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Tan XT, Mokhtar NNB, Hii S, Amran F. Antifungal Susceptibility and Genotypic Analysis of cyp51A Mutations in Aspergillus fumigatus Isolates in Malaysia. Infect Drug Resist 2024; 17:2159-2168. [PMID: 38828376 PMCID: PMC11144424 DOI: 10.2147/idr.s452619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/09/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Azole resistance in Aspergillus fumigatus poses a significant challenge in the management of invasive aspergillosis. This study aimed to investigate the antifungal susceptibility and cyp51A mutation profiles of A. fumigatus isolates in Malaysia. Patients and Methods Sixty clinical A. fumigatus isolates were collected and subjected to antifungal susceptibility testing (AFST) and molecular analysis. The antifungal susceptibility testing was performed according to CLSI M38 guideline. The geometric mean (GM) minimum inhibitory concentration (MIC), MIC50/MIC90 for voriconazole, itraconazole, posaconazole, amphotericin B, and isavuconazole against A. fumigatus in non-invasive cases and invasive cases were calculated. In addition, the presence of cyp51A mutations was also identified. Results The present study revealed an overall resistance rate of 6.7% among the isolates. In non-invasive cases, isavuconazole and posaconazole demonstrated the lowest GM MIC of 0.08 µg/mL. Following them were itraconazole, voriconazole, and amphotericin B with concentrations of 0.15µg/mL, 0.16µg/mL and 0.90µg/mL, respectively. Similarly, in invasive cases, isavuconazole and posaconazole exhibited the lowest GM MIC of 0.09µg/mL. Following them were itraconazole, voriconazole, and amphotericin B with concentrations of 0.14µg/mL, 0.17µg/mL and 0.80µg/mL, respectively. Genotypic analysis revealed various cyp51A mutations, including F46Y, M172V, N248K, R34L, V244A, V244S, and E427K. However, not all mutations corresponded to antifungal resistance. Conclusion The majority of clinical Aspergillus fumigatus isolates demonstrated susceptibility to the antifungal agents tested, with isavuconazole and posaconazole demonstrating the lowest MIC values. However, cyp51A mutations were discovered without a consistent correlation to antifungal resistance, emphasising the need for additional research.
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Affiliation(s)
- Xue Ting Tan
- Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Nurin Nazirah Binti Mokhtar
- Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Shirley Yi Fen Hii
- Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Fairuz Amran
- Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
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Shukla R, Soni J, Kumar A, Pandey R. Uncovering the diversity of pathogenic invaders: insights into protozoa, fungi, and worm infections. Front Microbiol 2024; 15:1374438. [PMID: 38596382 PMCID: PMC11003270 DOI: 10.3389/fmicb.2024.1374438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
Post COVID-19, there has been renewed interest in understanding the pathogens challenging the human health and evaluate our preparedness towards dealing with health challenges in future. In this endeavour, it is not only the bacteria and the viruses, but a greater community of pathogens. Such pathogenic microorganisms, include protozoa, fungi and worms, which establish a distinct variety of disease-causing agents with the capability to impact the host's well-being as well as the equity of ecosystem. This review summarises the peculiar characteristics and pathogenic mechanisms utilized by these disease-causing organisms. It features their role in causing infection in the concerned host and emphasizes the need for further research. Understanding the layers of pathogenesis encompassing the concerned infectious microbes will help expand targeted inferences with relation to the cause of the infection. This would strengthen and augment benefit to the host's health along with the maintenance of ecosystem network, exhibiting host-pathogen interaction cycle. This would be key to discover the layers underlying differential disease severities in response to similar/same pathogen infection.
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Affiliation(s)
- Richa Shukla
- Division of Immunology and Infectious Disease Biology, INGEN-HOPE (INtegrative GENomics of HOst-PathogEn) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
| | - Jyoti Soni
- Division of Immunology and Infectious Disease Biology, INGEN-HOPE (INtegrative GENomics of HOst-PathogEn) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Ashish Kumar
- Division of Immunology and Infectious Disease Biology, INGEN-HOPE (INtegrative GENomics of HOst-PathogEn) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
| | - Rajesh Pandey
- Division of Immunology and Infectious Disease Biology, INGEN-HOPE (INtegrative GENomics of HOst-PathogEn) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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Khateb AM, Alkhaibari SA. Cross-sectional investigation of mycological diagnosis challenges in Saudi Arabia. Front Cell Infect Microbiol 2023; 13:1203892. [PMID: 37434785 PMCID: PMC10332264 DOI: 10.3389/fcimb.2023.1203892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/19/2023] [Indexed: 07/13/2023] Open
Abstract
Background The global incidence of fungal infection has increased dramatically over the last two decades. Fungal diseases threaten both immunocompetent, and immunocompromised patients. The current fungal diagnostics status in Saudi Arabia needs to be evaluated, especially with the increase of the immunosuppressed population. This cross-sectional study investigated the gaps in mycological diagnosis on a national level. Materials and methods The call interview questionnaire responses were collected to evaluate the demand for fungal assays, diagnostic methods' quality, and mycological expertise of laboratory technologists in both public and private medical intuitions. The data were analyzed using (IBM SPSS ® software version 22.0). Results A total of 57 hospitals from all Saudi regions participated in the questionnaire; however, only 32% received or processed mycological samples. Most participants were from the Mecca region (25%), Riyadh region (19%), and Eastern region (14%). The top fungal isolates identified were Candida spp., Aspergillus spp., and dermatophyte. Fungal investigation is highly requested by intensive care, dermatology, and obstetrics and gynecology units. Most laboratories rely on fungal culture and microscopic examination, which mostly identify Candida to the genus level, and use 37°C incubators for culture (67%). Antifungal susceptibility testing (AST) and serological and molecular methods are rarely performed and mostly outsourced. Using accurate identification and AST are the primary factors to improve fungal diagnosis in respect to turnaround time and cost. The three major obstacles identified were availability of facility (47%), reagents and kits (32%), and good training (21%). Conclusions The results indicated that fungal diagnosis demand was relatively higher in high-population regions. This study highlighted the gaps in fungal diagnostics reference laboratories to encourage their improvement in Saudi hospitals.
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Affiliation(s)
- Aiah Mustafa Khateb
- Department of Medical Laboratory Technology, Collage of Applied Medical Science, Taibah University, Medina, Saudi Arabia
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shatha Ali Alkhaibari
- Department of Medical Laboratory Technology, Collage of Applied Medical Science, Taibah University, Medina, Saudi Arabia
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Pasqua S, Monaco F, Cardinale F, Bonelli S, Conaldi PG, D’Apolito D. Growth Performance and Recovery of Nosocomial Aspergillus spp. in Blood Culture Bottles. Microorganisms 2022; 10:microorganisms10102026. [PMID: 36296302 PMCID: PMC9608713 DOI: 10.3390/microorganisms10102026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022] Open
Abstract
Theoretically, Aspergillus spp. grow in culture media, but frequently, blood cultures of patients with invasive Aspergillosis are negative, even if until now, the reasons are not clear. This aspect underlines the lack of a good strategy for the cultivation and isolation of Aspergillus spp. In order to develop a complete analytical method to detect Aspergillus in clinical and pharmaceutical samples, we investigated the growth performance of two blood culture systems versus the pharmacopeia standard method. At <72 h, all test systems showed comparable sensitivity, about 1−2 conidia. However, the subculture analysis showed a suboptimal recovery for the methods, despite the positive growth and the visualization of the “Aspergillus balls” in the culture media. To investigate this issue, we studied three different subculture approaches: (i) the use of a sterile subculture unit, (ii) the use of a sterile subculture unit and the collection of a larger aliquot (100 µL), following vigorous agitation of the vials, and (iii) to decapsulate the bottle, withdrawing and centrifuging the sample, and aliquot the pellet onto SDA plates. Our results showed that only the third procedure recovered Aspergillus from all positive culture bottles. This work confirmed that our strategy is a valid and faster method to culture and isolate Aspergillus spp. from blood culture bottles.
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Affiliation(s)
- Salvatore Pasqua
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Francesco Monaco
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Francesca Cardinale
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Simone Bonelli
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Edificio 16, 90128 Palermo, Italy
- Proteomics Group of Fondazione Ri.MED, Department of Research IRCCS ISMETT, Via Ernesto Tricomi 5, 90145 Palermo, Italy
| | - Pier Giulio Conaldi
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Danilo D’Apolito
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
- Correspondence: mailto: or ; Tel.: +39-091-2192472
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Saad-Hussein A, Moubarz G, Mahdy-Abdallah H, Helmy MA. Impact of mannose-binding lectin gene polymorphism on lung functions among workers exposed to airborne Aspergillus in a wastewater treatment plant in Egypt. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:63193-63201. [PMID: 35449337 PMCID: PMC9477903 DOI: 10.1007/s11356-022-20234-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
In this study, the risk of Aspergillus (Asp.) positivity and its respiratory health impacts on wastewater treatment plant (WWTP) workers were studied. In addition, it identified the geno-susceptibility role of mannose-binding lectin 2 (MBL2) gene polymorphisms and the mannose-binding lectin (MBL) serum levels on the pulmonary functions of the Asp.-positive workers. Pulmonary function tests (PFTs) were performed for 89 workers from a selected WWTP, after exclusion of the smokers. Molecular identification of Asp. blood positivity was done by 18S rRNA sequencing. Determination of MBL2 gene polymorphism and estimation of MBL serum levels were done. PFTs revealed abnormalities in 49.2% of the workers. Asp. was positive in 42.5% of the workers with different species. Among the Asp.-positive workers, 6.5% of the workers were with obstructive PFTs, 12.9% with restriction, and 22.6% with combined PFT abnormalities. MBL2 genotyping showed that wild genotype AA was common (68.5%) among Asp.-positive workers compared to the other genotypes. This allele, whether homozygous or heterozygous, was significantly associated with decline in PFTs of the exposed workers. MBL serum levels were significantly lower in workers with obstructive, restrictive, and combined PFT abnormalities compared to those with normal PFTs, and in the workers with Asp.-positive species than the Asp.-negative workers. Moreover, it was significantly lower in workers with Asp. fumigatus compared to that in the workers with other Asp. species, and in the Asp.-positive workers with homozygous or heterozygous A allele compared to that in the Asp.-positive workers with homozygous B allele. Working in a WWTP can be associated with impaired PFTs due to exposure to airborne fungi. MBL2 genotyping showed that Asp.-positive workers with homozygous or heterozygous A allele were at risk to develop decline in their PFTs.
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Affiliation(s)
- Amal Saad-Hussein
- Environmental and Occupational Medicine Department, National Research Centre, Environment and Climate Change Research Institute, Cairo, Egypt
| | - Gehan Moubarz
- Environmental and Occupational Medicine Department, National Research Centre, Environment and Climate Change Research Institute, Cairo, Egypt
| | - Heba Mahdy-Abdallah
- Environmental and Occupational Medicine Department, National Research Centre, Environment and Climate Change Research Institute, Cairo, Egypt.
| | - Mona Adel Helmy
- Environmental and Occupational Medicine Department, National Research Centre, Environment and Climate Change Research Institute, Cairo, Egypt
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Mirchevska G, Cekovska Z, Kaftandzieva A, Zafirovik Z, Trajkovska-Dokic E. Evaluation of (1,3)--d-glucan assay in diagnosis of invasive fungal infections with Aspergillus. Arch Public Health 2022. [DOI: 10.3889/aph.2022.6045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Invasive fungal infections caused by Aspergillus are a significant problem in immunocompromised and critically ill patients and associated with increased morbidity and mortality. Early diagnosis of invasive aspergillosis is still a big clinical and diagnostic challenge. Conventional methods are not sensitive enough, and therefore, there is a need for rapid, more sensitive methods for early diagnosis of invasive fungal infections with Aspergillus. The aim of this study was to evaluate the diagnostic performance, sensitivity and specificity of serological panfungal (1,3)-b-D-glucan marker compared to conventional method for diagnosis of invasive fungal infections with Aspergillus. Material and methods: Specimens of 125 patients divided into 4 groups (group I - immune deficiency, group II - prolonged ICU stay, group III - chronic aspergillosis, group IV - cystic fibrosis), classified according to clinical diagnosis and EORTC/MSG criteria, were analyzed at the Institute of Microbiology and Parasitology, with conventional and serological methods, during a period of two years. Results: A total of 71 isolates of Aspergillus were confirmed in this study. Four isolates were recovered from bloodculture of patients with primary immune deficiency. With BAL culture, Aspergillus was detected in the group of chronic aspergillosis (63.33%), followed by the groups of cystic fibrosis (56.67%), primary immune deficiency (51.43%), and the group with prolonged ICU stay (43.33%). Sensitivity and specificity of BAL culture were: 64.29% and 100%, 59.09% and 100%, 54.55% and 12.5%, 100% and 54.17%, in I, II, III and IV group, respectively. In 79.1% (53/67) from positive BAL cultures in all groups, A. fumigatus was confirmed, of which, 32.1% (17/53) in group III, followed by group I – 26.42% (14/53) and group IV – 26.42% (14/53), and 15.1% (8/53) in group II. Other species confirmed in BAL were A. flavus 16.42% (11/67) and A.terreus 4.48% (3/67). Sensitivity and specificity of the serological panfungal (1,3)-b-D-glucan (BDG) marker were: 64.71% and 85.71%, 50% and 87.5%, 36.36% and 50%, in groups I, II and III, respectively. No positive findings of the panfungal (1,3)-b-D-glucan (BDG) marker were found in the group with cystic fibrosis. Conclusion: The results obtained in this study have demonstrated that a positive (1,3)-b-D-glucan assay highlights the value of this test as a diagnostic adjunct in the serodiagnosis of invasive fungal infections with Aspergillus, and along with the results from conventional mycological investigation, helped in reaching a timely antifungal treatment with a favorable clinical outcome.
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Challenges in Serologic Diagnostics of Neglected Human Systemic Mycoses: An Overview on Characterization of New Targets. Pathogens 2022; 11:pathogens11050569. [PMID: 35631090 PMCID: PMC9143782 DOI: 10.3390/pathogens11050569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
Systemic mycoses have been viewed as neglected diseases and they are responsible for deaths and disabilities around the world. Rapid, low-cost, simple, highly-specific and sensitive diagnostic tests are critical components of patient care, disease control and active surveillance. However, the diagnosis of fungal infections represents a great challenge because of the decline in the expertise needed for identifying fungi, and a reduced number of instruments and assays specific to fungal identification. Unfortunately, time of diagnosis is one of the most important risk factors for mortality rates from many of the systemic mycoses. In addition, phenotypic and biochemical identification methods are often time-consuming, which has created an increasing demand for new methods of fungal identification. In this review, we discuss the current context of the diagnosis of the main systemic mycoses and propose alternative approaches for the identification of new targets for fungal pathogens, which can help in the development of new diagnostic tests.
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Xing XW, Yu SF, Zhang JT, Tan RS, Ma YB, Tian X, Wang RF, Yao GE, Cui F, Gui QP, Yu SY. Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Diagnosis of Cerebral Aspergillosis. Front Microbiol 2022; 12:787863. [PMID: 35003020 PMCID: PMC8740169 DOI: 10.3389/fmicb.2021.787863] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/29/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose: Cerebral aspergillosis (CA) is a rare but often fatal, difficult-to-diagnose, opportunistic infection. The utility of metagenomic next-generation sequencing (mNGS) for diagnosis of CA is unclear. We evaluated the usefulness of mNGS of the cerebrospinal fluid (CSF) for the diagnosis of CA. Methods: This prospective study involved seven consecutive patients with confirmed CA in whom CSF mNGS was performed. Serum (1→3)-β-D-glucan and galactomannan levels were determined, and histopathological examination and mNGS of the CSF were conducted. CSF specimens from three non-infected patients were used as positive controls. Results: mNGS of the CSF was positive in six of the seven confirmed CA cases (85.71% sensitivity). In the cryptococcal meningitis group (control), mNGS of the CSF was positive for Aspergillus in two patients (84.62% specificity). The positive likelihood ratio, negative likelihood ratio, and Youden's index of mNGS for CA in the CSF were 5.565, 0.169, and 0.7, respectively. Among the six mNGS-positive cases, more than two Aspergillus species were found in four (4/6, 66.67%). In the positive controls, the addition of one A. fumigatus spore yielded a standardised species-specific read number (SDSSRN) of 25.45 by mNGS; the detection rate would be 0.98 if SDSSRN was 2. Conclusion: mNGS facilitates the diagnosis of CA and may reduce the need for cerebral biopsy in patients with suspected CA. Trial Registration Number: Chinese Clinical Trial Registry, ChiCTR1800020442.
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Affiliation(s)
- Xiao-Wei Xing
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Su-Fei Yu
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Jia-Tang Zhang
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, China
| | | | - Yu-Bao Ma
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xia Tian
- Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rong-Fei Wang
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guo-En Yao
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fang Cui
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Qiu-Ping Gui
- Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Sheng-Yuan Yu
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, China
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Hassanien AA, Elsherif WM, Hamed R, Hussein AAA. Suppression effect of thyme and carvacrol nano-emulsions on Aspergillus fumigatus isolated from patients in the intensive care unit of Assiut University Hospital, Egypt. INTERNATIONAL JOURNAL OF ONE HEALTH 2021. [DOI: 10.14202/ijoh.2021.116-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Aspergillus fumigatus is a zoonotic fungus that causes several diseases in humans ranging from allergic reaction to fatal disseminated invasive infection, especially in immunocompromised patients. This study aimed to investigate the incidence of invasive A. fumigatus in patients admitted to the intensive care unit (ICU) of Assiut University Hospital, highlight the factors associated with their infection, and determine the antifungal effect of thyme nano-emulsion (TNE) and carvacrol nano-emulsion (CNE) on isolated A. fumigatus strains.
Materials and Methods: Mycological culture method and scanning electron microscopy (SEM) were used in the identification of A. fumigatus in 630 blood samples collected from 210 patients. TNE and CNE at five concentrations (1%, 2%, 4%, 6%, and 8%) and average sizes of 90.3 and 75.6 nm, respectively, were characterized by transmission electron microscopy. Their effect on A. fumigatus isolate growth was evaluated by the well-diffusion method and SEM, which was used for the detection of the degenerative effect of A. fumigatus ultrastructure.
Results: A. fumigatus was detected in 54 of 210 (25.7%) patients in the ICU. Advanced age and chronic diseases were considered important risk factors for invasive aspergillosis, especially in patients with more than 1 clinical disease. TNE and CNE showed an inhibitory effect on A. fumigatus isolates, which significantly increased with high concentrations. The respective values for TNE at concentrations of 6% and 8% were 6±0.41 mm and 15±0.67 mm. CNE completely inhibited A. fumigatus growth at concentrations of 4%, 6%, and 8%, while mean inhibition zones of 22±0.68 mm and 30±0.32 mm appeared at concentrations of 1% and 2%. SEM demonstrated degenerative changes in A. fumigatus structure.
Conclusion: TNE and CNE can be used in bioactive treatments against A. fumigatus, and additional studies are required to determine the safe and effective doses and best method for application in human and veterinary medicine.
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Affiliation(s)
- Alshimaa A. Hassanien
- Department of Zoonoses, Faculty of Veterinary Medicine, Sohag University, Sohag, Egypt
| | - Walaa M. Elsherif
- Nanotechnology Research Unit, Animal Health Research Institute, Agriculture Research Centre, Egypt
| | - Rasha Hamed
- Department of Anaesthesia, Intensive Care Unit and Pain Management, Faculty of Medicine, Assiut University, Egypt
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Springer J, Held J, Mengoli C, Schlegel PG, Gamon F, Träger J, Kurzai O, Einsele H, Loeffler J, Eyrich M. Diagnostic Performance of (1→3)-β-D-Glucan Alone and in Combination with Aspergillus PCR and Galactomannan in Serum of Pediatric Patients after Allogeneic Hematopoietic Stem Cell Transplantation. J Fungi (Basel) 2021; 7:jof7030238. [PMID: 33810069 PMCID: PMC8004996 DOI: 10.3390/jof7030238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/28/2023] Open
Abstract
Data on biomarker-assisted diagnosis of invasive aspergillosis (IA) in pediatric patients is scarce. Therefore, we conducted a cohort study over two years including 404 serum specimens of 26 pediatric patients after allogeneic hematopoietic stem cell transplantation (alloSCT). Sera were tested prospectively twice weekly for Aspergillus-specific DNA, galactomannan (GM), and retrospectively for (1→3)-β-D-glucan (BDG). Three probable IA and two possible invasive fungal disease (IFD) cases were identified using the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSGERC) 2019 consensus definitions. Sensitivity and specificity for diagnosis of probable IA and possible IFD was 80% (95% confidential interval (CI): 28–99%) and 55% (95% CI: 32–77%) for BDG, 40% (95% CI: 5–85%) and 100% (95% CI: 83–100%) for GM, and 60% (95% CI: 15–95%) and 95% (95% CI: 75–100%) for Aspergillus-specific real-time PCR. However, sensitivities have to be interpreted with great caution due to the limited number of IA cases. Interestingly, the low specificity of BDG was largely caused by false-positive BDG results that clustered around the date of alloSCT. The following strategies were able to increase BDG specificity: two consecutive positive BDG tests for diagnosis (specificity 80% (95% CI: 56–94%)); using an optimized cutoff value of 306 pg/mL (specificity 90% (95% CI: 68–99%)) and testing BDG only after the acute posttransplant phase. In summary, BDG can help to diagnose IA in pediatric alloSCT recipients. However, due to the poor specificity either an increased cutoff value should be utilized or BDG results should be confirmed by an alternative Aspergillus assay.
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Affiliation(s)
- Jan Springer
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
- Correspondence: ; Tel.: +49-931-201-36404; Fax: +49-931-201-36409
| | - Jürgen Held
- Mikrobiologisches Institut—Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.H.); (J.T.)
| | - Carlo Mengoli
- Department of Histology, Microbiology, and Medical Biotechnology, University of Padua, 35122 Padua, Italy;
| | - Paul Gerhardt Schlegel
- Kinderklinik und Poliklinik, University Medical Center Würzburg, 97080 Würzburg, Germany; (P.G.S.); (M.E.)
| | - Florian Gamon
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
| | - Johannes Träger
- Mikrobiologisches Institut—Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.H.); (J.T.)
| | - Oliver Kurzai
- National Reference Center for Invasive Fungal Infections (NRZMyk), Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, 07745 Jena, Germany;
- Institute for Hygiene and Microbiology, University Würzburg, 97080 Würzburg, Germany
| | - Hermann Einsele
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
| | - Juergen Loeffler
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
| | - Matthias Eyrich
- Kinderklinik und Poliklinik, University Medical Center Würzburg, 97080 Würzburg, Germany; (P.G.S.); (M.E.)
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12
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Porzionato A, Stocco E, Emmi A, Macchi V, De Caro R. Case Report: Sudden Fatal Hemorrhage in Ulcerative Fungal Laryngotracheitis-A Pediatric Case Report. Front Pediatr 2021; 9:764027. [PMID: 35087772 PMCID: PMC8787292 DOI: 10.3389/fped.2021.764027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022] Open
Abstract
In this report, we describe an autopsy case of a child affected by acute lymphoblastic leukemia and opportunistic pulmonary aspergillosis. The patient died because of a full-thickness tracheal wall ulceration with right inferior thyroid artery lesion and sudden hemorrhage, likely ascribable to undiagnosed invasive Aspergillus laryngotracheitis. Aspergillus infection, particularly in immunocompromised patients, should be considered an urgent risk factor to manage as it may lead to sudden fatal events in absence of evident critical symptoms.
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Affiliation(s)
- Andrea Porzionato
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Elena Stocco
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Aron Emmi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Veronica Macchi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
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13
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Huseynov RM, Javadov SS, Osmanov A, Khasiyev S, Valiyeva SR, Almammadova E, Denning DW. The burden of serious fungal infections in Azerbaijan. Ther Adv Infect Dis 2021; 8:20499361211043969. [PMID: 34497715 PMCID: PMC8419541 DOI: 10.1177/20499361211043969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Azerbaijan is an upper middle-income country in South Caucasus with an area of 86,600 km2 and a total population of 10 million people and gross domestic product of US $4480 per capita. The aim of this research is to estimate fungal infection burden and highlight the problem at national and international levels. METHODS Fungal infection burden was estimated using data from epidemiological papers and population at risk and LIFE (Leading International Fungal Education) modelling. RESULTS The number of people living with human immunodeficiency virus (PLHIV) in 2018 was 6193, 29% of them not receiving antiretroviral therapy. Based on 90% and 20% rates of oral and oesophageal candidiasis in patients with CD4 cell count <200 µl-1 we estimate 808 and 579 patients with oral and oesophageal candidiasis, respectively. The annual incidences of cryptococcal meningitis and Pneumocystis pneumonia are 5 and 55 cases, respectively. We estimated 2307 cases of chronic pulmonary aspergillosis (CPA), 4927 patients with allergic bronchopulmonary aspergillosis (ABPA), and 6504 with severe asthma with fungal sensitization (SAFS). Using data on chronic obstructive pulmonary diseases (COPD), lung cancer, acute myeloid leukaemia rates, and number of transplantations, we estimated 693 cases of invasive aspergillosis following these conditions. Using a low-European rate for invasive candidiasis, we estimated 499 and 75 patients with candidemia and intra-abdominal candidiasis respectively. The number of adult women (15-55 years) in Azerbaijan is ~2,658,000, so it was estimated that 159,490 women suffer from recurrent vulvovaginal candidiasis (rVVC). DISCUSSION In total, the estimated number of people suffering from fungal diseases in Azerbaijan is 225,974 (2.3% of the population). However, the fungal rate is underestimated due to lack of epidemiological data. The most imminent need is improvement in diagnostic capabilities. This aim should be achieved via establishing a reference laboratory and equipping major clinical centers with essential diagnostics assays.
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Affiliation(s)
- Ravil M. Huseynov
- The Department of Medical Microbiology and Immunology, Azerbaijan Medical University, Mardanov Qardashlari 98, Baku, Azerbaijan
| | - Samir S. Javadov
- The Department of Medical Microbiology and Immunology, Azerbaijan Medical University, Baku, Azerbaijan
| | - Ali Osmanov
- Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - Shahin Khasiyev
- The Department of Informatics and Statistics, Ministry of Health of Azerbaijan Republic, Baku, Azerbaijan
| | - Samira R. Valiyeva
- Republican Centre for Combating AIDS, Ministry of Health of Azerbaijan Republic, Baku, Azerbaijan
| | - Esmira Almammadova
- Republican Centre for Combating AIDS, Ministry of Health of Azerbaijan Republic, Baku, Azerbaijan
| | - David W. Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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14
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Establishment of a New PNA-FISH Method for Aspergillus fumigatus Identification: First Insights for Future Use in Pulmonary Samples. Microorganisms 2020; 8:microorganisms8121950. [PMID: 33316925 PMCID: PMC7763223 DOI: 10.3390/microorganisms8121950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 01/01/2023] Open
Abstract
Aspergillus fumigatus is the main causative agent of Invasive Aspergillosis. This mold produces conidia that when inhaled by immunocompromized hosts can be deposited in the lungs and germinate, triggering disease. In this paper, the development of a method using peptide nucleic acid-fluorescence in situ hybridization (PNA-FISH) is described. The PNA-FISH probe was tested in several strains and a specificity and sensitivity of 100% was obtained. Detection of A. fumigatussensu stricto was then achieved in artificial sputum medium (ASM) pre-inoculated with 1 × 102 conidia·mL-1-1 × 103 conidia·mL-1, after a germination step of 24 h. The PNA-FISH method was evaluated in 24 clinical samples (10 sputum, 8 bronchoalveolar lavage (BAL), and 6 bronchial lavage (BL)) that were inoculated with 1 × 104 conidia·mL-1 in sputum; 1 × 103 conidia·mL-1 in BL and BAL, for 24 h. Despite a specificity of 100%, the sensitivity was 79%. This relatively low sensitivity can be explained by the fact that hyphae can yield "fungal ball" clusters, hindering pipetting procedures and subsequent detection, leading to false negative results. Nonetheless, this study showed the potential of the PNA-FISH method for A. fumigatussensu stricto detection since it takes only 1 h 30 m to perform the procedure with a pre-enrichment step of 6 h (pure cultures) and 24 h (clinical samples), and might provide a suitable alternative to the existing methods for studies in pure cultures and in clinical settings.
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15
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Jenks JD, Miceli MH, Prattes J, Mercier T, Hoenigl M. The Aspergillus Lateral Flow Assay for the Diagnosis of Invasive Aspergillosis: an Update. CURRENT FUNGAL INFECTION REPORTS 2020; 14:378-383. [PMID: 33312332 PMCID: PMC7717101 DOI: 10.1007/s12281-020-00409-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
Purpose of Review To review the data on the Aspergillus lateral flow assay for the diagnosis of invasive Aspergillosis. Recent Findings Aspergillus spp. cause a wide spectrum of disease with invasive aspergillosis (IA) as its most severe manifestation. Early and reliable diagnosis of disease is crucial to decrease associated morbidity and mortality, and enable prompt initiation of treatment for IA. Most recently, non-culture-based tests, such as Aspergillus galactomannan (GM), have been useful in early identification and treatment of patients with IA. However, cost, turnaround time, and variable performance indifferent populations at risk for IA remain significant drawbacks to the use of this test. Several diagnostic tests for IA have been developed, including the sōna Aspergillus GM Lateral flow assay (GM-LFA) rapid test. Summary The GM-LFA has shown excellent performance for the diagnosis of IA in patients with hematologic malignancy and may be a viable option for settings where ELISA GM testing is not feasible. Further evaluation of the GM-LFA in the non-hematology setting is ongoing, including in solid organ transplant recipients and patients in the intensive care unit.
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Affiliation(s)
- Jeffrey D. Jenks
- Division of General Internal Medicine, University of California San Diego, La Jolla, CA USA
- Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, CA USA
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA USA
| | - Marisa H. Miceli
- Division of Infectious Diseases, Department of Medicine, University of Michigan, Ann Arbor, MI USA
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Toine Mercier
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, CA USA
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA USA
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria
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16
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Jenks JD, Hoenigl M. Point-of-care diagnostics for invasive aspergillosis: nearing the finish line. Expert Rev Mol Diagn 2020; 20:1009-1017. [PMID: 32902359 DOI: 10.1080/14737159.2020.1820864] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The spectrum of disease caused by Aspergillus spp. is dependent on the immune system of the host, with invasive aspergillosis (IA) its most severe manifestation. Early and reliable diagnosis of Aspergillus disease is important to decrease associated morbidity and mortality from IA. AREAS COVERED The following review searched Pub Med for literature published since 2007 and will give an update on the current point-of-care diagnostic strategies for the diagnosis of IA, discuss needed areas of improvement for these tests, and future directions. EXPERT OPINION Several new diagnostic tests for IA - including point-of-care tests - are now available to complement conventional galactomannan (GM) testing. In particular, the Aspergillus-specific Lateral Flow Device (LFD) test and the sōna Aspergillus GM Lateral Flow Assay (LFA) are promising for the diagnosis of IA in patients with hematologic malignancy, although further evaluation in the non-hematology setting is needed. In addition, a true point-of-care test, particularly for easily obtained specimens like serum or urine that can be done at the bedside or in the Clinic in a matter of minutes is needed, such as the lateral flow dipstick test, which is under current evaluation. Lastly, improved diagnostic algorithms to diagnose IA in non-neutropenic patients is needed.
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Affiliation(s)
- Jeffrey D Jenks
- Division of General Internal Medicine, Department of Medicine, University of California San Diego , La Jolla, CA, USA.,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego , La Jolla, CA, USA.,Clinical and Translational Fungal - Working Group, University of California San Diego , La Jolla, CA, USA
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego , La Jolla, CA, USA.,Clinical and Translational Fungal - Working Group, University of California San Diego , La Jolla, CA, USA.,Division of Pulmonology and Section of Infectious Diseases, Medical University of Graz , Graz, Austria
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17
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Waqas S, Dunne K, Talento AF, Wilson G, Martin-Loeches I, Keane J, Rogers TR. Prospective observational study of respiratory Aspergillus colonization or disease in patients with various stages of chronic obstructive pulmonary disease utilizing culture versus nonculture techniques. Med Mycol 2020; 59:myaa077. [PMID: 32926151 DOI: 10.1093/mmy/myaa077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients have been recognized to be at increased risk of Aspergillus spp. colonization, which may progress to invasive pulmonary aspergillosis (IPA). The objective of this study was to determine the frequency of Aspergillus colonization, or disease, in a cohort of COPD patients. A prospective observational study was undertaken to determine Aspergillus colonization, or disease, in consecutive COPD patients undergoing bronchoscopy. Fungal culture as well as galactomannan antigen (GM) and Aspergillus nucleic acid detection (PCR) were performed on bronchoalveolar lavage fluid (BAL) samples. One hundred and fifty patients were recruited. One hundred and twelve (74.7%) were outpatients, 38 (25.33%) were inpatients, of whom 6 (4%) were in the intensive care unit. Most patients (N = 122, 81.3%) were either COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages 1 or 2. Nine (6%) patients were on systemic steroids, 64 (42.7%) on inhaled steroids, and 9 (6%) on both. Seventeen patients (11.3%) had at least one positive test for Aspergillus detection (culture ± galactomannan ± polymerase chain reaction [PCR]), 13 (76.4%) of whom were COPD GOLD stages 1 or 2. Five patients had probable or putative IPA. Aspergillus sp. was detected in five patients (3.3%) by culture, but detection increased to 17 (11.3%) by the additional testing for GM or Aspergillus DNA. The frequency of Aspergillus detection in this cohort of COPD patients may reflect the predominance of early GOLD stages among the study population but deserves further investigation to determine its relevance as a predictive risk factor for IPA. LAY SUMMARY COPD is a risk factor for Aspergillus spp. colonization. Bronchoalveolar lavage samples of 150 COPD patients were tested for presence of Aspergillus fumigatus, which was detected in five patients (3.3%) by culture, but detection of Aspergillus increased to 17 (11.3%) by additional GM and PCR testing.
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Affiliation(s)
- Sarmad Waqas
- Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Katie Dunne
- Department of Clinical Microbiology, Trinity College Dublin, Ireland
| | - Alida Fe Talento
- Department of Clinical Microbiology, Trinity College Dublin, Ireland
- Department of Microbiology, St. James's Hospital, Dublin 8, Ireland
| | - Graham Wilson
- Department of Radiology, St. James's Hospital, Dublin 8, Ireland
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, Trinity College Dublin, Ireland
- Department of Intensive Care Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Joseph Keane
- Department of Clinical Medicine, Trinity College Dublin, Ireland
- Department of Respiratory Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Thomas R Rogers
- Department of Clinical Microbiology, Trinity College Dublin, Ireland
- Department of Microbiology, St. James's Hospital, Dublin 8, Ireland
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18
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Tanpaibule T, Jinawath N, Taweewongsounton A, Niparuck P, Rotjanapan P. Genetic Risk Surveillance for Invasive Aspergillosis in Hematology Patients: A Prospective Observational Study. Infect Dis Ther 2020; 9:807-821. [PMID: 32860206 PMCID: PMC7680473 DOI: 10.1007/s40121-020-00331-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The association between genetic background and the risk of invasive aspergillosis (IA) has not been addressed in Thailand. We conducted genetic risk surveillance for IA among Thai hematologic patients. METHODS We conducted a prospective observational cohort study including moderate- to high-risk hematology patients at Ramathibodi Hospital. IA occurrence, relevant clinical data, and genetic analyses were assessed. Odds ratios (ORs) of IA were assessed for the presence of the selected single nucleotide polymorphism genotype using logistic regression. RESULTS A total of 357 patients were enrolled. The most common hematologic disease was non-Hodgkin lymphoma (45.1%). IA was diagnosed in 36 patients (10.10%). The C allele of IL10rs1800896 was associated with an increased risk of IA (adjusted OR 5.297; 95% confidence interval [CI] 2.032-13.809, p = 0.001). In multivariate Cox regression analysis, prolonged neutropenia and the C allele of IL10rs1800896 were associated with IA (hazard ratio [HR] 12.585; 95% CI 3.866-40.967, p < 0.001 and HR 2.449; 95% CI 1.097-5.468, p = 0.042, respectively). CONCLUSIONS Carrying the C allele of IL10rs1800896 was associated with an increased risk of IA among moderate- to high-risk Thai patients with hematologic diseases. This finding can potentially lead to a novel risk stratification scheme to further prevent IA in resource-limited settings.
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Affiliation(s)
- Tananun Tanpaibule
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natini Jinawath
- Program in Translational Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Integrative Computational BioScience Center (ICBS), Mahidol University, Nakhon Pathom, Thailand
| | | | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Porpon Rotjanapan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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19
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Steinbrink JM, Zaas AK, Betancourt M, Modliszewski JL, Corcoran DL, McClain MT. A transcriptional signature accurately identifies Aspergillus Infection across healthy and immunosuppressed states. Transl Res 2020; 219:1-12. [PMID: 32165060 PMCID: PMC7170547 DOI: 10.1016/j.trsl.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 12/12/2022]
Abstract
Invasive aspergillosis (IA) is a major cause of critical illness in immunocompromised (IC) patients. However, current fungal tests are limited. Disease-specific gene expression patterns in circulating host cells show promise as novel diagnostics, however it is unknown whether such a 'signature' exists for IA and the effect of iatrogenic immunosuppression on any such biomarkers. Male BALB/c mice were separated into 6 experimental groups based on Aspergillus fumigatus inhalational exposure and IC status (no immunosuppression, cyclophosphamide, and corticosteroids). Mice were sacrificed 4 days postinfection. Whole blood was assayed for transcriptomic responses in peripheral white blood cells via microarray. An elastic net regularized logistic regression was employed to develop classifiers of IA based on gene expression. Aspergillus infection triggers a powerful response in non-IC hosts with 2718 genes differentially expressed between IA and controls. We generated a 146-gene classifier able to discriminate between non-IC infected and uninfected mice with an AUC of 1. However, immunosuppressive medications exhibited a confounding effect on this transcriptomic classifier. After controlling for the genomic effects of immunosuppression, we were able to generate a 187-gene classifier with an AUC of 0.92 in the absence of immunosuppression, 1 with cyclophosphamide, and 0.9 with steroids. The host transcriptomic response to IA is robust and conserved. Pharmacologic perturbation of the host immune response has powerful effects on classifier performance and must be considered when developing such novel diagnostics. When appropriately designed, host-derived peripheral blood transcriptomic responses demonstrate the ability to accurately diagnose Aspergillus infection, even in the presence of immunosuppression.
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Affiliation(s)
- Julie M Steinbrink
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina; Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina.
| | - Aimee K Zaas
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Marisol Betancourt
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina; Augusta University Medical Center, Augusta, Georgia
| | | | - David L Corcoran
- Duke Center for Genomic and Computational Biology, Duke University, Durham North Carolina
| | - Micah T McClain
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina; Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina
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20
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Sharma A, Bisht D, Das S, Rai G, Dutt S, Arora VK. Molecular Detection of Aspergillus in Sputum of Patients with Lower Respiratory Tract Infections. Int J Appl Basic Med Res 2020; 10:86-90. [PMID: 32566523 PMCID: PMC7289198 DOI: 10.4103/ijabmr.ijabmr_364_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/30/2019] [Accepted: 02/13/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Raised incidences of respiratory tract infections due to fungal agents in immunocompetent individuals are a cause of concern due to the unavailability of rapid diagnostic methods. MATERIALS AND METHODS Sputum and serum samples were collected from patients having lower respiratory tract infections (LRTIs), serum samples were screened for the presence of anti Aspergillus antibodies and sputum samples were homogenized and processed for identification of Aspergillus by conventional methods and further subjected to polymerase chain reaction (PCR) using genus-specific ITS 4-5 primers. RESULTS PCR identified Aspergillus in 28% sputum samples, which was high as compared to conventional methods. CONCLUSION Simple conventional PCR technique proves to be useful screening in for early identification of Aspergillus colonization in patients with LRTI, which can prevent irreversible damage in their lungs by fungal invasion.
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Affiliation(s)
- Alosha Sharma
- Department of Microbiology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Dakshina Bisht
- Department of Microbiology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Shukla Das
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - Gargi Rai
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - Shyama Dutt
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - V K Arora
- Department of TB and Chest, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
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21
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Molecular Detection of Aspergillus: Application of a Real-Time PCR Multiplex Assay in Tissue Samples. J Fungi (Basel) 2020; 6:jof6010011. [PMID: 31936735 PMCID: PMC7151104 DOI: 10.3390/jof6010011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 01/29/2023] Open
Abstract
Diagnosis of invasive fungal infections is complex, and the lack of standardization of molecular methods is still a challenge. Several methods are available for the diagnosis of invasive aspergillosis, but their effectiveness will depend on the studied population, the patients' comorbidities, and the use of mold active prophylaxis, among others. The ability to determine the identity of the infecting Aspergillus species, and to detect mutations conferring specific resistance patterns directly from DNA extracted from the biological product, is an advantage of nucleic acid testing compared with antigen-based assays. In this study, we to present laboratory cases where the diagnosis of aspergillosis was performed using a real-time multiplex PCR for the detection of Aspergillus DNA in tissue samples, showing its usefulness as one more tool in the diagnosis of aspergillosis in tissue samples. Aspergillus real-time multiplex PCR was also used to detect azole-resistance in some cases. In the majority of the PCR positive cases, cultures remained negative after 60 days. The PCR assay directed to Aspergillus gave positive signals for Aspergillus fumigatus sensu stricto. Results were confirmed by panfungal PCR, followed by sequencing, revealing 100% homology with Aspergillus fumigatus sensu stricto. Mutations conferring azole resistance were not detected.
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22
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Zoran T, Weber M, Springer J, White PL, Bauer J, Schober A, Löffler C, Seelbinder B, Hünniger K, Kurzai O, Scherag A, Schäuble S, Morton CO, Einsele H, Linde J, Löffler J. Treatment with etanercept and low monocyte concentration contribute to the risk of invasive aspergillosis in patients post allogeneic stem cell transplantation. Sci Rep 2019; 9:17231. [PMID: 31754120 PMCID: PMC6872713 DOI: 10.1038/s41598-019-53504-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/29/2019] [Indexed: 12/16/2022] Open
Abstract
Invasive aspergillosis (IA) is a life-threatening complication among allogeneic hematopoietic stem cell transplant (alloSCT) recipients. Despite well known risk factors and different available assays, diagnosis of invasive aspergillosis remains challenging. 103 clinical variables from patients with hematological malignancies and subsequent alloSCT were collected. Associations between collected variables and patients with (n = 36) and without IA (n = 36) were investigated by applying univariate and multivariable logistic regression. The predictive power of the final model was tested in an independent patient cohort (23 IA cases and 25 control patients). Findings were investigated further by in vitro studies, which analysed the effect of etanercept on A. fumigatus-stimulated macrophages at the gene expression and cytokine secretion. Additionally, the release of C-X-C motif chemokine ligand 10 (CXCL10) in patient sera was studied. Low monocyte concentration (p = 4.8 × 10−06), severe GvHD of the gut (grade 2–4) (p = 1.08 × 10−02) and etanercept treatment of GvHD (p = 3.5 × 10−03) were significantly associated with IA. Our studies showed that etanercept lowers CXCL10 concentrations in vitro and ex vivo and down-regulates genes involved in immune responses and TNF-alpha signaling. Our study offers clinicians new information regarding risk factors for IA including low monocyte counts and administration of etanercept. After necessary validation, such information may be used for decision making regarding antifungal prophylaxis or closely monitoring patients at risk.
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Affiliation(s)
- Tamara Zoran
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany.,Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Michael Weber
- Friedrich Löffler Institute, Institute of Molecular Pathogenesis, Jena, Germany.,Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Jan Springer
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | | | - Joachim Bauer
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | - Annika Schober
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | - Claudia Löffler
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | - Bastian Seelbinder
- Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Kerstin Hünniger
- Septomics Research Centre, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany.,Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Oliver Kurzai
- Septomics Research Centre, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany.,Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, University Hospital, Jena, Germany
| | - Sascha Schäuble
- Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - C Oliver Morton
- Western Sydney University, School of Science and Health, Campbelltown, NSW, 2560, Australia
| | - Hermann Einsele
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | - Jörg Linde
- Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany.,Friedrich Löffler Institute, Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - Jürgen Löffler
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany.
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del Rocío Reyes-Montes M, Duarte-Escalante E, Guadalupe Frías-De-León M, Obed Martínez-Herrera E, Acosta-Altamirano G. Molecular Diagnosis of Invasive Aspergillosis. Mol Med 2019. [DOI: 10.5772/intechopen.78694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Raval KM, Ghormade V, Rajamohanan PR, Choudhary H, Rudramurthy SM, Chakrabarti A, Paknikar K. Development of a nano-gold immunodiagnostic assay for rapid on-site detection of invasive aspergillosis. J Med Microbiol 2019; 68:1341-1352. [PMID: 31355743 DOI: 10.1099/jmm.0.001040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction. Timely detection of invasive aspergillosis (IA) caused by fungal pathogens, i.e. Aspergillus fumigatus and Aspergillus flavus, in immunocompromised patients is crucial in preventing high mortality.Aim. To develop a simple immunoassay for the detection of galactomannan (GM), an IA biomarker.Methodology. GM from A. fumigatus and A. flavus clinical strains was purified and characterized by X-ray diffraction, IR spectroscopy and 13C/1H nuclear magnetic resonance (NMR) for polyclonal antibody (pAb) production in rabbits. An enzyme-linked immunosorbent assay (ELISA) was standardized using concanavalin A to capture Aspergillus GM and pAbs to detect it. Gold nanoparticles (AuNPs) were synthesized and conjugated to pAbs for the development of a dot-blot immunoassay. The developed dot-blot was evaluated with 109 clinical serum and bronchoalveolar lavage samples.Results. Spectroscopy studies characterized the d-galactofuranosyl groups of GM responsible for the immune response and generation of pAbs. The ELISA employing pAbs showed a sensitivity of 1 ng ml-1 for Aspergillus GM. Furthermore, a sensitive, visual, rapid dot-blot assay developed by the conjugation of pAbs to AuNPs (~24±5 nm size, -36±2 mV zeta potential) had a detection limit of 1 pg ml-1 in serum. The pAbs interacted with Aspergillus spp. but did not cross-react with other fungal pathogen genera such as Penicillium and Candida. Evaluation of the dot-blot with 109 clinical samples showed high sensitivity (80 %) and specificity (93.2 %), with an overall assay accuracy of 89%.Conclusion. The developed nano-gold immunodiagnostic assay has immense potential for practical use in rapid, specific and sensitive on-site diagnosis of IA, even under resource-limited settings.
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Affiliation(s)
- Komal M Raval
- Savitribai Phule Pune University, Ganeshkhind, Pune 411007, India.,Nanobioscience Group, Agharkar Research Institute, Pune 411004, India
| | - Vandana Ghormade
- Nanobioscience Group, Agharkar Research Institute, Pune 411004, India.,Savitribai Phule Pune University, Ganeshkhind, Pune 411007, India
| | - P R Rajamohanan
- Central NMR Facility, National Chemical Laboratory, Pune 411008, India
| | - Hansraj Choudhary
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Kishore Paknikar
- Nanobioscience Group, Agharkar Research Institute, Pune 411004, India.,Savitribai Phule Pune University, Ganeshkhind, Pune 411007, India
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Ray S, Balaini N, Chakravarty K, Pattanayak S, Goel A, Takkar A, Lal V. Special scenarios in the management of central nervous system aspergillosis: a case series and review of literature. Postgrad Med J 2019; 95:382-389. [DOI: 10.1136/postgradmedj-2018-136095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/14/2019] [Accepted: 04/07/2019] [Indexed: 12/12/2022]
Abstract
Aspergillus is a rare but important opportunistic pathogen to invade the central nervous system (CNS). It is a significant pathogen of not only immunocompromised but also immunocompetent patients. Its manifestations are pleiotropic, reflecting multiple mechanisms of pathogenesis and host interactions. Despite significant advances in diagnostic methods and therapeutic options, the mortality remains high. Several advances have been made in medications and surgical management, yet, current treatment practices lack uniformity. Patient woes are further heightened by the high costs of treatment and prolonged duration of therapy. In view of the challenging aspects of this disease, we present a short review of four challenging cases touching on the varied aspects of management of CNS aspergillosis covering pathogenesis, diagnostic pitfalls, surgical and medical options and evidence-based guidelines for the management of the same.
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26
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Gao S, Zheng X, Tang Y, Cheng Y, Hu X, Wu J. Development of a Fluorescently Labeled Aptamer Structure-Switching Assay for Sensitive and Rapid Detection of Gliotoxin. Anal Chem 2019; 91:1610-1618. [PMID: 30567425 DOI: 10.1021/acs.analchem.8b05094] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Gliotoxin, one of the most toxic metabolites produced during the growth of Aspergillus fumigatus, can cause direct damage to the immune system and results in infection and spread of Aspergillus, or even leads to invasive aspergillosis. Accurate, rapid, and sensitive detection of the disease-specific marker gliotoxin, particularly in serum, urine, or other body fluids, is therefore an important approach to achieving early and rapid diagnosis of Invasive Aspergillus Fumigatus Infection (IAFI). In this study, aptamers that specifically bind to gliotoxin were successfully obtained using immobilization-free GO-SELEX technology. Furthermore, the performance of the aptamer, including binding affinity, targeting specificity, and structural stability, was further improved by optimizing through truncation and mutation. Finally, the optimized aptamer APT8T1M was used to develop a novel fluorescently labeled aptamer structure-switching assay (FLASSA) for the detection of gliotoxin. The method exhibited a good linear range from 0.1 nM to 100 nM of gliotoxin, with a lower detection limit of 0.05 nM. Moreover, FLASSA was applied to the detection of gliotoxin in spiked serum and urine samples. A good mean recovery of 98.76-110.85% and a low coefficient of variation (5.45-14.59%) were obtained, indicating a high degree of selectivity for gliotoxin, good reproducibility, and stability. These results show that the developed FLASSA has significant potential and offers an alternative to the traditional analytical methods for the rapid, sensitive, and efficient detection of gliotoxin, thus, providing an effective tool for the early and rapid diagnosis of IAFI.
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Affiliation(s)
- Shunxiang Gao
- Eye Institute, Eye and ENT Hospital , College of Medicine, Fudan University , Shanghai , China.,Shanghai Key Laboratory of Visual Impairment and Restoration , Science and Technology Commission of Shanghai Municipality , Shanghai , China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , China
| | - Xin Zheng
- Department of Clinical Laboratory , Longhua Hospital, Shanghai University of Traditional Chinese Medicine , Shanghai , China
| | - Yuan Tang
- Department of Gastrointestinal Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Yajun Cheng
- Department of Orthopedics , Changhai Hospital, Second Military Medical University , Shanghai , China
| | - Xiaobo Hu
- Department of Clinical Laboratory , Longhua Hospital, Shanghai University of Traditional Chinese Medicine , Shanghai , China
| | - Jihong Wu
- Eye Institute, Eye and ENT Hospital , College of Medicine, Fudan University , Shanghai , China.,Shanghai Key Laboratory of Visual Impairment and Restoration , Science and Technology Commission of Shanghai Municipality , Shanghai , China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , China
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27
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Nasir IA, Shuwa HA, Emeribe AU, Adekola HA, Dangana A. Phenotypic profile of pulmonary aspergillosis and associated cellular immunity among people living with human immunodeficiency virus in Maiduguri, Nigeria. Tzu Chi Med J 2019; 31:149-153. [PMID: 31258289 PMCID: PMC6559025 DOI: 10.4103/tcmj.tcmj_46_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: Aspergillus causes many forms of pulmonary infectious diseases ranging from colonization (noninvasive) to invasive aspergillosis. This largely depends on the underlying host's lung health and immune status. Pulmonary aspergillosis (PA), especially the invasive form, occurs as opportunistic to human immunodeficiency virus (HIV) as a result of cluster of differentiation (CD)4+ lymphopenia. The majority of patients with comorbid HIV and aspergillosis go undiagnosed. This study aimed to isolate, identify the etiologies, and determine the prevalence of PA among HIV-infected persons with a productive cough (at least <2 weeks) at the HIV Clinics of the University of Maiduguri Teaching Hospital, Nigeria. Materials and Methods: After ethical approval, three consecutive early morning sputum samples were collected from patients with negative tuberculosis results. The samples were individually inoculated onto Sabouraud dextrose agar supplemented with chloramphenicol and cycloheximide in duplicate for 7 days at 37°C and 25°C, respectively. The fungal isolates were examined morphologically and microscopically and identified using the standard biochemical reagents. CD4+ cell counts were performed using flow cytometry. Self-administered questionnaires were used to assess the patients data. All patients were antiretroviral naïve. Results: The prevalence of PA was 12.7% in these 150 patients. Of the 19 fungal culture-positive individuals, Aspergillus fumigatus accounted for the highest proportion of the isolates (8, 42.1%) followed by Aspergillus niger (5, 26.3%), Aspergillus flavus (4, 21.1%), and Aspergillus terreus (2, 10.5%). Based on the assessment of functionality of cellular immunity, HIV participants who were negative for PA (131/150) had significantly higher mean ± standard deviation CD4 T-cell counts (245.65 ± 178.32 cells/mL) than those with aspergillosis (126.13 ± 105.27 cells/mL) (P = 0.0051). PA was relatively highest among patients with CD4+ cell counts <200 cells/mL (12. 34.3%) followed by those with CD4+ cell counts between 200 and 350 cells/mL (5, 9.6%) and least among those with CD4+ cell counts >350 cells/mL (2, 3.2%). The Chi-square test showed a significant association between the prevalence of PA and the CD4+ cell count, age, and gender (P < 0.05) but not with occupation or education level (P > 0.05). Conclusion: The findings from this study indicate that Aspergillus spp. is a significant etiology of acute productive cough in people living with HIV and this is related to the CD4+ cell count of coinfected persons.
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Affiliation(s)
- Idris Abdullahi Nasir
- Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,Department of Medical Microbiology and Parasitology, University of Ilorin, Ilorin, Nigeria
| | - Halima Ali Shuwa
- Department of Immunology, Faculty of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | | | | | - Amos Dangana
- Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
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Jenks JD, Salzer HJF, Hoenigl M. Improving the rates of Aspergillus detection: an update on current diagnostic strategies. Expert Rev Anti Infect Ther 2018; 17:39-50. [PMID: 30556438 DOI: 10.1080/14787210.2018.1558054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The spectrum of disease caused by Aspergillus spp. is dependent on the immune system of the host, and ranges from invasive aspergillosis (IA) to chronic pulmonary aspergillosis (CPA). Early and reliable diagnosis of Aspergillus disease is important to decrease associated morbidity and mortality. Areas covered: The following review will give an update on current diagnostic strategies for the diagnosis of IA and CPA. Expert commentary: Several new diagnostics for IA (including point-of-care tests) are now available to complement galactomannan testing. In particular, immunoPET/MRI imaging may be a promising approach for diagnosing IA in the near future. Notably, nearly all new biomarkers and tests for IA have been evaluated in the hematology setting only. Validation of biomarkers and tests is therefore needed for the increasing proportion of patients who develop IA outside the hematology setting. As an important first step, reliable definitions of IA are needed for non-hematology settings as clinical presentation and radiologic findings differ in these settings. CPA diagnosis is based on a combination of radiological findings in chest CT, mycological evidence (e.g. by the Aspergillus-specific IgG assay), exclusion of alternative diagnosis and chronicity. ([18F]FDG) PET/CT and immuno PET/MRI imaging are promising new imaging approaches.
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Affiliation(s)
- Jeffrey D Jenks
- a Department of Medicine , University of California-San Diego , San Diego , CA , USA
| | - Helmut J F Salzer
- b Department of Pulmonary Medicine , Kepler University Hospital , Linz , Austria.,c Institute of Nuclear Medicine and Endocrinology , Kepler University Hospital , Linz , Austria
| | - Martin Hoenigl
- d Division of Infectious Diseases, Department of Medicine , University of California-San Diego , San Diego , CA , USA.,e Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology , Medical University of Graz , Graz , Austria
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Invasive Aspergillosis in Children: Update on Current Guidelines. Mediterr J Hematol Infect Dis 2018; 10:e2018048. [PMID: 30210741 PMCID: PMC6131109 DOI: 10.4084/mjhid.2018.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/15/2018] [Indexed: 01/01/2023] Open
Abstract
Invasive aspergillosis (IA) is an important cause of infectious morbidity and mortality in immunocompromised paediatric patients. Despite improvements in diagnosis, prevention, and treatment, IA is still associated with high mortality rates. To address this issue, several international societies and organisations have proposed guidelines for the management of IA in the paediatric population. In this article, we review current recommendations of the Infectious Diseases Society of America, the European Conference on Infection in Leukaemia and the European Society of Clinical Microbiology and Infectious Diseases for the management and prevention of IA in children.
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30
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Dissanayake HA, Weeratunga PN, Karunanayake P, Lanerolle RD, Chandu de Silva MV, Jayasinghe S. Embolizing pulmonary aspergillosis, mycobacterial & aspergillous splenic abscess and cytomegalovirus co-infection following steroid induced immunosuppression: a case report. BMC Infect Dis 2018; 18:367. [PMID: 30081818 PMCID: PMC6080400 DOI: 10.1186/s12879-018-3293-4] [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: 01/22/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aspergillosis is a serious infection particularly affecting the immunodeficient host. Its co-infection with tuberculosis and cytomegalovirus has not been reported before. Embolic events are well recognized with aspergillous endocarditis and aortitis. Splenic abscess is a rare serious complication of disseminated aspergillosis and is difficult to treat. We report the first case of multiple embolic events and splenic abscess in a patient with pulmonary aspergillosis and cytomegaloviral and tuberculous co-infection, without endocarditis or aortitis. CASE PRESENTATION Thirty-year-old male presented with fever and non-productive cough while on glucocorticoids for glomerulonephritis. He was found to have pulmonary aspergillosis and subsequently developed bilateral lower limb and cerebral fungal emboli and fungal abscess in the spleen. He had IgM and B cell deficiency and cytomegalovirus (CMV) and tuberculous co-infections. He recovered after prolonged course of antimicrobials, splenectomy and cessation of glucocorticoid therapy which also lead to the resolution of immune deficiencies. CONCLUSION This report illustrates rare combination of B and T cell suppressive effects of glucocorticoids leading to co-infections with CMV, Mycobacterium tuberculosis and Aspergillus and systemic fungal embolization from pulmonary aspergillosis.
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Affiliation(s)
| | | | - Panduka Karunanayake
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Rushika D Lanerolle
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Investigating the Presence of Aspergillus fumigatus and A. flavus Using Galactomannan Enzyme Assay and TaqMan Real-Time PCR Technique. Jundishapur J Microbiol 2018. [DOI: 10.5812/jjm.13670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yang R, Yan Y, Wang Y, Liu X, Su X. Plain and contrast-enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients. Exp Ther Med 2017; 14:4417-4424. [PMID: 29104652 DOI: 10.3892/etm.2017.5096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/23/2017] [Indexed: 11/05/2022] Open
Abstract
Pulmonary cryptococcosis is most commonly reported in immunocompromised patients, whereas immunocompetent hosts are rarely affected and may be asymptomatic, resulting in reduced diagnostic performance of computed tomography (CT) imaging. Thus, the aim of the present study was to review the plain and contrast-enhanced chest CT scan findings of primary pulmonary cryptococcosis in immunocompetent patients, with the aim of improving the diagnosis of this type of pulmonary disease. In the present study, a total of 27 immunocompetent patients of clinically confirmed pulmonary cryptococcosis were analyzed retrospectively. Of the 27 patients, 14 patients underwent plain and contrast-enhanced chest CT scans, while 13 patients only underwent plain chest CT scanning. The clinical and imaging characteristics, including the location, shape, size, number, edge and attenuation or intensity of each lesion, in unenhanced and contrast-enhanced CT scans were reviewed. The results indicated that the most common CT finding was pulmonary nodules (40.74%), with multiple nodules (25.93%) being more common compared with solitary nodules (14.81%). The majority of the nodules were poorly defined and inhomogeneous with observed air-bubble sign. Other findings included consolidation (25.93%), ground-glass opacities (GGO; 22.22%) and a mass (11.11%). The halo, air bronchogram and cavity signs were observed more frequently (22.22, 18.52 and 14.81%, respectively). The pulmonary lesions presented a predominant distribution in the lower lung lobes and peripheral area in 55.55 and 74.07% of the cases, respectively. On the contrast-enhanced CT images, the majority of nodules presented ring enhancement with the mean maximal enhancement value of 20.92±5.67 Hu, and masses demonstrated inhomogeneous enhancement with a mean maximal enhancement value of 35.61±8.32 Hu. In conclusion, familiarity with the CT findings and occupational environment exposure history will assist in earlier and easier diagnosis of pulmonary cryptococcosis in immunocompetent patients.
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Affiliation(s)
- Rongshui Yang
- Department of Radiology, Xinglin Branch Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Yan Yan
- Department of Radiology, Xinglin Branch Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Yuhuan Wang
- Department of Pathology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Xiaohuan Liu
- Department of Radiology, Xinglin Branch Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Xinhui Su
- Department of Nuclear Medicine, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
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Paulovičová E, Paulovičová L, Hrubiško M, Krylov VB, Argunov DA, Nifantiev NE. Immunobiological Activity of Synthetically Prepared Immunodominant Galactomannosides Structurally Mimicking Aspergillus Galactomannan. Front Immunol 2017; 8:1273. [PMID: 29081774 PMCID: PMC5645502 DOI: 10.3389/fimmu.2017.01273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/25/2017] [Indexed: 12/16/2022] Open
Abstract
The study is oriented at the in vitro evaluation of the immunobiological activity and efficacy of synthetically prepared isomeric pentasaccharides representing fragments of Aspergillus fumigatus cell-wall galactomannan and containing β-(1→5)-linked tetragalactofuranoside chain attached to O-6 (GM-1) or O-3 (GM-2) of a spacer-armed mannopyranoside residue. These compounds were studied as biotinylated conjugates which both demonstrated immunomodulatory activities on the RAW 264.7 cell line murine macrophages as in vitro innate immunity cell model. Immunobiological studies revealed time- and concentration-dependent efficient immunomodulation. The proliferation of RAW 264.7 macrophages was induced at higher concentration (100 µg/mL) of studied glycoconjugates and longer exposure (48 h), with more pronounced efficacy for GM-1. The increase of proliferation followed the previous increase of IL-2 production. The cytokine profile of the macrophages treated with the glycoconjugates was predominantly pro-inflammatory Th1 type with significant increase of TNFα, IL-6, and IL-12 release for both glycoconjugates. The RAW 264.7 macrophages production of free radicals was not significantly affected by glycoconjugates stimulation. The phagocytic activity of RAW 264.7 cells was reduced following GM-1 treatment and was significantly increased after 24 h stimulation with GM-2, contrary to 48 h stimulation. Moreover, the synthetically prepared galactomannoside derivatives have been evaluated as efficient serodiagnostic antigens recognized by specific Ig isotypes, and significant presence of specific IgM antibodies in serum of patients suffering from vulvovaginitis was observed.
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Affiliation(s)
- Ema Paulovičová
- Cell Culture Laboratory, Department of Immunochemistry of Glycoconjugates, Center for Glycomics, Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Lucia Paulovičová
- Cell Culture Laboratory, Department of Immunochemistry of Glycoconjugates, Center for Glycomics, Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Martin Hrubiško
- Department of Clinical Immunology and Allergy, Oncology Institute of St. Elisabeth, Bratislava, Slovakia
| | - Vadim B Krylov
- Laboratory of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - Dmitry A Argunov
- Laboratory of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - Nikolay E Nifantiev
- Laboratory of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russia
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Taghizadeh-Armaki M, Hedayati MT, Moqarabzadeh V, Ansari S, Mahdavi Omran S, Zarrinfar H, Saber S, Verweij PE, Denning DW, Seyedmousavi S. Effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis. J Med Microbiol 2017; 66:898-904. [PMID: 28693685 DOI: 10.1099/jmm.0.000512] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia Aspergillus GM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus. METHODOLOGY In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IA patients referred to two university hospitals in Tehran, Iran. KEY FINDINGS According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IA patients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index ≥1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index ≥0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatus patients were 100 and 73 %, respectively. CONCLUSION Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections.
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Affiliation(s)
- Mojtaba Taghizadeh-Armaki
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology and Parasitology, School of Medicine, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad T Hedayati
- Department of Medical Mycology and Parasitology, School of Medicine, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vahid Moqarabzadeh
- Department of Biostatistics, Faculty of Health, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saham Ansari
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Mahdavi Omran
- Department of Medical Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sasan Saber
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Paul E Verweij
- Department of Medical Microbiology, Radboudumc and Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - David W Denning
- The National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, Manchester, Academic Health Science Centre, Manchester, UK
| | - Seyedmojtaba Seyedmousavi
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Microbiology, Radboudumc and Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.,Present address: Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
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35
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Thakur R, Shankar J. Proteome Profile of Aspergillus terreus Conidia at Germinating Stage: Identification of Probable Virulent Factors and Enzymes from Mycotoxin Pathways. Mycopathologia 2017. [PMID: 28647921 DOI: 10.1007/s11046-017-0161-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aspergillus terreus is an emerging opportunistic fungal pathogen that causes invasive aspergillosis in immunocompromised individuals. The main risk group of individuals for this organism is leukopenic patients, individuals having cancers, bone marrow transplant persons and those who have immunological disorders. The lack of early diagnostic marker for A. terreus and intrinsic resistance to Amphotericin B, further limits the successful therapy of A. terreus-associated infections. The germination of inhaled conidia is the key step to establish successful invasion in host tissues or organs. Thus, profiling of expressed proteins during germination of conidia not only shed light on proteins that are involved in invasion or virulence but may also provide early diagnostic markers. We used nanoLC-Q-TOF to study the proteome of germinating conidia (at 16 h time points) of A. terreus. We observed expression of 373 proteins in germinating conidia of A. terreus. A total of 74 proteins were uncharacterized in the database. The expressed proteins were associated with various processes like cell wall modulation, virulence factors and secondary metabolite biosynthesis. The most abundant proteins were associated with protein biosynthesis, carbohydrate metabolism and unknown functions. Among virulent proteins, mitogen-activated protein kinase (hog1) and mitogen-activated protein kinase (mpkC) are key virulent proteins observed in our study. We observed 7 enzymes from terretonin and 10 enzymes from geodin mycotoxin biosynthesis pathway. Interestingly, we observed expression of terrelysin protein, associated with blood cell lysis. Quantitative RT-PCR analysis showed 26-fold increase in transcripts encoding for dihydrogeodin oxidase and 885-fold for terrelysin gene in germinating conidia in comparison to conidia. Further, we propose that terrelysin protein and secondary metabolite such as geodin could be explored as diagnostic marker for A. terreus-associated infections.
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Affiliation(s)
- Raman Thakur
- Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Waknaghat Solan, Himachal Pradesh, 173234, India
| | - Jata Shankar
- Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Waknaghat Solan, Himachal Pradesh, 173234, India.
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Buchheidt D, Reinwald M, Hofmann WK, Boch T, Spiess B. Evaluating the use of PCR for diagnosing invasive aspergillosis. Expert Rev Mol Diagn 2017; 17:603-610. [PMID: 28460550 DOI: 10.1080/14737159.2017.1325735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Aspergillus species, primarily Aspergillus fumigatus, are still the most emerging fungal pathogens. Within recent years, novel molecular methods have been developed to improve the diagnosis of life-threatening invasive aspergillosis in high risk patients. Especially patients with malignant hematological diseases undergoing intensive chemotherapy are at risk and mortality rates are exceptionally high, in part due to difficulties and delays in establishing a microbiologic diagnosis. Early diagnosis and treatment are crucial for an adequate therapeutical management, but, however, are hardly achieved in the clinical setting because most of the current conventional diagnostic tools either lack specificity or acceptable sensitivity at the critical early phase of the infection. Areas covered: To review the clinical value, advantages and problems as well as drawbacks of molecular approaches, especially polymerase chain reaction (PCR)-based assays to detect genomic DNA of Aspergillus species in clinical samples of immunocompromised, especially hematological patients at high risk for IA, a comprehensive review of the literature was performed and expert opinion was expressed. Expert commentary: The results of numerous attempts to diagnose invasive aspergillosis by PCR-based detection of fungal genome in clinical samples highlight the potential of the PCR technique to improve early diagnosis of invasive aspergillosis in patients with hematological malignancies during intensive antineoplastic treatment, combined with imaging surveillance and serologic diagnostic tools. Further comparative validation of reliable assays in prospective multicenter studies is mandatory and urgently needed in order to establish a harmonization and standardization, so that 'gold standard assays' may be incorporated into diagnostic and therapeutic algorithms that improve the prognosis of patients with life-threatening infections caused by Aspergillus species.
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Affiliation(s)
- Dieter Buchheidt
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
| | - Mark Reinwald
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
| | - Wolf-Karsten Hofmann
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
| | - Tobias Boch
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
| | - Birgit Spiess
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
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Warris A, Lehrnbecher T. Progress in the Diagnosis of Invasive Fungal Disease in Children. CURRENT FUNGAL INFECTION REPORTS 2017; 11:35-44. [PMID: 28680525 PMCID: PMC5487864 DOI: 10.1007/s12281-017-0274-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the fungal diagnostic measures currently available for use in paediatric patients at high risk for developing invasive fungal disease (IFD) and those suspected of having an IFD. The clinical utility of each test is described based on reported performances of individual tests in specific paediatric populations. RECENT FINDINGS Available studies in the paediatric population are scarce and are characterized by a huge heterogeneity in underlying diseases (e.g. different risk for IFD), different study objectives and management strategies (screening versus diagnostic) used. SUMMARY A final valuation of paediatric studies on fungal diagnostic tools is limited. While the galactomannan and fungal PCR assays are useful to exclude the presence of IFD, it is unclear if mannan, mannan antibodies and β-D-glucan are of benefit due to a lack of studies or validation of the cut-off, respectively. Well-designed multicentre paediatric studies are urgently needed to improve the outcome of IFD.
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Affiliation(s)
- Adilia Warris
- Aberdeen Fungal Group, MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
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Prospective Biomarker Screening for Diagnosis of Invasive Aspergillosis in High-Risk Pediatric Patients. J Clin Microbiol 2016; 55:101-109. [PMID: 27795339 DOI: 10.1128/jcm.01682-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/12/2016] [Indexed: 11/20/2022] Open
Abstract
Combined biomarker screening is increasingly used to diagnose invasive aspergillosis (IA) in high-risk patients. In adults, the combination of galactomannan (GM) and fungal DNA detection has proven to be beneficial in the diagnosis of IA. Data in purely pediatric cohorts are scarce. Here, we monitored 39 children shortly before and after allogeneic stem cell transplantation twice weekly by use of a commercial GM enzyme-linked immunosorbent assay (ELISA) and a PCR assay based on amplification of the pan-Aspergillus ITS1/5.8S ribosomal operon. In addition, clinical data were recorded and classification of IA was performed according to the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria. Among the 39 high-risk children, we identified 4 patients (10.3%) with probable and 2 (5.1%) with possible IA. All patients with probable IA were repeatedly positive for both tests (means of 9.5 and 6.8 positive GM and PCR samples, respectively), whereas both possible IA cases were detected by PCR. The sensitivity and specificity were, respectively, 67% and 89% for GM and 100% and 63% for PCR. Positive and negative predictive values were, respectively, 50% and 100% for GM and 27% and 100% for PCR. For the combined testing approach, both values were 100%. The number of positive samples seemed to be lower in patients undergoing antifungal therapy. Sporadically positive tests occurred in 12% (GM) and 42% (PCR) of unclassified patients. In summary, our data show that combined monitoring for GM and fungal DNA also results in a high diagnostic accuracy in pediatric patients. Future studies have to determine whether combined testing is suitable for early detection of subclinical disease and how antifungal prophylaxis impacts assay performance.
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Du L, Xia Y, He Y, Pu Q, Hua R, Wu W. Development and evaluation of enzyme-linked immunosorbent assay of nucleic acid sequence-based amplification for diagnosis of invasive aspergillosis. AMB Express 2016; 6:91. [PMID: 27714704 PMCID: PMC5053951 DOI: 10.1186/s13568-016-0266-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
Invasive aspergillosis (IA) is a life-threatening infection in immunocompromised patients, rapid and sensitive detection of Aspergillus from clinical samples has been a major challenge in the early diagnosis of IA. An enzyme-linked immunosorbent assay of nucleic acid sequence-based amplification (NASBA-ELISA) was developed to fulfil the need for the efficient diagnosis of these infections. The primers targeting 18S rRNA were selected for the amplification of Aspergillus RNA by the isothermal digoxigenin (DIG)-labeling NASBA process. The DIG-labeled RNA amplicons were hybridized with a specific biotinylated DNA probe immobilized on streptavidin-coated microtiter plate. The hybrids were colorimetrically detected by the addition of an anti-DIG antibodies linked to ALP and substrate (disodium 4-nitrophenyl phosphate). The detection limit of the Aspergillus NABSA-ELISA system was 1 CFU and the RNA in non-target bacteria or fungus was not amplified. The performance of this NASBA-ELISA compared to RT-PCR and galactomannan (GM) was evaluated by testing blood samples from 86 patients at high risk for IA. The sensitivity of NASBA-ELISA, RT-PCR and GM-ELISA was 80.56 % (95 % CI 63.98-91.81), 72.22 % (95 % CI 54.81-85.80), 58.33 % (95 % CI 40.76-74.49), respectively, and the specificity was 80.00 % (95 % CI 66.28-89.97), 84.00 % (95 % CI 70.89-92.83), 82.00 % (95 % CI 68.56-91.42). The efficiency of the three methods in various combinations was also evaluated. Combination of NASBA-ELISA and GM-ELISA testing achieved perfect specificity (100 %; 95 % CI 92.89-100) and perfect positive predictive value (100 %; 95 % CI 83.16-100). The best sensitivity (97.22 %; 95 % CI 85.47-99.93) and the highest Youden index (0.652) were obtained by testing with both NASBA and RT-PCR in parallel. In conclusion, the NASBA-ELISA assay consists of an alternative process for large-scale samples detection with semi-quantitative results and provides good clinical performance without resorting to expensive equipment. This assay makes it possible for the NASBA based RNA diagnosis to become a routine work in laboratories in less developed countries with fewer resources.
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40
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Gupta P, Ahmad A, Khare V, Kumar A, Banerjee G, Verma N, Singh M. Comparative evaluation of pan-fungal real-time PCR, galactomannan and (1-3)-β-D-glucan assay for invasive fungal infection in paediatric cancer patients. Mycoses 2016; 60:234-240. [DOI: 10.1111/myc.12584] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/01/2016] [Accepted: 10/20/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Prashant Gupta
- Department of Microbiology; King George's Medical University; Lucknow India
| | - Abrar Ahmad
- Department of Microbiology; King George's Medical University; Lucknow India
| | - Vineeta Khare
- Department of Microbiology; Era's Lucknow Medical College; Lucknow India
| | - Archana Kumar
- Department of Pediatrics; King George's Medical University; Lucknow India
| | - Gopa Banerjee
- Department of Microbiology; King George's Medical University; Lucknow India
| | - Nitya Verma
- Department of Otorhinolaryngology; King George's Medical University; Lucknow India
| | - Mastan Singh
- Department of Microbiology; King George's Medical University; Lucknow India
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Sulik-Tyszka B, Figiel W, Krawczyk M, Wróblewska M. Invasive Aspergillosis of the Stomach and Co-infection With Candida krusei in a Patient With Terminal Liver Failure: A Case Report. Transplant Proc 2016; 48:3149-3152. [DOI: 10.1016/j.transproceed.2016.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/26/2016] [Accepted: 06/06/2016] [Indexed: 10/20/2022]
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42
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Jonaitytė B, Kibarskytė R, Danila E, Miglinas M, Šeinin D, Stulpinas R, Mitrikevičienė J, Gruslys V, Šileikienė V, Zablockis R. Fatal pulmonary complication during induction therapy in a patient with ANCA-associated vasculitis. Acta Med Litu 2016; 23:142-146. [PMID: 28356801 PMCID: PMC5088747 DOI: 10.6001/actamedica.v23i2.3331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ANCA-associated vasculitis (AAV) is an inflammatory systemic disorder affecting small to medium sized vessels and likely leading to any organ dysfunction. Adequate treatment is important to avoid mortality or severe organ damage. In most cases initial treatment (induction therapy) allows to achieve remission. Induction therapy leads to immunosuppression and may cause severe infections. However, in vasculitis patients even an intensive immunosuppressive therapy is rarely complicated by an invasive fungal infection. We present a case in a 29-year old male patient with newly diagnosed AAV. He suffered a fatal pulmonary complication of the induction immunosuppressive treatment. Pathological (infectious) changes in the lungs were misinterpreted as progression of the vasculitis and he died due to disseminated angioinvasive aspergillosis. A clinical course, imaging and histopathology of this case are described and discussed.
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Affiliation(s)
| | - Rūta Kibarskytė
- Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Edvardas Danila
- Clinic of Infectious and Chest Diseases, Dermatovenereology and Allergology of Vilnius University.,Center of Pulmonology and Allergology of Vilnius University Hospital Santariškių Klinikos
| | - Marius Miglinas
- Faculty of Medicine of Vilnius University, Vilnius, Lithuania.,Nephrology Center of Vilnius University Hospital Santariškių Klinikos
| | - Dmitrij Šeinin
- National Center of Pathology, Affiliate of Vilnius University Hospital Santariškių Klinikos (Santariskiu Clinics)
| | - Rokas Stulpinas
- National Center of Pathology, Affiliate of Vilnius University Hospital Santariškių Klinikos (Santariskiu Clinics)
| | - Jurgita Mitrikevičienė
- Faculty of Medicine of Vilnius University, Vilnius, Lithuania.,Nephrology Center of Vilnius University Hospital Santariškių Klinikos
| | - Vygantas Gruslys
- Clinic of Infectious and Chest Diseases, Dermatovenereology and Allergology of Vilnius University.,Center of Pulmonology and Allergology of Vilnius University Hospital Santariškių Klinikos
| | - Virginija Šileikienė
- Clinic of Infectious and Chest Diseases, Dermatovenereology and Allergology of Vilnius University.,Center of Pulmonology and Allergology of Vilnius University Hospital Santariškių Klinikos
| | - Rolandas Zablockis
- Clinic of Infectious and Chest Diseases, Dermatovenereology and Allergology of Vilnius University.,Center of Pulmonology and Allergology of Vilnius University Hospital Santariškių Klinikos
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Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JAH, Bennett JE. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63:e1-e60. [PMID: 27365388 DOI: 10.1093/cid/ciw326] [Citation(s) in RCA: 1635] [Impact Index Per Article: 204.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Thomas F Patterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System
| | | | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, United Kingdom
| | - Jay A Fishman
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Vicki A Morrison
- Hennepin County Medical Center and University of Minnesota, Minneapolis
| | | | - Brahm H Segal
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and Roswell Park Cancer Institute, New York
| | | | | | - Thomas J Walsh
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | | | - John E Bennett
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
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44
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Chermetz M, Gobbo M, Rupel K, Ottaviani G, Tirelli G, Bussani R, Luzzati R, Di Lenarda R, Biasotto M. Combined Orofacial Aspergillosis and Mucormycosis: Fatal Complication of a Recurrent Paediatric Glioma-Case Report and Review of Literature. Mycopathologia 2016; 181:723-33. [PMID: 27350324 DOI: 10.1007/s11046-016-0021-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
Abstract
Mucormycosis and aspergillosis are two opportunistic fungal infections, which can evolve into life-threatening complications. They generally affect patients with relevant risk factors such as immunocompromisation or long-term use of antibiotics or corticosteroids. Treatment usually combines medical and surgical approaches, often including extended necrosectomies, although the prognosis of generalized fungal infections is very poor. In this paper, we present the case of a 17-year-old girl affected by combined aspergillosis and mucormycosis, following treatment of a recurrent glioma. The patient was hospitalized for a suspected cellulitis of the right hemi-face, involving frontal maxillary area and the upper airways and was immediately put on intravenous antibiotic therapies; after performing nasal septum and maxillary biopsies, concomitant mucormycosis and aspergillosis were diagnosed and antimycotic therapy with liposomal B-amphotericin was administered. After evaluation by the oral surgeon and otolaryngologist, surgical cranio-facial necrosectomy was suggested, but refused by the parents of the patient. The girl died only few days later, due to a respiratory arrest. Awareness of this pathology with prompt diagnosis and early treatment may improve the outcome of these infections and reduce the mortality.
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Affiliation(s)
- Maddalena Chermetz
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Margherita Gobbo
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Katia Rupel
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Giulia Ottaviani
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy
| | - Rossana Bussani
- UCO Pathological Anatomy and Histopathology Unit, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy
| | - Roberto Luzzati
- Infectious Diseases Unit, University Hospital, Trieste, Italy
| | - Roberto Di Lenarda
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Matteo Biasotto
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy.
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Shedding light on Aspergillus niger volatile exometabolome. Sci Rep 2016; 6:27441. [PMID: 27264696 PMCID: PMC4893740 DOI: 10.1038/srep27441] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/09/2016] [Indexed: 01/22/2023] Open
Abstract
An in-depth exploration of the headspace content of Aspergillus niger cultures was performed upon different growth conditions, using a methodology based on advanced multidimensional gas chromatography. This volatile fraction comprises 428 putatively identified compounds distributed over several chemical families, being the major ones hydrocarbons, alcohols, esters, ketones and aldehydes. These metabolites may be related with different metabolic pathways, such as amino acid metabolism, biosynthesis and metabolism of fatty acids, degradation of aromatic compounds, mono and sesquiterpenoid synthesis and carotenoid cleavage. The A. niger molecular biomarkers pattern was established, comprising the 44 metabolites present in all studied conditions. This pattern was successfully used to distinguish A. niger from other fungi (Candida albicans and Penicillium chrysogenum) with 3 days of growth by using Partial Least Squares-Discriminant Analysis (PLS-DA). In addition, PLS-DA-Variable Importance in Projection was applied to highlight the metabolites playing major roles in fungi distinction; decreasing the initial dataset to only 16 metabolites. The data pre-processing time was substantially reduced, and an improvement of quality-of-fit value was achieved. This study goes a step further on A. niger metabolome construction and A. niger future detection may be proposed based on this molecular biomarkers pattern.
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46
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Sulik-Tyszka B, Kacprzyk P, Mądry K, Ziarkiewicz-Wróblewska B, Jędrzejczak W, Wróblewska M. Aspergillosis of the Heart and Lung and Review of Published Reports on Fungal Endocarditis. Mycopathologia 2016; 181:583-8. [PMID: 27245170 PMCID: PMC4937097 DOI: 10.1007/s11046-016-0012-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/25/2016] [Indexed: 11/30/2022]
Abstract
Invasive aspergillosis (IA) is increasingly diagnosed in high-risk patients. The lesions are usually located in the lungs and/or sinuses, and the fungus may spread haematogenously to different organs; however, involvement of the heart during IA is very rare. We describe a unique case of invasive aspergillosis of the heart septum and the lungs in the allogeneic haematopoietic stem cell transplant recipient.
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Affiliation(s)
- Beata Sulik-Tyszka
- Department of Microbiology, Public Central Teaching Hospital in Warsaw, Warsaw, Poland
| | - Piotr Kacprzyk
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Mądry
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Wiesław Jędrzejczak
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marta Wróblewska
- Department of Microbiology, Public Central Teaching Hospital in Warsaw, Warsaw, Poland. .,Department of Dental Microbiology, Medical University of Warsaw, 1a Banacha Street, 02-097, Warsaw, Poland.
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Mirhendi H, Zarei F, Motamedi M, Nouripour-Sisakht S. Aspergillus tubingensis and Aspergillus niger as the dominant black Aspergillus, use of simple PCR-RFLP for preliminary differentiation. J Mycol Med 2016; 26:9-16. [PMID: 26852194 DOI: 10.1016/j.mycmed.2015.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 12/20/2022]
Abstract
This work aimed to identify the species distribution of common clinical and environmental isolates of black Aspergilli based on simple restriction fragment length polymorphism (RFLP) analysis of the β-tubulin gene. A total of 149 clinical and environmental strains of black Aspergilli were collected and subjected to preliminary morphological examination. Total genomic DNAs were extracted, and PCR was performed to amplify part of the β-tubulin gene. At first, 52 randomly selected samples were species-delineated by sequence analysis. In order to distinguish the most common species, PCR amplicons of 117 black Aspergillus strains were identified by simple PCR-RFLP analysis using the enzyme TasI. Among 52 sequenced isolates, 28 were Aspergillus tubingensis, 21 Aspergillus niger, and the three remaining isolates included Aspergillus uvarum, Aspergillus awamori, and Aspergillus acidus. All 100 environmental and 17 BAL samples subjected to TasI-RFLP analysis of the β-tubulin gene, fell into two groups, consisting of about 59% (n=69) A. tubingensis and 41% (n=48) A. niger. Therefore, the method successfully and rapidly distinguished A. tubingensis and A. niger as the most common species among the clinical and environmental isolates. Although tardy, the Ehrlich test was also able to differentiate A. tubingensis and A. niger according to the yellow color reaction specific to A. niger. A. tubingensis and A. niger are the most common black Aspergillus in both clinical and environmental isolates in Iran. PCR-RFLP using TasI digestion of β-tubulin DNA enables rapid screening for these common species.
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Affiliation(s)
- H Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - F Zarei
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - M Motamedi
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - S Nouripour-Sisakht
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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48
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Chen H, Liu C, Chen D, Madrid K, Peng S, Dong X, Zhang M, Gu Y. Bacteria-Targeting Conjugates Based on Antimicrobial Peptide for Bacteria Diagnosis and Therapy. Mol Pharm 2015; 12:2505-16. [DOI: 10.1021/acs.molpharmaceut.5b00053] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Haiyan Chen
- Department of Biomedical Engineering, School of Engineering, State Key Laboratory of Natural Medicines, and ‡School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Gulou
District, Nanjing 210009, China
| | - Cuicui Liu
- Department of Biomedical Engineering, School of Engineering, State Key Laboratory of Natural Medicines, and ‡School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Gulou
District, Nanjing 210009, China
| | - Dan Chen
- Department of Biomedical Engineering, School of Engineering, State Key Laboratory of Natural Medicines, and ‡School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Gulou
District, Nanjing 210009, China
| | - Kyle Madrid
- Department of Chemistry, University of California, 900 University Avenue, Riverside, California 92521, United States
| | - Shuwen Peng
- Department of Biomedical Engineering, School of Engineering, State Key Laboratory of Natural Medicines, and ‡School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Gulou
District, Nanjing 210009, China
| | | | - Min Zhang
- Department of Biomedical Engineering, School of Engineering, State Key Laboratory of Natural Medicines, and ‡School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Gulou
District, Nanjing 210009, China
| | - Yueqing Gu
- Department of Biomedical Engineering, School of Engineering, State Key Laboratory of Natural Medicines, and ‡School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Gulou
District, Nanjing 210009, China
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49
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Lee KC, Tam EWT, Lo KC, Tsang AKL, Lau CCY, To KKW, Chan JFW, Lam CW, Yuen KY, Lau SKP, Woo PCY. Metabolomics Analysis Reveals Specific Novel Tetrapeptide and Potential Anti-Inflammatory Metabolites in Pathogenic Aspergillus species. Int J Mol Sci 2015; 16:13850-67. [PMID: 26090713 PMCID: PMC4490527 DOI: 10.3390/ijms160613850] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 05/19/2015] [Accepted: 06/03/2015] [Indexed: 01/02/2023] Open
Abstract
Infections related to Aspergillus species have emerged to become an important focus in infectious diseases, as a result of the increasing use of immunosuppressive agents and high fatality associated with invasive aspergillosis. However, laboratory diagnosis of Aspergillus infections remains difficult. In this study, by comparing the metabolomic profiles of the culture supernatants of 30 strains of six pathogenic Aspergillus species (A. fumigatus, A. flavus, A. niger, A. terreus, A. nomius and A. tamarii) and 31 strains of 10 non-Aspergillus fungi, eight compounds present in all strains of the six Aspergillus species but not in any strain of the non-Aspergillus fungi were observed. One of the eight compounds, Leu–Glu–Leu–Glu, is a novel tetrapeptide and represents the first linear tetrapeptide observed in Aspergillus species, which we propose to be named aspergitide. Two other closely related Aspergillus-specific compounds, hydroxy-(sulfooxy)benzoic acid and (sulfooxy)benzoic acid, may possess anti-inflammatory properties, as 2-(sulfooxy)benzoic acid possesses a structure similar to those of aspirin [2-(acetoxy)benzoic acid] and salicylic acid (2-hydroxybenzoic acid). Further studies to examine the potentials of these Aspergillus-specific compounds for laboratory diagnosis of aspergillosis are warranted and further experiments will reveal whether Leu–Glu–Leu–Glu, hydroxy-(sulfooxy)benzoic acid and (sulfooxy)benzoic acid are virulent factors of the pathogenic Aspergillus species.
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Affiliation(s)
- Kim-Chung Lee
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Emily W T Tam
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Ka-Ching Lo
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Alan K L Tsang
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Candy C Y Lau
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Kelvin K W To
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong.
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong.
- Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Jasper F W Chan
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong.
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong.
- Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Ching-Wan Lam
- Department of Pathology, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong.
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong.
- Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Susanna K P Lau
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong.
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong.
- Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Patrick C Y Woo
- Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong.
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong.
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong.
- Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong.
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50
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Genetic Analysis Using an Isogenic Mating Pair of Aspergillus fumigatus Identifies Azole Resistance Genes and Lack of MAT Locus's Role in Virulence. PLoS Pathog 2015; 11:e1004834. [PMID: 25909486 PMCID: PMC4409388 DOI: 10.1371/journal.ppat.1004834] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/25/2015] [Indexed: 11/20/2022] Open
Abstract
Invasive aspergillosis (IA) due to Aspergillus fumigatus is a major cause of mortality in immunocompromised patients. The discovery of highly fertile strains of A. fumigatus opened the possibility to merge classical and contemporary genetics to address key questions about this pathogen. The merger involves sexual recombination, selection of desired traits, and genomics to identify any associated loci. We constructed a highly fertile isogenic pair of A. fumigatus strains with opposite mating types and used them to investigate whether mating type is associated with virulence and to find the genetic loci involved in azole resistance. The pair was made isogenic by 9 successive backcross cycles of the foundational strain AFB62 (MAT1-1) with a highly fertile (MAT1-2) progeny. Genome sequencing showed that the F9MAT1-2 progeny was essentially identical to the AFB62. The survival curves of animals infected with either strain in three different animal models showed no significant difference, suggesting that virulence in A. fumigatus was not associated with mating type. We then employed a relatively inexpensive, yet highly powerful strategy to identify genomic loci associated with azole resistance. We used traditional in vitro drug selection accompanied by classical sexual crosses of azole-sensitive with resistant isogenic strains. The offspring were plated under varying drug concentrations and pools of resulting colonies were analyzed by whole genome sequencing. We found that variants in 5 genes contributed to azole resistance, including mutations in erg11A (cyp51A), as well as multi-drug transporters, erg25, and in HMG-CoA reductase. The results demonstrated that with minimal investment into the sequencing of three pools from a cross of interest, the variation(s) that contribute any phenotype can be identified with nucleotide resolution. This approach can be applied to multiple areas of interest in A. fumigatus or other heterothallic pathogens, especially for virulence associated traits. Invasive aspergillosis (IA) caused by Aspergillus fumigatus is increasing due to medical interventions that suppress the ability of patients’ immune systems to control infections. These invasive lung infections are difficult to diagnose and consequently treatment is frequently not started promptly. Some controversy surrounds the role of mating type in virulence of A. fumigatus and the emergence of azole resistant strains has posed difficult challenges for clinical management of IA. We generated nearly identical A. fumigatus strains with opposite mating types that allowed us to test whether different mating types have different virulence profiles. We found no difference in virulence in three different animal models, which suggests that mating type does not influence virulence. We also took advantage of the essentially identical genomes of both strains to apply classical genetic approaches combined with genomics technologies to identify A. fumigatus genes that contribute to azole resistance. We performed genetic crosses of azole sensitive with azole resistant strains and analyzed the resistance status and genome composition of the offspring. Using this approach we cataloged several genes that were not previously associated with azole resistance. This information will be valuable for finding ways to manage azole resistance in IA patients.
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