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Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
Emerging Aspergillus lentulus infections in Taiwan: clinical and environmental surveillance
Pao-Yu Chen1,2, Chien-Ming Chao3, Chwan-Yau Luo4
1Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Objectives:
This study aimed to investigate the prevalence and characteristics of Aspergillus lentulus clinical and environmental isolates in Taiwan.
Methods:
Aspergillus isolates obtained from patients at three hospitals and from 530 soil samples across Taiwan were screened. A. lentulus, confirmed by calmodulin sequencing, was subjected to antifungal susceptibility testing and cyp51A analyses. Soil samples yielding A. lentulus were analysed for residues of 25 azole fungicides.
Results:
Nine A. lentulus isolates were identified, which included seven (1.2%, 7/601) isolates from three antifungal-naïve patients out of 601 Aspergillus section Fumigati clinical isolates and two (0.3%, 2/659) isolates out of 659 Aspergillus soil isolates. All isolates developed white colonies and failed to grow at 48°C. They were susceptible to anidulafungin but showed reduced susceptibility to amphotericin B (AmB), voriconazole and azole fungicides. One heart transplant recipient with proven invasive pulmonary aspergillosis (IPA) initially showed suboptimal response to voriconazole monotherapy but was cured with a combination of voriconazole-caspofungin, liposomal AmB (LAmB)-caspofungin, along with surgery, followed by voriconazole maintenance therapy. Among two critically ill patients with probable IPA, one survived with micafungin, while the other died of aspergillosis despite sequential isavuconazole and LAmB monotherapy. Clinical and environmental isolates sharing identical Cyp51A sequence are identified, matching the Cyp51A sequence of A. lentulus NIID0096. Flusilazole (0.0009 mg/kg) was detected in one soil sample.
Conclusions:
This study raises concerns about health threat posed by human pathogenic A. lentulus originating from natural environments and underscores the need for increased clinical and laboratory vigilance regarding A. lentulus infections.
Insights
Aspergillus lentulus, a fungus found in Taiwan
Area of Science:
- Medical Mycology
- Environmental Microbiology
- Fungal Pathogenesis
Background:
- Aspergillus lentulus is an emerging fungal pathogen.
- Its prevalence in clinical and environmental settings in Taiwan is not well-documented.
Purpose of the Study:
- To investigate the prevalence and characteristics of Aspergillus lentulus in Taiwan.
- To assess antifungal susceptibility and genetic profiles of A. lentulus isolates.
- To identify potential environmental sources and azole fungicide residues.
Main Methods:
- Screening of Aspergillus isolates from patients and soil samples.
- Identification of A. lentulus using calmodulin sequencing.
- Antifungal susceptibility testing and cyp51A gene analysis.
- Analysis of soil samples for azole fungicide residues.
Main Results:
- Nine A. lentulus isolates were identified (7 clinical, 2 environmental).
- Isolates showed reduced susceptibility to voriconazole and amphotericin B.
- Successful treatment of invasive pulmonary aspergillosis (IPA) with combination therapy was observed.
- Identical Cyp51A sequences were found in clinical and environmental isolates.
Conclusions:
- Aspergillus lentulus poses a potential health threat from environmental sources.
- Increased clinical and laboratory vigilance for A. lentulus infections is necessary.
