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Yerbanga IW, Nakanabo Diallo S, Rouamba T, Resendiz-Sharpe A, Lagrou K, Denis O, Rodriguez-Villalobos H, Montesinos I, Bamba S. Performances of disk diffusion method for determining triazole susceptibility of Aspergillus species: Systematic review. J Mycol Med 2023; 33:101413. [PMID: 37603962 DOI: 10.1016/j.mycmed.2023.101413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023]
Abstract
The therapeutic management of invasive aspergillosis should be guided by antifungal susceptibility testing (AFST). The disk diffusion (DD) method due to its simplicity and low cost could be an appropriate alternative to the reference methods (CLSI, EUCAST) which are not suitable for AFST in routine clinical microbiology laboratories, particularly in resource-constrained settings. This review summarizes the available data on the performance of the DD method in determining triazole susceptibility profile of Aspergillus species. The published articles on the performance of DD method for determining triazole susceptibility of Aspergillus spp. were systematically searched on major medical databases and Google Scholar. We identified 2725 articles of which 13 met the inclusion criteria. The overall average agreement value obtained between DD and CLSI broth microdilution (CLSI-BMD) methods for the itraconazole 10 µg disk (70.75%) was low especially when the medium used was not Mueller-Hinton (MH) agar. In contrast average agreement for the voriconazole 1 µg disk and the posaconazole 5 µg disk were > 94% regardless of media used. The correlation coefficient values between the DD and CLSI-BMD methods on MH agar were acceptable (≥ 0.71) for the itraconazole 10 µg disk and posaconazole 5 µg disk and good (≥ 0.80) for the voriconazole 1 and 10 µg disk. The reproducibility of the DD method regardless to the medium used was ≥ 82%. This systematic review shows that the disk diffusion method could be a real alternative for triazole antifungals susceptibility testing of Aspergillus spp.
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Affiliation(s)
- Isidore W Yerbanga
- Centre Hospitalier Universitaire Régional de Ouahigouya, 01 BP 36 Ouahigouya 01, Burkina Faso; Université Nazi Boni, 01 BP 1091 Bobo-Dioulasso 01, Burkina Faso.
| | - Seydou Nakanabo Diallo
- Université Nazi Boni, 01 BP 1091 Bobo-Dioulasso 01, Burkina Faso; Centre Muraz/Institut National de Santé Publique, 01 BP 390 Bobo-Dioulasso 01, Burkina Faso
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, BP: 218 Ouaga 11, Ouagadougou, Burkina Faso
| | | | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine and National Reference Center for Mycosis, Excellence Center for Medical Mycology (ECMM), University Hospitals Leuven, Leuven, Belgium
| | - Olivier Denis
- Department of Microbiology, CHU Namur site-Godinne, Université Catholique de Louvain, Rue Dr Gaston Therasse 1, 5530 Yvoir, Belgium; Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Hector Rodriguez-Villalobos
- Department of Microbiology, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - Isabel Montesinos
- Department of Microbiology, CHU Namur site-Godinne, Université Catholique de Louvain, Rue Dr Gaston Therasse 1, 5530 Yvoir, Belgium
| | - Sanata Bamba
- Université Nazi Boni, 01 BP 1091 Bobo-Dioulasso 01, Burkina Faso; Centre Hospitalier Universitaire Sourô Sanou, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
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Vanhoffelen E, Resendiz-Sharpe A, Velde GV. Microcomputed Tomography to Visualize and Quantify Fungal Infection Burden and Inflammation in the Mouse Lung Over Time. Methods Mol Biol 2023; 2667:211-224. [PMID: 37145287 DOI: 10.1007/978-1-0716-3199-7_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Pulmonary mycoses are an important threat for immunocompromised patients, and although current treatments are effective, they suffer from multiple limitations and fail to further reduce mortality. With the increasing immunocompromised population and increased antifungal resistance, fungal infection research is more relevant than ever. In preclinical respiratory fungal infection research, animal models are indispensable. However, too often researchers still rely on endpoint measurements to assess fungal burden while the dynamics of disease progression are left undiscovered. To open up this "black box", microcomputed tomography (μCT) can be implemented to longitudinally visualize lung pathology in a noninvasive way and to quantify μCT-image derived biomarkers. That way, disease onset, progression, and responsiveness to treatment can be followed up with high resolution spatially and temporally in individual mice, increasing statistical power. Here, we describe a general method for the use of low-dose high-resolution μCT to longitudinally visualize and quantify lung pathology in mouse models of respiratory fungal infections, applied to mouse models of aspergillosis and cryptococcosis.
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Affiliation(s)
- Eliane Vanhoffelen
- KU Leuven Department of Imaging and Pathology, Biomedical MRI/MoSAIC, Leuven, Belgium
| | | | - Greetje Vande Velde
- KU Leuven Department of Imaging and Pathology, Biomedical MRI/MoSAIC, Leuven, Belgium.
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Resendiz-Sharpe A, Vanhoffelen E, Velde GV. Bioluminescence Imaging, a Powerful Tool to Assess Fungal Burden in Live Mouse Models of Infection. Methods Mol Biol 2023; 2667:197-210. [PMID: 37145286 DOI: 10.1007/978-1-0716-3199-7_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Aspergillus fumigatus and Cryptococcus neoformans species infections are two of the most common life-threatening fungal infections in the immunocompromised population. Acute invasive pulmonary aspergillosis (IPA) and meningeal cryptococcosis are the most severe forms affecting patients with elevated associated mortality rates despite current treatments. As many unanswered questions remain concerning these fungal infections, additional research is greatly needed not only in clinical scenarios but also under controlled preclinical experimental settings to increase our understanding concerning their virulence, host-pathogen interactions, infection development, and treatments. Preclinical animal models are powerful tools to gain more insight into some of these needs. However, assessment of disease severity and fungal burden in mouse models of infection are often limited to less sensitive, single-time, invasive, and variability-prone techniques such as colony-forming unit counting. These issues can be overcome by in vivo bioluminescence imaging (BLI). BLI is a noninvasive tool that provides longitudinal dynamic visual and quantitative information on the fungal burden from the onset of infection and potential dissemination to different organs throughout the development of disease in individual animals. Hereby, we describe an entire experimental pipeline from mouse infection to BLI acquisition and quantification, readily available to researchers to provide a noninvasive, longitudinal readout of fungal burden and dissemination throughout the course of infection development, which can be applied for preclinical studies into pathophysiology and treatment of IPA and cryptococcosis in vivo.
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Affiliation(s)
| | - Eliane Vanhoffelen
- KU Leuven, Department of Imaging and Pathology, Biomedical MRI / MoSAIC, Leuven, Belgium
| | - Greetje Vande Velde
- KU Leuven, Department of Imaging and Pathology, Biomedical MRI / MoSAIC, Leuven, Belgium.
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Amona MF, Oladele RO, Resendiz-Sharpe A, Denning DW, Kosmidis C, Lagrou K, Zhong H, Han L. Triazole resistance in Aspergillus fumigatus isolates in Africa: a systematic review. Med Mycol 2022; 60:6652216. [PMID: 35906879 DOI: 10.1093/mmy/myac059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Emergence of triazole resistance has been observed in Aspergillus fumigatus over the past decade including in Africa. This review summarizes the current published data on the epidemiology and reported mechanisms of triazole-resistant Aspergillus fumigatus (TRAF) in both environmental and clinical isolates from Africa. Searches on databases Medline, PubMed, HINARI, Science Direct, Scopus and Google Scholar on triazole resistance published between 2000 and 2021 from Africa were performed. Isolate source, antifungal susceptibility using internationally recognized methods, cyp51A mechanism of resistance and genotype were collected. Eleven published African studies were found that fitted the search criteria; these were subsequently analyzed. In total this constituted of 1686 environmental and 46 clinical samples. A TRAF prevalence of 17.1% (66/387) and 1,3% (5/387) was found in respectively environmental and clinical settings in African studies. Resistant to itraconazole, voriconazole, and posaconazole was documented. Most of the triazole-resistant isolates (30/71, 42.25%) were found to possess the TR34/L98H mutation in the cyp51A-gene; fewer with TR46/Y121F/T289A (n = 8), F46Y/M172V/E427K (n = 1), G54E (n = 13), and M172V (n = 1) mutations. African isolates with the TR34/L98H, TR46/Y121F/T289A and the G54E mutations were closely related and could be grouped in one of two clusters (cluster-B), whereas the cyp51A-M172V mutation clustered with most cyp51A- WT strains (cluster-A). A single case from Kenya shows that TR34/L98H from environmental and clinical isolates are closely related. Our findings highlight that triazole resistance in environmental and clinical A. fumigatus is a cause for concern in a number of African countries. There is need for epidemiological surveillance to determine the true burden of the problem in Africa.
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Affiliation(s)
- Modeste Fructueux Amona
- Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Republic of Congo.,Research Center and Study of Infectious and Tropical Pathologies, Oyo, Republic of Congo
| | - Rita Okeoghene Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Agustin Resendiz-Sharpe
- Department of Microbiology, Laboratory of Clinical Bacteriology and Mycology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Imaging and Pathology, Biomedical MRI, KU Leuven, Leuven, Belgium
| | - David W Denning
- Manchester Fungal Infection Group, the University of Manchester and Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chris Kosmidis
- National Aspergillosis Centre, Manchester University Foundation Trust, UK, and Manchester Academic Health Science Centre, the University of Manchester, Manchester, UK
| | - Katrien Lagrou
- Department of Microbiology, Laboratory of Clinical Bacteriology and Mycology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Hanying Zhong
- Department for Disinfection and Infection Control, Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Li Han
- Department for Disinfection and Infection Control, Chinese PLA Center for Disease Control and Prevention, Beijing, China
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Resendiz-Sharpe A, da Silva RP, Geib E, Vanderbeke L, Seldeslachts L, Hupko C, Brock M, Lagrou K, Vande Velde G. Longitudinal multimodal imaging-compatible mouse model of triazole-sensitive and -resistant invasive pulmonary aspergillosis. Dis Model Mech 2022; 15:274857. [PMID: 35352801 PMCID: PMC8990085 DOI: 10.1242/dmm.049165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/09/2022] [Indexed: 12/18/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) caused by the mold Aspergillus fumigatus is one of the most important life-threatening infections in immunocompromised patients. The alarming increase of isolates resistant to the first-line recommended antifungal therapy urges more insights into triazole-resistant A. fumigatus infections. In this study, we systematically optimized a longitudinal multimodal imaging-compatible neutropenic mouse model of IPA. Reproducible rates of pulmonary infection were achieved through immunosuppression (sustained neutropenia) with 150 mg/kg cyclophosphamide at day −4, −1 and 2, and an orotracheal inoculation route in both sexes. Furthermore, increased sensitivity of in vivo bioluminescence imaging for fungal burden detection, as early as the day after infection, was achieved by optimizing luciferin dosing and through engineering isogenic red-shifted bioluminescent A. fumigatus strains, one wild type and two triazole-resistant mutants. We successfully tested appropriate and inappropriate antifungal treatment scenarios in vivo with our optimized multimodal imaging strategy, according to the in vitro susceptibility of our luminescent fungal strains. Therefore, we provide novel essential mouse models with sensitive imaging tools for investigating IPA development and therapy in triazole-susceptible and triazole-resistant scenarios. Summary: A novel reproducible longitudinal multimodal imaging-compatible neutropenic mouse model of invasive pulmonary aspergillosis provides increased early fungal detection through novel red-shifted luciferase-expressing triazole-susceptible and -resistant Aspergillus fumigatus strains, and boosted bioluminescence.
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Affiliation(s)
- Agustin Resendiz-Sharpe
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, 3000 Leuven, Belgium
| | - Roberta Peres da Silva
- Fungal Biology Group, School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - Elena Geib
- Fungal Biology Group, School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - Lore Vanderbeke
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, 3000 Leuven, Belgium
| | - Laura Seldeslachts
- Department of Imaging and Pathology, Biomedical MRI unit/MoSAIC, KU Leuven, 3000 Leuven, Belgium
| | - Charlien Hupko
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, 3000 Leuven, Belgium
| | - Matthias Brock
- Fungal Biology Group, School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - Katrien Lagrou
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, 3000 Leuven, Belgium.,Department of Laboratory Medicine and National Reference Centre for Mycosis, Excellence Centre for Medical Mycology (ECMM), University Hospitals Leuven, 3000 Leuven, Belgium
| | - Greetje Vande Velde
- Department of Imaging and Pathology, Biomedical MRI unit/MoSAIC, KU Leuven, 3000 Leuven, Belgium
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Khalife S, Resendiz-Sharpe A, Lagrou K, Fréalle E. Molecular identification and azole susceptibility testing of Aspergillus section Fumigati isolated from soil samples in Lebanon. J Mycol Med 2021; 32:101242. [PMID: 35030518 DOI: 10.1016/j.mycmed.2021.101242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/27/2021] [Accepted: 12/24/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Sara Khalife
- Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Tripoli, Lebanon.
| | - Agustin Resendiz-Sharpe
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine and National Reference Center for Mycosis, Excellence Center for Medical Mycology (ECMM), University Hospitals Leuven, Leuven, Belgium
| | - Emilie Fréalle
- Center for Infection and Immunity of Lille, University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL, Lille F-59000, France; CHU Lille, Laboratoire de Parasitologie-Mycologie, Lille F-59000, France
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Resendiz-Sharpe A, Merckx R, Verweij PE, Maertens J, Lagrou K. Stable prevalence of triazole-resistance in Aspergillus fumigatus complex clinical isolates in a Belgian tertiary care center from 2016 to 2020. J Infect Chemother 2021; 27:1774-1778. [PMID: 34518094 DOI: 10.1016/j.jiac.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/06/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prevalence reports of triazole-resistance in Aspergillus fumigatus differ between countries and centers and may likewise vary over time. Continuous local surveillance programs to establish the evolving epidemiology of triazole-resistance in A. fumigatus are crucial to guide therapeutic recommendations. Here, we determined the prevalence of triazole-resistance in A. fumigatus complex culture-positive patients at the tertiary care center University Hospitals Leuven in Belgium in clinical isolates from 2016 to 2020. METHODS All A. fumigatus complex isolates cultured from UZ Leuven patients between 2016 and 2020 were screened for triazole-resistance. Confirmation of resistance to voriconazole, posaconazole and itraconazole was performed with the European Committee for Antimicrobial Susceptibility Testing (EUCAST) broth microdilution method. Mutations in the cyp51A gene in triazole-resistant isolates were determined by sequencing. Patients were classified as susceptible or resistant cases based on their isolate's susceptibility phenotype. RESULTS We screened 2494 A. fumigatus complex isolates from 1600 patients (320 ± 38 [SD] patients per year). The prevalence of triazole-resistance in patients was 8.3% (28/337), 6.7% (26/386), 7.0% (21/301), 7.1% (21/294) and 7.4% (21/282) in 2016, 2017, 2018, 2019 and 2020 respectively, with an overall triazole-resistance prevalence of 7.1% (85/1192; 95% CI 6.6-7.7%). The TR34/L98H mutation was the most prevalent (83.0%, 78/94) with most isolates displaying resistance to all triazole antifungals tested (94.8%, 74/78). CONCLUSION The prevalence of triazole-resistance in A. fumigatus has remained stable from 2016 to 2020 in our center ranging between 6.7 and 8.3%, with an overall five-year prevalence of 7.1%. The environmentally associated cyp51A gene mutations were most prevalent amongst triazole-resistant isolates and conferred resistance to all antifungals tested in 73% of the isolates.
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Affiliation(s)
| | - Rita Merckx
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands; Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
| | - Johan Maertens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine and National Reference Center for Mycosis, Excellence Center for Medical Mycology (ECMM), University Hospitals Leuven, Leuven, Belgium.
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Resendiz-Sharpe A, Dewaele K, Merckx R, Bustamante B, Vega-Gomez MC, Rolon M, Jacobs J, Verweij PE, Maertens J, Lagrou K. Triazole-Resistance in Environmental Aspergillus fumigatus in Latin American and African Countries. J Fungi (Basel) 2021; 7:jof7040292. [PMID: 33921497 PMCID: PMC8070258 DOI: 10.3390/jof7040292] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/10/2021] [Accepted: 04/10/2021] [Indexed: 01/10/2023] Open
Abstract
Triazole-resistance has been reported increasingly in Aspergillus fumigatus. An international expert team proposed to avoid triazole monotherapy for the initial treatment of invasive aspergillosis in regions with >10% environmental-resistance, but this prevalence is largely unknown for most American and African countries. Here, we screened 584 environmental samples (soil) from urban and rural locations in Mexico, Paraguay, and Peru in Latin America and Benin and Nigeria in Africa for triazole-resistant A. fumigatus. Samples were screened using triazole-containing agars and confirmed as triazole-resistant by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) broth dilution reference method. Isolates were further characterized by cyp51A sequencing and short-tandem repeat typing. Fungicide presence in samples was likewise determined. Among A. fumigatus positive samples, triazole-resistance was detected in 6.9% (7/102) of samples in Mexico, 8.3% (3/36) in Paraguay, 9.8% (6/61) in Peru, 2.2% (1/46) in Nigeria, and none in Benin. Cyp51A gene mutations were present in most of the triazole-resistant isolates (88%; 15/17). The environmentally-associated mutations TR34/L98H and TR46/Y121F/T289A were prevalent in Mexico and Peru, and isolates harboring these mutations were closely related. For the first time, triazole-resistant A. fumigatus was found in environmental samples in Mexico, Paraguay, Peru, and Nigeria with a prevalence of 7-10% in the Latin American countries. Our findings emphasize the need to establish triazole-resistance surveillance programs in these countries.
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Affiliation(s)
- Agustin Resendiz-Sharpe
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (R.M.); (J.J.); (J.M.)
| | - Klaas Dewaele
- Excellence Center for Medical Mycology (ECMM), Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Rita Merckx
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (R.M.); (J.J.); (J.M.)
| | - Beatriz Bustamante
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru;
| | - Maria Celeste Vega-Gomez
- Centro para el Desarrollo de la Investigación Científica, CEDIC, Asunción 1255, Paraguay; (M.C.V.-G.); (M.R.)
| | - Miriam Rolon
- Centro para el Desarrollo de la Investigación Científica, CEDIC, Asunción 1255, Paraguay; (M.C.V.-G.); (M.R.)
| | - Jan Jacobs
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (R.M.); (J.J.); (J.M.)
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerpen, Belgium
| | - Paul E. Verweij
- Radboud University Medical Center, Department of Medical Microbiology, 6500 HB Nijmegen, The Netherlands;
- Center of Expertise in Mycology Radboudumc/CWZ, 6500 HB Nijmegen, The Netherlands
| | - Johan Maertens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (R.M.); (J.J.); (J.M.)
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (R.M.); (J.J.); (J.M.)
- Excellence Center for Medical Mycology (ECMM), Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, 3000 Leuven, Belgium;
- Correspondence: ; Tel.: +32-016-34-70-98
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Resendiz-Sharpe A, Hokken MWJ, Mercier T, Merckx R, Verhagen K, Dewitte L, Melchers WJG, Verweij PE, Maertens J, Lagrou K. Hmg1 Gene Mutation Prevalence in Triazole-Resistant Aspergillus fumigatus Clinical Isolates. J Fungi (Basel) 2020; 6:jof6040227. [PMID: 33081232 PMCID: PMC7711918 DOI: 10.3390/jof6040227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/02/2020] [Accepted: 10/14/2020] [Indexed: 12/21/2022] Open
Abstract
Recently, mutations in the 3-hydroxy-3-methylglutaryl-coenzyme-A-reductase-encoding gene (hmg1), a gene involved in ergosterol production, were associated with triazole-resistance in Aspergillus fumigatus. In this study, we determined the prevalence and characteristics of hmg1 mutations in a collection of clinical triazole-resistant A. fumigatus isolates collected during 2001–2019 from two international mycology reference centers: the Belgian National Reference Center for Mycosis and the Center of Expertise in Mycology Radboudumc/CWZ. Clinical isolates with and without cyp51A gene mutations and randomly selected wild-type (WT) controls were included. Isolates were characterized by in vitro susceptibility testing, cyp51A and hmg1 sequencing, and short tandem repeat typing. Available clinical records were analyzed for previous triazole exposure. In 23 isolates (24%) of the 95 triazole-resistant A. fumigatus isolates, hmg1 gene mutations were observed; including 5/23 (22%) isolates without cyp51A gene mutations and 18/72 (25%) with cyp51A mutations. Four previously described hmg1 gene mutations (E105K, G307R/D, G466V, and S541G) and two novel mutations (W273S and L304P) were found; 4/23 (17%) in the sterol-sensing-domain region. No triazole-antifungal exposure was reported in 75% (9/12) of patients harboring an isolate with hmg1 gene mutations. Three of 39 WT isolates (8%) contained a hmg1 gene mutation; E105K (2-isolates) and S541G. Hmg1 gene mutations were predominantly found in A. fumigatus with cyp51A mutations with voriconazole MICs ≥ 8 mg/L.
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Affiliation(s)
- Agustin Resendiz-Sharpe
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (T.M.); (R.M.); (L.D.); (J.M.)
| | - Margriet W. J. Hokken
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Radboud Institute for Molecular Life Sciences, 6525 Nijmegen, The Netherlands; (M.W.J.H.); (K.V.); (W.J.G.M.); (P.E.V.)
| | - Toine Mercier
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (T.M.); (R.M.); (L.D.); (J.M.)
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Rita Merckx
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (T.M.); (R.M.); (L.D.); (J.M.)
| | - Kamiel Verhagen
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Radboud Institute for Molecular Life Sciences, 6525 Nijmegen, The Netherlands; (M.W.J.H.); (K.V.); (W.J.G.M.); (P.E.V.)
| | - Lisa Dewitte
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (T.M.); (R.M.); (L.D.); (J.M.)
| | - Willem J. G. Melchers
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Radboud Institute for Molecular Life Sciences, 6525 Nijmegen, The Netherlands; (M.W.J.H.); (K.V.); (W.J.G.M.); (P.E.V.)
- Center of Expertise in Mycology, Radboudumc/CWZ, 6525 Nijmegen, The Netherlands
| | - Paul E. Verweij
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Radboud Institute for Molecular Life Sciences, 6525 Nijmegen, The Netherlands; (M.W.J.H.); (K.V.); (W.J.G.M.); (P.E.V.)
- Center of Expertise in Mycology, Radboudumc/CWZ, 6525 Nijmegen, The Netherlands
| | - Johan Maertens
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (T.M.); (R.M.); (L.D.); (J.M.)
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, 3000 Leuven, Belgium; (A.R.-S.); (T.M.); (R.M.); (L.D.); (J.M.)
- Department of Laboratory Medicine and National Reference Center for Mycosis, Excellence Center for Medical Mycology (ECMM), University Hospitals Leuven, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-016-34-70-98
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10
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Resendiz-Sharpe A, Mercier T, Lestrade PPA, van der Beek MT, von dem Borne PA, Cornelissen JJ, De Kort E, Rijnders BJA, Schauwvlieghe AFAD, Verweij PE, Maertens J, Lagrou K. Prevalence of voriconazole-resistant invasive aspergillosis and its impact on mortality in haematology patients. J Antimicrob Chemother 2020; 74:2759-2766. [PMID: 31236587 DOI: 10.1093/jac/dkz258] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Increasing resistance of Aspergillus fumigatus to triazoles in high-risk populations is a concern. Its impact on mortality is not well understood, but rates from 50% to 100% have been reported. OBJECTIVES To determine the prevalence of voriconazole-resistant A. fumigatus invasive aspergillosis (IA) and its associated mortality in a large multicentre cohort of haematology patients with culture-positive IA. METHODS We performed a multicentre retrospective study, in which outcomes of culture-positive haematology patients with proven/probable IA were analysed. Patients were stratified based on the voriconazole susceptibility of their isolates (EUCAST broth microdilution test). Mycological and clinical data were compared, along with survival at 6 and 12 weeks. RESULTS We identified 129 A. fumigatus culture-positive proven or probable IA cases; 103 were voriconazole susceptible (79.8%) and 26 were voriconazole resistant (20.2%). All but one resistant case harboured environment-associated resistance mutations in the cyp51A gene: TR34/L98H (13 cases) and TR46/Y121F/T289A (12 cases). Triazole monotherapy was started in 75.0% (97/129) of patients. Mortality at 6 and 12 weeks was higher in voriconazole-resistant cases in all patients (42.3% versus 28.2%, P = 0.20; and 57.7% versus 36.9%, P = 0.064) and in non-ICU patients (36.4% versus 21.6%, P = 0.16; and 54.4% versus 30.7%; P = 0.035), compared with susceptible ones. ICU patient mortality at 6 and 12 weeks was very high regardless of triazole susceptibility (75.0% versus 66.7%, P = 0.99; and 75.0% versus 73.3%, P = 0.99). CONCLUSIONS A very high prevalence of voriconazole resistance among culture-positive IA haematology patients was observed. The overall mortality at 12 weeks was significantly higher in non-ICU patients with voriconazole-resistant IA compared with voriconazole-susceptible IA.
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Affiliation(s)
- Agustin Resendiz-Sharpe
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Toine Mercier
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Pieter P A Lestrade
- Department of Medical Microbiology, Viecuri Medical Centre, Venlo, The Netherlands
| | - Martha T van der Beek
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Peter A von dem Borne
- Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan J Cornelissen
- Department of Haematology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - Elizabeth De Kort
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bart J A Rijnders
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Alexander F A D Schauwvlieghe
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre of Expertise in Mycology, Radboud UMC/CWZ, Nijmegen, The Netherlands
| | - Johan Maertens
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine and National Reference Center for Mycosis, Excellence Centre for Medical Mycology (ECMM), University Hospitals Leuven, Leuven, Belgium
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11
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Bastos RW, Valero C, Silva LP, Schoen T, Drott M, Brauer V, Silva-Rocha R, Lind A, Steenwyk JL, Rokas A, Rodrigues F, Resendiz-Sharpe A, Lagrou K, Marcet-Houben M, Gabaldón T, McDonnell E, Reid I, Tsang A, Oakley BR, Loures FV, Almeida F, Huttenlocher A, Keller NP, Ries LNA, Goldman GH. Functional Characterization of Clinical Isolates of the Opportunistic Fungal Pathogen Aspergillus nidulans. mSphere 2020; 5:e00153-20. [PMID: 32269156 PMCID: PMC7142298 DOI: 10.1128/msphere.00153-20] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/06/2020] [Indexed: 02/08/2023] Open
Abstract
Aspergillus nidulans is an opportunistic fungal pathogen in patients with immunodeficiency, and virulence of A. nidulans isolates has mainly been studied in the context of chronic granulomatous disease (CGD), with characterization of clinical isolates obtained from non-CGD patients remaining elusive. This study therefore carried out a detailed biological characterization of two A. nidulans clinical isolates (CIs), obtained from a patient with breast carcinoma and pneumonia and from a patient with cystic fibrosis that underwent lung transplantation, and compared them to the reference, nonclinical FGSC A4 strain. Both CIs presented increased growth in comparison to that of the reference strain in the presence of physiologically relevant carbon sources. Metabolomic analyses showed that the three strains are metabolically very different from each other in these carbon sources. Furthermore, the CIs were highly susceptible to cell wall-perturbing agents but not to other physiologically relevant stresses. Genome analyses identified several frameshift variants in genes encoding cell wall integrity (CWI) signaling components. Significant differences in CWI signaling were confirmed by Western blotting among the three strains. In vivo virulence studies using several different models revealed that strain MO80069 had significantly higher virulence in hosts with impaired neutrophil function than the other strains. In summary, this study presents detailed biological characterization of two A. nidulanssensu stricto clinical isolates. Just as in Aspergillus fumigatus, strain heterogeneity exists in A. nidulans clinical strains that can define virulence traits. Further studies are required to fully characterize A. nidulans strain-specific virulence traits and pathogenicity.IMPORTANCE Immunocompromised patients are susceptible to infections with opportunistic filamentous fungi from the genus Aspergillus Although A. fumigatus is the main etiological agent of Aspergillus species-related infections, other species, such as A. nidulans, are prevalent in a condition-specific manner. A. nidulans is a predominant infective agent in patients suffering from chronic granulomatous disease (CGD). A. nidulans isolates have mainly been studied in the context of CGD although infection with A. nidulans also occurs in non-CGD patients. This study carried out a detailed biological characterization of two non-CGD A. nidulans clinical isolates and compared the results to those with a reference strain. Phenotypic, metabolomic, and genomic analyses highlight fundamental differences in carbon source utilization, stress responses, and maintenance of cell wall integrity among the strains. One clinical strain had increased virulence in models with impaired neutrophil function. Just as in A. fumigatus, strain heterogeneity exists in A. nidulans clinical strains that can define virulence traits.
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Affiliation(s)
- Rafael Wesley Bastos
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Clara Valero
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Lilian Pereira Silva
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Taylor Schoen
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Milton Drott
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Verônica Brauer
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Rafael Silva-Rocha
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Abigail Lind
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jacob L Steenwyk
- Department of Biological Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Antonis Rokas
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Biological Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Fernando Rodrigues
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- Life and Health Sciences Research Institute/3B's Associate Laboratory, Guimarães, Portugal
| | - Agustin Resendiz-Sharpe
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Marina Marcet-Houben
- Centre for Genomic Regulation, Barcelona, Spain
- Life Sciences Program, Barcelona Supercomputing Centre, Barcelona, Spain
- Mechanisms of Disease Program, Institute for Research in Biomedicine, Barcelona, Spain
| | - Toni Gabaldón
- Centre for Genomic Regulation, Barcelona, Spain
- Life Sciences Program, Barcelona Supercomputing Centre, Barcelona, Spain
- Mechanisms of Disease Program, Institute for Research in Biomedicine, Barcelona, Spain
- ICREA, Barcelona, Spain
| | - Erin McDonnell
- Centre for Structural and Functional Genomics, Concordia University, Montreal, Quebec, Canada
| | - Ian Reid
- Centre for Structural and Functional Genomics, Concordia University, Montreal, Quebec, Canada
| | - Adrian Tsang
- Centre for Structural and Functional Genomics, Concordia University, Montreal, Quebec, Canada
| | - Berl R Oakley
- Department of Molecular Biosciences, University of Kansas, Lawrence, Kansas, USA
| | - Flávio Vieira Loures
- Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, São José dos Campos, Brazil
| | - Fausto Almeida
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Anna Huttenlocher
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nancy P Keller
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Gustavo H Goldman
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
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