Rare/Crypticaspergillusspecies Infections And Importance Of Antifungal Susceptibility Testing

Background The number of patients infected withAspergillusrose dramatically in recent years. However, studies on the clinical spectrum and antifungal susceptibilities of non-classical (non-fumigatus, non-flavus, non-nigerand non-terreus) pathogenicAspergillusspecies are very limited. Objectives We examined the clinical spectrum and antifungal susceptibilities of 34 non-duplicated, non-classicalAspergillusisolates collected from Hong Kong, Shenzhen and Shanghai. Methods TheAspergillusisolates were identified by internal transcribed spacer, partialBenAand partialCaMsequencing and phylogenetic analyses. Susceptibility testing against eight antifungals was performed following the European Committee for Antimicrobial Susceptibility Testing's methodology. Results The 34Aspergillusisolates were identified as 14 different rare/cryptic species of four sections (Flavi[n = 8],Nidulantes[n = 8],Nigri[n = 17] andRestricti[n = 1]). Except for one patient whose clinical history could not be retrieved, 72.7% of the remaining patients had underlying conditions predisposing them toAspergillusinfections. The most common diseases were pulmonary infections (n = 15), followed by skin/nail infections (n = 6), chronic otitis externa and/or media (n = 5), wound infections (n = 2) and mastoiditis/radionecrosis (n = 1), while three were colonisations. Five patients succumbed due to the infections during the admission, and another two died 5 years later because of chronic pulmonary aspergillosis. Antifungal susceptibility testing showed that they possessed different susceptibility profiles compared to the classicalAspergillusspecies. The majority of isolates characterised were sensitive or wild-type to amphotericin B. The minimum effective concentrations for all the three echinocandins were also low. Conclusion Susceptibility testing should be performed for infections due to these rare/crypticAspergillusspecies to guide proper patient management.