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Homa M, Manikandan P, Szekeres A, Kiss N, Kocsubé S, Kredics L, Alshehri B, Dukhyil AAB, Revathi R, Narendran V, Vágvölgyi C, Shobana CS, Papp T. Characterization of Aspergillus tamarii Strains From Human Keratomycoses: Molecular Identification, Antifungal Susceptibility Patterns and Cyclopiazonic Acid Producing Abilities. Front Microbiol 2019; 10:2249. [PMID: 31649626 PMCID: PMC6794953 DOI: 10.3389/fmicb.2019.02249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/17/2019] [Indexed: 11/25/2022] Open
Abstract
Aspergillus tamarii appears to be an emerging aetiological agent of human keratomycoses in South India. The investigated strains were isolated from six suspected fungal keratitis patients attending a tertiary care eye hospital in Coimbatore (Tamil Nadu, India), and were initially identified by the microscopic examinations of the scrapings and the cultures. Our data suggest that A. tamarii could be easily overlooked when identification is carried out based on morphological characteristics alone, while the sequence analysis of the calmodulin gene can be used successfully to recognize this species accurately. According to the collected clinical data, ocular trauma is a common risk factor for the infection that gradually developed from mild to severe ulcers and could be healed with an appropriate combined antifungal therapy. Antifungal susceptibility testing revealed that A. tamarii strains are susceptible to the most commonly used topical or systemic antifungal agents (i.e., econazole, itraconazole and ketoconazole) except for natamycin. Moreover, natamycin proved to be similarly less effective than the azoles against A. tamarii in our drug interaction tests, as the predominance of indifferent interactions was revealed between natamycin and econazole and between natamycin and itraconazole as well. Four and five isolates of A. tamarii were confirmed to produce cyclopiazonic acid (CPA) in RPMI-1640 – which is designed to mimic the composition of human extracellular fluids – and in yeast extract sucrose (YES) medium, respectively, which is a widely used culture medium for testing mycotoxin production. Although a ten times lower mycelial biomass was recorded in RPMI-1640 than in YES medium, the toxin contents of the samples were of the same order of magnitude in both types of media. There might be a relationship between the outcome of infections and the toxigenic properties of the infecting fungal strains. However, this remains to be investigated in the future.
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Affiliation(s)
- Mónika Homa
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Szeged, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Palanisamy Manikandan
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majma'ah, Saudi Arabia.,Greenlink Analytical and Research Laboratory (India) Private Limited, Coimbatore, India
| | - András Szekeres
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Noémi Kiss
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Sándor Kocsubé
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - László Kredics
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Bader Alshehri
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majma'ah, Saudi Arabia
| | - Abdul Aziz Bin Dukhyil
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majma'ah, Saudi Arabia
| | - Rajaraman Revathi
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | | | - Csaba Vágvölgyi
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | | | - Tamás Papp
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Szeged, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
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Salah H, Lackner M, Houbraken J, Theelen B, Lass-Flörl C, Boekhout T, Almaslamani M, Taj-Aldeen SJ. The Emergence of Rare Clinical Aspergillus Species in Qatar: Molecular Characterization and Antifungal Susceptibility Profiles. Front Microbiol 2019; 10:1677. [PMID: 31447794 PMCID: PMC6697061 DOI: 10.3389/fmicb.2019.01677] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/08/2019] [Indexed: 12/31/2022] Open
Abstract
Aspergillus are ubiquitous mold species that infect immunocompetent and immunocompromised patients. The symptoms are diverse and range from allergic reactions, bronchopulmonary infection, and bronchitis, to invasive aspergillosis. The aim of this study was to characterize 70 Aspergillus isolates recovered from clinical specimens of patients with various clinical conditions presented at Hamad general hospital in Doha, Qatar, by using molecular methods and to determine their in vitro antifungal susceptibility patterns using the Clinical and Laboratory Standards Institute (CLSI) M38-A2 reference method. Fourteen Aspergillus species were identified by sequencing β-tubulin and calmodulin genes, including 10 rare and cryptic species not commonly recovered from human clinical specimens. Aspergillus welwitschiae is reported in this study for the first time in patients with fungal rhinosinusitis (n = 6) and one patient with a lower respiratory infection. Moreover, Aspergillus pseudonomius is reported in a patient with fungal rhinosinusitis which is considered as the first report ever from clinical specimens. In addition, Aspergillus sublatus is reported for the first time in a patient with cystic fibrosis. In general, our Aspergillus strains exhibited low MIC values for most of the antifungal drugs tested. One strain of Aspergillus fumigatus showed high MECs for echinocandins and low MICs for the rest of the drugs tested. Another strain of A. fumigatus exhibited high MIC for itraconazole and categorized as non-wild type. These findings require further analysis of their molecular basis of resistance. In conclusion, reliable identification of Aspergillus species is achieved by using molecular sequencing, especially for the emerging rare and cryptic species. They are mostly indistinguishable by conventional methods and might exhibit variable antifungal susceptibility profiles. Moreover, investigation of the antifungal susceptibility patterns is necessary for improved antifungal therapy against aspergillosis.
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Affiliation(s)
- Husam Salah
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.,Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jos Houbraken
- Applied and Industrial Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Bart Theelen
- Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Teun Boekhout
- Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Netherlands
| | - Muna Almaslamani
- Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Netherlands
| | - Saad J Taj-Aldeen
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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Aries P, Hoffmann C, Schaal JV, Leclerc T, Donat N, Cirodde A, Masson Y, Renner J, Soler C. Aspergillus tamarii: an uncommon burn wound infection. J Clin Pathol 2018; 71:379-380. [DOI: 10.1136/jclinpath-2017-204858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/22/2017] [Accepted: 12/29/2017] [Indexed: 11/04/2022]
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Cuadros J, Gros-Otero J, Gallego-Angui P, Scheu AK, Montes-Mollón Á, Pérez-Rico C, Moreno JP, Gómez-Herruz P, Soliveri J, Teus M. Aspergillus tamarii keratitis in a contact lens wearer. Med Mycol Case Rep 2017; 19:21-24. [PMID: 29234586 PMCID: PMC5723276 DOI: 10.1016/j.mmcr.2017.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 11/30/2022] Open
Abstract
Keratitis produced by Aspergillus tamarii has been previously described associated to an ocular injury. We report a case in a contact lens wearer with a history of previous bilateral myopic LASIK ablation, bilateral intracorneal rings and vitrectomy and scleral buckling in his left eye. The fungus could be quickly identified combining phenotype, microscopy and mass spectrometry. Treatment with intravenous amphotericin, oral voriconazole, and topical amphotericin and natamycin and voriconazole was needed for corneal preservation.
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Affiliation(s)
- Juan Cuadros
- Microbiology Department, Hospital Universitario Príncipe de Asturias, Alcalá Meco S/N, Madrid 28805, Spain
| | - Juan Gros-Otero
- Ophtamology Department, Hospital Universitario Príncipe de Asturias, Alcalá Meco S/N, Madrid 28805, Spain
| | - Patricia Gallego-Angui
- Microbiology Department, Hospital Universitario Príncipe de Asturias, Alcalá Meco S/N, Madrid 28805, Spain
| | - Ann Karolin Scheu
- Biomedicine and Biotechnology Department, Universidad de Alcalá de Henares, Campus Universitario C/ 19, Av. de Madrid, Km 33,600 , Alcalá de Henares, Madrid 28871, Spain
| | - Ángeles Montes-Mollón
- Ophtamology Department, Hospital Universitario Príncipe de Asturias, Alcalá Meco S/N, Madrid 28805, Spain
| | - Cinta Pérez-Rico
- Ophtamology Department, Hospital Universitario Príncipe de Asturias, Alcalá Meco S/N, Madrid 28805, Spain
| | - Javier Paz Moreno
- Ophtamology Department, Hospital Universitario Príncipe de Asturias, Alcalá Meco S/N, Madrid 28805, Spain
| | - Peña Gómez-Herruz
- Microbiology Department, Hospital Universitario Príncipe de Asturias, Alcalá Meco S/N, Madrid 28805, Spain
| | - Juan Soliveri
- Biomedicine and Biotechnology Department, Universidad de Alcalá de Henares, Campus Universitario C/ 19, Av. de Madrid, Km 33,600 , Alcalá de Henares, Madrid 28871, Spain
| | - Miguel Teus
- Ophtamology Department, Hospital Universitario Príncipe de Asturias, Alcalá Meco S/N, Madrid 28805, Spain
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Falahati M, Ghojoghi A, Abastabar M, Ghasemi Z, Farahyar S, Roudbary M, Hedayati MT, Armaki MT, Hoseinnejad A. The First Case of Total Dystrophic Onychomycosis Caused by Aspergillus clavatus Resistant to Antifungal Drugs. Mycopathologia 2015; 181:273-7. [PMID: 26474550 DOI: 10.1007/s11046-015-9954-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
Onychomycosis is a common fungal infection of nails which is mainly caused by dermatophyte species and less often by yeasts and non-dermatophyte molds. We present a case of onychomycosis due to Aspergillus clavatus for the first time worldwide. The patient was an immunocompetent 32-year-old woman who identified with Psoriasis of the nail. The presence of A. clavatus in a nail sample was confirmed using microscopic and culture analysis followed by PCR of the β-tubulin gene. After antifungal susceptibility test, it is revealed that the isolate was resistant to the majority of common antifungal drugs, but finally the patient was treated with itraconazole 200 mg daily. A. clavatus and drug-resistant A. clavatus have not previously been reported from onychomycosis.
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Affiliation(s)
- Mehraban Falahati
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aynaz Ghojoghi
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran.
| | - Zeinab Ghasemi
- Department of Medical Mycology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Farahyar
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Roudbary
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran
| | - Mojtaba Taghizadeh Armaki
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran
| | - Akbar Hoseinnejad
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran
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Misidentification of Aspergillus nomius and Aspergillus tamarii as Aspergillus flavus: characterization by internal transcribed spacer, β-Tubulin, and calmodulin gene sequencing, metabolic fingerprinting, and matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 2014; 52:1153-60. [PMID: 24452174 DOI: 10.1128/jcm.03258-13] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aspergillus nomius and Aspergillus tamarii are Aspergillus species that phenotypically resemble Aspergillus flavus. In the last decade, a number of case reports have identified A. nomius and A. tamarii as causes of human infections. In this study, using an internal transcribed spacer, β-tubulin, and calmodulin gene sequencing, only 8 of 11 clinical isolates reported as A. flavus in our clinical microbiology laboratory by phenotypic methods were identified as A. flavus. The other three isolates were A. nomius (n = 2) or A. tamarii (n = 1). The results corresponded with those of metabolic fingerprinting, in which the A. flavus, A. nomius, and A. tamarii strains were separated into three clusters based on ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC MS) analysis. The first two patients with A. nomius infections had invasive aspergillosis and chronic cavitary and fibrosing pulmonary and pleural aspergillosis, respectively, whereas the third patient had A. tamarii colonization of the airway. Identification of the 11 clinical isolates and three reference strains by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) showed that only six of the nine strains of A. flavus were identified correctly. None of the strains of A. nomius and A. tamarii was correctly identified. β-Tubulin or the calmodulin gene should be the gene target of choice for identifying A. flavus, A. nomius, and A. tamarii. To improve the usefulness of MALDI-TOF MS, the number of strains for each species in MALDI-TOF MS databases should be expanded to cover intraspecies variability.
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In vitro antifungal susceptibility of clinically relevant species belonging to Aspergillus section Flavi. Antimicrob Agents Chemother 2013; 57:1944-7. [PMID: 23335742 DOI: 10.1128/aac.01902-12] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The in vitro antifungal susceptibility of 77 isolates belonging to different clinically relevant species of Aspergillus section Flavi, including those of different phylogenetic clades of A. flavus, was tested for nine antifungal agents using a microdilution reference method (CLSI, M38-A2). Terbinafine and the echinocandins demonstrated lower MICs/MECs for all species evaluated, followed by posaconazole. Amphotericin B showed MICs ≥ 2 μg/ml for 38 (49.4%) of the 77 isolates tested.
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Kredics L, Varga J, Kocsubé S, Dóczi I, Samson RA, Rajaraman R, Narendran V, Bhaskar M, Vágvölgyi C, Manikandan P. Case of keratitis caused by Aspergillus tamarii. J Clin Microbiol 2007; 45:3464-7. [PMID: 17699648 PMCID: PMC2045365 DOI: 10.1128/jcm.00920-07] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of Aspergillus tamarii keratitis. Ocular injury was known to be a predisposing factor. Topical natamycin and econazole treatment and subsequent systemic ketoconazole treatment proved effective. The isolate was identified by morphological characteristics and sequence analysis as A. tamarii, a member of Aspergillus section Flavi not hitherto reported from keratomycosis.
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Affiliation(s)
- László Kredics
- Department of Microbiology, University of Szeged, Hungary
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