Aspergillus monitoring project in a large educational hospital using molecular assay

Clinicomycological Study of the Spectrum of Pulmonary Aspergillosis at a Tertiary Care Hospital in Central India

Knowing the spectrum, prevalence, and modes of diagnosis of pulmonary aspergillosis (PA) will be beneficial to clinicians for its early diagnosis and management. This study aims to estimate the prevalence, spectrum, and role of serological tests and radiological findings in the diagnosis of PA. A total of 150 patients were suspected of having PA after obtaining relevant clinical history and radiological imaging. The patients were grouped into each spectrum of PA as invasive PA (IPA), chronic necrotizing PA (CNPA), aspergilloma, allergic bronchopulmonary aspergillosis (ABPA) based on predisposing factors, clinical and radiological findings, and the guidelines of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG). Samples (bronchoalveolar lavage (BAL), sputum, blood) were collected from these patients and processed in a microbiology lab. BAL and sputum were subjected to microscopy by potassium hydroxide mount, calcofluor white mount, and culture. The serum was separated from blood by centrifugation and subjected to specific serological tests based on the spectrum of PA that the patient was suspected to have. For IPA, serum and BAL galactomannan antigen enzyme-linked immunosorbent assay (ELISA) was performed. For CNPA and aspergilloma, the anti-Aspergillus IgG antibody ELISA was performed. For ABPA, the tests performed were total immunoglobulin E (IgE) ELISA, Aspergillus fumigatus-specific IgE ELISA, and anti-Aspergillus immunoglobulin G (IgG) antibody ELISA. After compiling the clinical, radiological, culture, and serological findings, patients were diagnosed to have a particular spectrum of PA. The prevalence of IPA was 1.4%, CNPA was 4%, ABPA was 3.2%, and aspergilloma was 2.9%. CNPA was the predominant spectrum of PA in our study. Culture positivity for Aspergillus species was seen the highest in aspergilloma patients, followed by IPA, ABPA, and CNPA patients. A. fumigatus was the most common causative agent of PA, except for IPA for which Aspergillus flavus was the most common causative. Aspergillus niger and Aspergillus terreus were less the frequent causes of PA. A combination of radiological, microbiological, and serological tests along with clinical correlation is needed to confirm the diagnosis of PA.

Does Prolonged Exposure of Environmental Fungi to Ultraviolet Irradiation Change the Pattern of Drug Resistance?

Background: The pathogenic and opportunistic fungal species cause life-threatening infections in immunocompromised patients. The ultraviolet (UV) germicidal irradiation is a well-known method for inactivating a significant number of microorganisms and has wide application for sterilization. Objectives: This study aimed to investigate the effect of ultraviolet C (UV-C) irradiation on the antifungal susceptibility pattern of some filamentous fungi. Methods: The effect of UV-C on the antifungal susceptibility pattern of itraconazole, voriconazole, fluconazole, and amphotericin B against filamentous fungi was examined. Changes in the morphological features of resistant strains following UV-C irradiation were also evaluated using scanning electron microscopy. Results: The results revealed a significant decrease in the number of the surviving spores of strains with the prolongation of UV-C irradiation (0 - 10 to 20 min; P < 0.05). Concerning the morphology of resistant Aspergillus spp., the results of scanning electron microscopy showed a significant increase in the length of irradiated hyphae compared to the non-irradiated hyphae (P < 0.05). In addition, colony count showed a significant decrease (P < 0.05). The findings revealed that UV-C radiation exposure could alter the antifungal susceptibility pattern of Aspergillus spp., such as increasing the minimum inhibitory concentration. Conclusions: Aspergillus spp. can cause systemic infections among lab technicians exposed to different doses of radiation. Moreover, this increase in susceptibility pattern can directly affect the duration of treatment.