspergillus lentulus is crucial for appropriate antifungal therapy.
  • Molecular or other advanced identification methods may be necessary to differentiate from A. fumigatus.
  • Increased awareness of A. lentulus is needed in clinical mycology.
Keywords:
Aspergillus lentulusDNA sequencingMALDI-TOF MScryptic speciesmultidrug resistancepulmonary aspergillosis

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