Distribution of Aspergillus species and prevalence of azole resistance in clinical and environmental samples from a Spanish hospital during a three-year study period

BACKGROUND

Surveillance studies are crucial for updating trends in Aspergillus species and antifungal susceptibility information.

OBJECTIVES

Determine the Aspergillus species distribution and azole resistance prevalence during this 3-year prospective surveillance study in a Spanish hospital.

MATERIALS AND METHODS

Three hundred thirty-five Aspergillus spp. clinical and environmental isolates were collected during a 3-year study. All isolates were screened for azole resistance using an agar-based screening method and resistance was confirmed by EUCAST antifungal susceptibility testing. The azole resistance mechanism was confirmed by sequencing the cyp51A gene and its promoter. All Aspergillus fumigatus strains were genotyped using TRESPERG analysis.

RESULTS

Aspergillus fumigatus was the predominant species recovered with a total of 174 strains (51.94%). The rest of Aspergillus spp. were less frequent: Aspergillus niger (14.93%), Aspergillus terreus (9.55%), Aspergillus flavus (8.36%), Aspergillus nidulans (5.37%) and Aspergillus lentulus (3.28%), among other Aspergillus species (6.57%). TRESPERG analysis showed 99 different genotypes, with 72.73% of the strains being represented as a single genotype. Some genotypes were common among clinical and environmental A. fumigatus azole-susceptible strains, even when isolated months apart. We describe the occurrence of two azole-resistant A. fumigatus strains, one clinical and another environmental, that were genotypically different and did not share genotypes with any of the azole-susceptible strains.

CONCLUSIONS

Aspergillus fumigatus strains showed a very diverse population although several genotypes were shared among clinical and environmental strains. The isolation of azole-resistant strains from both settings suggest that an efficient analysis of clinical and environmental sources must be done to detect azole resistance in A. fumigatus.

Biocontrol of Rice Seed-Associated Fungal Pathogens Using Green Synthesis Approaches

Rice (Oryza sativa) is a major cereal crop that balances the food demand of the worldwide population. The crop quality drops daily due to their exposure to biotic and abiotic stresses, especially pathogens. It needs to be improved to maintain the consumption level to cope with increasing population demands for food. The current study was designed to analyze the comparison of the effects of green synthesis approaches on pathogens associated with rice seeds. In this study, essential oils were extracted from Cymbopogon citratus, Thymus vulgaris, and Origanum vulgaris medicinal plants and used as fungicides on fungal strains of Aspergillus spp. T. vulgaris effectively controlled the growth of Aspergillus niger, Aspergillus flavus, and Aspergillus terreus as compared with O. vulgaris and Cymbopogon. Further, silica nanoparticles (SiNPs) were synthesized from rice husk to evaluate their antifungal activities. SiNPs were characterized by ultraviolet-visible spectroscopy with a broad peak at 281.62 nm. Fourier-transform infrared spectroscopy spectrum confirms the presence of Si-H, Si-OH, and Si-O-Si bonds functional groups, and SiO4 tetrahedral coordination unit. X-ray diffraction pattern describes the crystalline structure with a sharp peak at 2θ = 22°. Scanning electron microscopy and energy-dispersive spectroscopy confirmed the spherical shape, size 70-115 nm, and elemental composition with pure silica contents. SiNPs showed no significant antifungal activity against Aspergillus strains. Moreover, Trichoderma was isolated from the rhizosphere of rice fields and showed a surprising antifungal effect against A. terreus, A. niger, and A. flavus. The current study successfully revealed environment-friendly and cost-effective green synthesizing approaches for analyzing biocontrol potential against rice seed-related Aspergillus spp. They will also help to improve pathogen control strategies in other cereals.

Fungal bioleaching of metals from WPCBs of mobile phones employing mixed Aspergillus spp.: Optimization and predictive modelling by RSM and AI models

In the present study, optimization and prediction models for fungal bioleaching for effective metal extraction from waste printed circuit boards (WPCBs) of mobile phones were developed employing central composite design (CCD) of response surface methodology (RSM), and two artificial intelligence (AI) models, i.e., artificial neural network (ANN) and, support vector machine (SVM), respectively. Two continuous process parameters, such as pH (4-9) and pulp density (1-10 g/L), and the bioleaching approaches, viz., one-step and two-step, were experimentally optimized for the extraction of targeted metals, i.e., Cu, Ni, and Zn from WPCBs by mixed cultures of Aspergillus niger and Aspergillus tubingensis. Datasets were then used for predictive modelling using AI tools. Results showed that the highest simultaneous bioleaching of Cu, Ni, and Zn, with an extraction efficacy of about 86%, 51%, and 100%, respectively, achieved at an optimal condition of pH 5.7 and pulp density of 3 g/L following the two-step bioleaching approach. Effective metal extraction in the two-step approach could be attributed to the abundant production of organic acids with a content of about 16.3 g/L, 8.4 g/L, and 0.5 g/L of citric acid, oxalic acid, and malic acid, respectively. Further, the predictive modelling revealed that the ANN model was found to predict the fungal bioleaching responses more accurately as compared to the SVM model with R2 values exceeding 0.96 for all targeted metals. This research demonstrates the applicability of the optimization and prediction models for efficient metal extraction from WPCBs using mixed Aspergillus spp. following the two-step approach.

Contaminated fungi in dried salted fishes: Isolation, identification, and their inhibition by chitooligosaccharide-gallic acid conjugate

Contaminated fungi on dried salted fish of three species including Talang queenfish (TQF, Scomberroides commersonianus), Hamilton's thryssa fish (HTF, Thryssa hamiltonii), and Cobia fish (CF, Rachycentron canadum) were isolated and identified. One hundred and sixty-nine isolates were obtained from TQF and HTF, respectively, while no fungi were detected in CF. The dominant genera were Aspergillus spp. (n = 79), Penicillium spp. (n = 60), and non-sporulating fungi (n = 30). The representative groups of Aspergillus spp. (n = 6) and Penicillium spp. (n = 3) based on different morphological characteristics were selected for species identification by molecular methods involving ITS1-5.8s-ITS2 region and Matrix-Assisted Laser Desorption/Ionization Time-of Flight Mass Spectrometer (MALDI-TOF MS) analysis. The nine isolates were identified to be Aspergillus versicolor (n = 2), Aspergillus montevidensis (n = 3), Penicillium citrinum (n = 3), and Aspergillus sp. (n = 1). The antifungal activity of chitooligosaccharide-gallic acid (COS-GAL) conjugate against A. versicolor F1/10M9, A. montevidensis F1/30M20, and P. citrinum F1/23M14 was examined. The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) values were in the range of 0.625-2.5 mg/mL and 1.25-10 mg/mL, respectively. COS-GAL conjugate at the concentration of 5 mg/mL completely inhibited the spore germination of A. versicolor F1/10M9 and P. citrinum F1/23M14 after 72 h of treatment. COS-GAL conjugate at 4 × MIC mainly affected the mycelium of A. versicolor F1/10M9 and P. citrinum F1/23M14 after treatment with COS-GAL conjugate for 3 days by coating mycelium surface and reducing the size of mycelium. Therefore, COS-GAL conjugate could be used as a food additive to inhibit or prevent the growth of fungi contaminated in dried salted fish or other relevant products. PRACTICAL APPLICATION: During processing, dried salted fish can be contaminated with fungi, which may cause food poisoning and food spoilage. The contaminated fungi are capable of producing mycotoxin that is harmful to consumers. Synthetic food preservatives have long been used to inhibit fungal growth, but the side effects to consumers are of concern. Chitooligosaccharide is a nontoxic chitosan derivative produced from shrimp shell and its conjugate namely chitooligosaccharide-gallic acid conjugate showed high efficacy in inhibiting the growth of fungi including Aspergillus spp. and Penicillium spp. Therefore, it can serve as a natural alternative preservative for the prevention of fungal growth in dried salted fish.

isolation in defining cases of COVID-19 Associated Pulmonary Aspergillosis - CAPA

COVID-19-Associated Pulmonary Aspergillosis (CAPA) is a relatively common complication in patients with severe forms of the disease caused by the SARS-CoV-2 virus. Diagnosing and confirming CAPA is challenging. In this study, Aspergillus spp. isolation in respiratory specimens from patients with COVID-19 was evaluated for identifying cases of CAPA. In 2020‒2021, 17 Aspergillus spp. were isolated from 15 COVID-19 patients admitted to a university hospital in Brazil. Patient records were retrospectively reviewed to obtain clinical-epidemiological data and other markers of Aspergillus spp. infection and then compared with the ECMM/ISHAM criteria for defining CAPA. Probable CAPA was defined in 5/10 patients, who had Aspergillus spp. isolated from Bronchoalveolar Lavage (BAL) or a positive galactomannan blood test. Additionally, anti-Aspergillus antibodies were detected in two of these patients, during active or follow-up phases of CAPA. In another seven patients with Aspergillus spp. isolated from tracheobronchial aspirate or sputum, CAPA was presumed, mainly due to deterioration of clinical conditions and new lung imaging suggestive of fungal infection. Antifungal agents to control CAPA, particularly voriconazole, were used in 9/15 cases. In cases of probable CAPA and remaining patients, clinical conditions and comorbidities were similar, with lethality being high, at 60% and 71%, respectively. The number of CAPA cases defined by scientific criteria was lower than that assumed in the clinical context. This was largely due to the lack of BAL collection for fungal culture and the non-intensive use of other markers of invasive aspergillosis. The isolation of Aspergillus spp. in different respiratory specimens should alert clinicians to the diagnosis of CAPA.

In vitro phytochemical analysis and antibacterial and antifungal efficacy assessment of ethanolic and aqueous extracts of Rumex nervosus leaves against selected bacteria and fungi

Background and Aim

Scientists are interested in identifying natural antibiotic substitutes that are effective against drug-resistant pathogenic microbes and spoilage fungi to counter pathogens and reduce the major public health problem of antibiotic residues in animal products. This study aimed to evaluate the antimicrobial activity of Rumex nervosus leaves (RNLs) as a medicinal herb against four bacterial and two fungal strains using absolute ethanol, 50% ethanol, and aqueous extracts.

Materials and Methods

The antimicrobial activities of various RNL extracts against selected microbes were evaluated using the disk diffusion antibiotic susceptibility test, minimum inhibitory concentrations (MICs), minimum bactericidal concentrations (MBCs), minimum fungicidal concentrations, and the poisoned food technique.

Results

The absolute ethanol RNL extract showed the best bacteriostatic/bactericidal activity against Salmonella Typhimurium, Escherichia coli, and Staphylococcus aureus (MIC/MBC: 0.20/0.40, 0.20/0.40, and 0.32/0.65 mg/mL, respectively). The diameter of the zone of inhibition was larger (p < 0.05) for the 100% ethanol RNL extract (8.17 mm) against Salmonella Typhimurium, the 50% ethanol-RNL extract (11.5 mm) against E. coli, and the aqueous RNL extract (14.0 mm) against S. aureus than for any other bacterial isolate. The aqueous RNL extract strongly (p < 0.0001) inhibited the mycelial growth of Aspergillus fumigatus (100%) and Aspergillus niger (81.4%) compared with the control.

Conclusion

The results of this study suggest that RNL is a promising new natural antimicrobial agent for food preservation. To date, most research on the antimicrobial properties of natural herbs has been conducted in vitro, with few exceptions in vivo and intervention-based research.

Fungal and bacterial oxylipins are signals for intra- and inter-cellular communication within plant disease

Lipids are central at various stages of host-pathogen interactions in determining virulence and modulating plant defense. Free fatty acids may act as substrates for oxidizing enzymes [e.g., lipoxygenases (LOXs) and dioxygenases (DOXs)] that synthesize oxylipins. Fatty acids and oxylipins function as modulators of several pathways in cell-to-cell communication; their structural similarity among plant, fungal, and bacterial taxa suggests potential in cross-kingdom communication. We provide a prospect of the known role of fatty acids and oxylipins in fungi and bacteria during plant-pathogen interactions. In the pathogens, oxylipin-mediated signaling pathways are crucial both in development and host infection. Here, we report on case studies suggesting that oxylipins derived from oleic, linoleic, and linolenic acids are crucial in modulating the pathogenic lifestyle in the host plant. Intriguingly, overlapping (fungi-plant/bacteria-plant) results suggest that different inter-kingdom pathosystems use similar lipid signals to reshape the lifestyle of the contenders and occasionally determine the outcome of the challenge.

Aspergillus fumigatus sternal osteomyelitis following cardiac surgery: Case report and literature review

BACKGROUND

Sternal osteomyelitis caused by Aspergillus spp is uncommon in cardiac surgery patients requiring sternotomy.

CASE PRESENTATION

We report a 77-year-old male with a history of poorly controlled diabetes who was diagnosed with Aspergillus sternal osteomyelitis, three months following an uneventful coronary artery bypass surgery. He underwent multiple debridement surgeries and was treated with voriconazole. Despite a complicated post-operative course, the patient responded well to voriconazole with clinical and biochemical evidence of remission. Unfortunately, he died of an unrelated cause due to decompensated heart failure.

DISCUSSION

Though uncommon, Aspergillus sternal osteomyelitis should be considered in the differential diagnosis of immunocompetent patients with post-operative sternal wound infections and negative bacterial tissue cultures. Management should include a combination of medical and surgical therapy.

Controlling the Microbial Composition during the Fermentation of Ishizuchi-kurocha

Ishizuchi-kurocha is a popular post-fermented tea in Japan. It is performed by domestic and natural fermentation relied on microorganisms derived from tea leaves or the environment of the manufacturing. Ishizuchi-kurocha undergoes aerobic fermentation of fungi first, then secondly fermented by anaerobic fermentation of lactic acid bacteria during natural fermentation processing. Aspergillus niger which produce mycotoxin is included in natural fermentation. This research aimed to build a novel fermentation method of Ishizuchi-kurocha by adding industrial koji fungi products and laboratory cultivated Lactobacillus plantarum (Lactiplantibacillus plantarum) artificially. Thus, safety and quality of tea products could be controlled simply. We found artificial fermentation of Ishizuchi-kurocha could get high lactic acid production within eight days. Final products only consisted of genus Aspergillus and genus Lactobacillus. while harmful Aspergillus niger was not found. However, artificial fermentation methods also decreased the content of polyphenols when compared with commercial tea.

L-asparaginase from Aspergillus oryzae spp.: effects of production process and biochemical parameters

L-asparaginases prevent the formation of acrylamide, a substance commonly found in foods subjected to heat and that also contains reducing sugars and L-asparagine. This work aimed to select a strain of Aspergillus spp. able to produce L-asparaginase and to optimize the fermentation parameters, the partial purification and biochemical characterization were also performed. The Aspergillus oryzae IOC 3999 was selected due to its greater enzymatic activity: 1443.57 U/mL of L-asparaginase after 48 h of fermentation. The optimized conditions allowed for an increase of 223% on the L-asparaginase production: 2.9% lactose, 2.9% L-asparagine and 0.7% hydrolyzed casein, 0.152% KH₂PO₄, 0.052% KCl and MgSO₄, 0.001% of CuNO₃.3H₂O, ZnSO₄.7H₂O and FeSO₄.7H₂O adjusted to pH 7.0; added a concentration of 5.05x10⁶ spores/mL at 30 °C for 100 rpm. A purification factor of 2.11 was found and the molecular mass was estimated at 20.8 kDa. The enzyme showed optimum activity at 60 °C and pH 5 and stability at 50 °C for 1 h. The enzyme presented desirable biochemical characteristics, mainly the acid pH stability, indicating that the enzyme would work well in food matrices due to the closeness of pH, meaning that it could be a potential option for use in the food industry.

Unusual case presentation of fungal ball infection causing diabetes insipidus and seizure disorder

Sphenoid sinus fungal ball (FB) is a noninvasive fungal infection affecting predominantly immunocompetent middle-aged female patients. Common clinical manifestations include headaches, postnasal drip, and nasal discharge. In this case report, we present a 56-year-old female with a 10-year history of occasional dizziness, vertigo, nystagmus, feeling disoriented and feeling her eyes moving rapidly. Complaints of restlessness, insomnia, anxiety, stress and anger were also present. Due to the nonspecific nature of her symptoms, a diagnosis of sphenoid sinus FB was overlooked. Definitive diagnosis was established after performing a nasal endoscopy and subsequent histopathological examination of the collected sinus tissues. The histopathology report disclosed Aspergillosis FB with chronic sinusitis. Due to the decade long delay in diagnosis and proper treatment, septal wall collapse occurred, with the patient developing diabetes insipidus with hyponatremia that led to a massive seizure and fall, resulting in multiple disc herniations. Surgical removal of the FA elicited a complete resolution of her symptoms and a full recovery.

Although fungal rhinosinusitis is a well recognized spectrum of diseases by ENT specialists, through this case report we hope to draw attention to this particular pathological entity within fungal infections, while simultaneously underlining the broad spectrum of symptoms with which it may manifest and the importance of including FA infections when considering the differential diagnosis in patients with long-standing chronic sinusitis.

Co-occurrence of mycotoxins, aflatoxin biosynthetic precursors, and Aspergillus metabolites in garlic (Allium sativum L) marketed in Zaria, Nigeria

Multi-mycotoxin analysis of 72 samples of garlic bulbs sold in Zaria markets was carried out using a liquid chromatography-mass spectrometry (LC-MS/MS) method. The results indicated the presence of seven major mycotoxins, including aflatoxin B1 (AFB₁), ochratoxin A (OTA), and the fumonisins B₁, B₂, B₃, B₄, and B₆, at different levels of contamination. AFB1 and OTA were detected in 1 of the 72 samples (1.4%) with median concentrations of 5.48 and 12.3 µg/kg, respectively. FB₁ and FB₂ were detected in 77% and 100% of the analysed samples, with median concentrations of 401 µg/kg and 491 µg/kg, respectively. The observed levels of AFB₁, OTA, FB₁, and FB₂ were above the EU maximum limit in herbal products. Sterigmatocystin (STC), an AFB₁ biosynthetic precursor, was present in all tested samples. The contamination level of mycotoxins and Aspergillus metabolites of marketed garlic in the study area is of public health concern.

Distribution of invasive fungal infections: Molecular epidemiology, etiology, clinical conditions, diagnosis and risk factors: A 3-year experience with 490 patients under intensive care

Recently, the prevalence of invasive fungal infections (IFIs) is rising. The global mortality rate of IFIs is 10-49%. This study aimed to determine the prevalence, the causative agents, and the risk factors associated with the invasive fungal infections in a tertiary health center to provide valid decision-grounds for healthcare professionals to effectively prevent, control, and treat fungal infections. The current study was conducted on 1477 patients suspected to have systemic fungal infections from different units of the hospital. After screening using routine mycological examination, the patients were confirmed with complementary mycological and molecular methods. Patients were included based on the confirmed diagnosis of IFI and excluded based on lack of a microbiologically and histologically proven diagnosis of IFI. Of the 1477 patients recruited in this study, confirmed cases of fungal infection were 490 (169 proven; 321 cases probable). Among the fungi recovered, Candida species had the highest frequency 337 (68.8%) followed by Aspergillus species 108 (22.1%), Zygomycetes species 21 (4.3%), non-Candida yeast 9 (1.8%). Others were black fungi 5 (1%), mycetoma agents 5 (1%), Fusarium 4 (0.8%), and Trichoderma (0.2%). Hematologic malignancies and diabetes mellitus were the most common underlying diseases among IFI-confirmed patients. This study observed an increased frequency of invasive candidiasis with non-albicans Candida and other invasive saprophytic fungal infections. The increased rate of invasive candidiasis with non-albicans agents highlights a new perspective in the epidemiology and treatment of invasive fungal infections.

Migratory birds as the potential source for the transmission of Aspergillus and other fungus to Bangladesh

Objectives

Migratory birds play a major role in the transmission of pathogens globally, but still their role in the transmission of fungi in Bangladesh is not known. The present study was carried out for the isolation and molecular detection of fungi including Aspergillus from migratory birds traveling to Bangladesh.

Materials and methods

A total of 50 fecal samples were collected from BaojaniBaor, Magura, and areas close to Jahangirnagar University, Savar. The isolation of fungus was based on culture on Potato Dextrose Agar (PDA), followed by staining, morphology, and molecular detection using polymerase chain reaction (PCR).

Results

Among 50 samples, 40 showed positive for fungal growth on PDA, of which 30 yield only yeast-like colonies, five only molds, and five yielded both yeast and molds. The isolated molds produced various pigmented colonies, namely, black, whitish, grayish, olive green, and yellow. Among 10 molds, six were confirmed as fungi by PCR using genus-specific primers such as ITS1 and ITS4. Later, of these six fungi, five were confirmed as Aspergillus by PCR with primers such as ASAP1 and ASAP2 specific for Aspergillus genus. Therefore, the overall occurrence of Aspergillus was 10% (5/50). PCR specific for Aspergillus fumigatus and Aspergillus niger failed to produce specific PCR amplicon, suggesting that the isolated Aspergillus belongs to other groups.

Conclusion

This is the first report describing the isolation and molecular detection of Aspergillus from fecal samples of migratory birds in Bangladesh. The present findings confirm that migratory birds are potential source for Aspergillus and other fungus in Bangladesh.

Educational Case: Chronic Pulmonary Aspergillosis

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.¹

Comparison of antifungal activity of essential oils from different plants against three fungi

The antifungal activity of plant essential oils (EOs) extracted by steam distillation from seven different species (Cinnamon, Anise, Clove, Citronella, Peppermint, Pepper, and Camphor) was investigated. Three common fungi were isolated from moldy wheat bread, which were identified as Aspergillus niger, A. oryzae, and A. ochraceus. The antifungal activity of anise, peppermint, clove, cinnamon, pepper, citronella, and camphor EOs from seven different spices was confirmed by agar diffusion assay against three fungi. Among all the EOs, the cinnamon EO showed the highest antifungal activity for all the fungi strains with the largest inhibition zone at the concentration of 800 mg/mL and lowest MIC ranging from 0.0625 to 0.125 mg/mL, followed by clove EO. The remaining EOs exerted moderate inhibitory effects. Further research indicated the substantial inhibitory activities of cinnamon and clove EOs on mycelial growth and spore germination in a dose-dependent manner. Further, the in vivo inhibitory activity of selected EOs on naturally infected bread demonstrated that cinnamon and clove EOs can as be used as natural antifungal agents.

The myriad challenges of respiratory fungal infection in cystic fibrosis

Fungal infection in cystic fibrosis (CF) is a recognized challenge, with many areas requiring further investigation. Consensus definitions exist for allergic bronchopulmonary aspergillus in CF, but the full scope of clinically relevant non-allergic fungal disease in CF-asymptomatic colonization, transient or chronic infection localized to endobronchial mucus plugs or airway tissue, and invasive disease-is yet to be clearly defined. Recent advances in mycological culture and non-culture identification have expanded the list of both potential pathogens and community commensals in the lower respiratory tract. Here we aim to outline the current understanding of fungal presence in the CF respiratory tract, risk factors for acquiring fungi, host-pathogen interactions that influence the role of fungi from bystander to pathogen, advances in the diagnostic approaches to isolating and identifying fungi in CF respiratory samples, challenges of classifying clinical phenotypes of CF patients with fungi, and current treatment approaches. Development and validation of biomarkers characteristic of different fungal clinical phenotypes, and controlled trials of antifungal agents in well-characterized target populations, remain central challenges to surmount and goals to be achieved.

Protease-based cross-linked enzyme aggregates with improved catalytic stability, silver removal, and dehairing potentials

Proteases have gained special research place due to their broader activity spectrum and applied perspectives for different industrial sectors. The present research focused on three aims, i.e., (1) to identify the best protease producer strain among three different Aspergillus strains, (2) the development of protease-based cross-linked enzyme aggregates (CLEAs) and (3) silver removal and dehairing potentialities of developed CLEAs. A. flavus gave optimum activity (98.50 U/mL) with the culture conditions (pH -7.5, 35 °C, inoculum 2.5 mL and fermentation time 48 h) by applying RSM under CCD. The protease-CLEAs were developed with recovery activity (37.45%) by optimizing conditions through RSM under CCD (80% ammonium sulfate, 65 mM glutaraldehyde, and 0.15 mM BSA). The adequacy of the model was checked by ANOVA, and the interactions among different variables were plotted using 3-D graphs. The characterization profile revealed high pH and thermal stability at pH -9 and 60 °C, respectively. The kinetic study revealed lower K_M and higher V_max values (31.02 μM and 91.16 U/mL, respectively) after CLEAs formation, as compared to the free protease (61.42 μM and 84.45 U/mL, respectively). By applying on X-ray film and animal hides, protease-CLEAs showed the best activity with minimum time as compared to free protease.

Aspergillus prevalence in air conditioning filters from vehicles: Taxis for patient transportation, forklifts, and personal vehicles

The frequency and importance of Aspergillus infections is increasing worldwide. This study aimed to assess the occupational exposure of forklifts and taxi drivers to Aspergillus spp. Nineteen filters from air conditioning system of taxis, 17 from forklifts and 37 from personal vehicles were assessed. Filters extract were streaked onto MEA, DG18 and in azole-supplemented media. Real-time quantitative PCR amplification of selected Aspergillus species-complex was also performed. Forklifts filter samples presented higher median values. Aspergillus section Nigri was the most observed in forklifts filters in MEA (28.2%) and in azole-supplemented media. DNA from Aspergillus sections Fumigati and Versicolores was successfully amplified by qPCR. This study enlightens the added value of using filters from the air conditioning system to assess Aspergillus spp. occupational exposure. Aspergillus azole resistance screening should be included in future occupational exposure assessments.

Clinical risk factors for invasive aspergillosis in lung transplant recipients: Results of an international cohort study

BACKGROUND

Invasive aspergillosis (IA) is a frequent complication in lung transplant recipients (LTRs). Clinical risk factors for IA have not been fully characterized, especially in the era of extensive anti-fungal prophylaxis. The primary objective of this study was to evaluate the clinical risk factors associated with IA in LTRs. The secondary objective was to assess the mortality in LTRs who had at least 1 episode of IA compared with LTRs who never had experienced IA.

METHODS

We conducted an international, multicenter, retrospective cohort study of 900 consecutive adults who received lung transplants between 2005 and 2008 with 4years of follow-up. Risk factors associated with IA were identified using univariate and multiple regression Cox proportional hazards models.

RESULTS

Anti-fungal prophylaxis was administered to 61.7% (555 of 900) of patients, and 79 patients developed 115 episodes of IA. The rate to development of the first episode was 29.6 per 1,000 person-years. Aspergillus fumigatus was the most common species isolated (63% [72 of 115 episodes]). Through multivariate analysis, significant risk factors identified for IA development were single lung transplant (hazard ratio, 1.84; 95% confidence interval, 1.09-3.10; p = 0.02,) and colonization with Aspergillus at 1 year post-transplantation (hazard ratio, 2.11; 95% confidence interval, 1.28-3.49; p = 0.003,). Cystic fibrosis, pre-transplant colonization with Aspergillus spp, and use of anti-fungal prophylaxis were not significantly associated with the development of IA. Time-dependent analysis showed IA was associated with higher mortality rates.

CONCLUSION

Incidence of IA remains high in LTRs. Single-lung transplant and airway colonization with Aspergillus spp. within 1 year post-transplant were significantly associated with IA.

Ultraviolet germicidal irradiation in tap water contaminated by Aspergillus spp

We investigated the effect of ultraviolet germicidal irradiation (UVI) from a low-pressure mercury lamp on several pathogenic Aspergillus spp. including A. flavipes, A. flavus, A. fumigatus, A. glaucus, A. nidulans, A. niger, A. terreus, A. ustus and A. versicolor suspended in tap water under laboratory-scale conditions. It was shown that within 10 s of exposure, time species such as A. glaucus, A. niudulans and A. ustus were completely inactivated, while 40 s were needed for the elimination of all the species tested. A. flavus and A. niger were found to be less susceptible than other species. Based on these results we conclude that UV disinfection could effectively inactivate Aspergillus spp. in tap water. Such disinfection could be used to reduce potential exposure of high-risk patients to fungal aerosols, particularly in hospital settings, where point-of-use (POU) UV light devices could be installed to provide safe water at a very low cost.

[Allergic bronchopulmonary aspergillosis in patients with asthma: Results of a prospective study]

AIM

To estimate the frequency of fungal sensitization and the incidence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients.

SUBJECTS AND METHODS

A total of 140 asthmatic patients were examined. They underwent allergologic (skin tests for fungal allergens, estimation of total and fungal allergen-specific IgE levels) and mycological (microscopy and inoculation of respiratory biosubstrates) examinations. Chest computed tomography, when indicated, was done. A group of patients with ABPA and that of patients with severe asthma and fungal sensitization were identified.

RESULTS

The frequency of fungal sensitization in asthmatic patients was 36%; the main allergenic fungi were Aspergillus and Alternaria. The incidence of ABPA was as high as 4% in the patients with asthma and 11% in those with severe asthma and fungal sensitization.

CONCLUSION

The given current diagnostic criteria will assist practitioners to identify ABPA, to prevent its progression, and to initiate specific anti-inflammatory and antifungal therapy in due time.

Raisins and Currants as Conventional Nutraceuticals in Italian Market: Natural Occurrence of Ochratoxin A

The healthy consumers make a strong pressure to natural products that can prevent the chronic diseases and improve the general health status, and therefore an important aspect that have to be considered is the safe level of the nutraceuticals. This study reports the occurrence of Ochratoxin A (OTA) and associated fungal contamination in 35 samples of dried vine fruits imported in the European community potentially used for the development of new nutraceutical supplements. High pressure liquid chromatography analysis identified 18 samples as contaminated by OTA with an average level of 2.6 μg/kg. OTA was measured in 4 samples of currants (mean value of 6.6 μg/kg) and 13 samples of raisins (mean value of 1.4 μg/kg). In one sample of currants and one of raisins from Turkey OTA exceeded the limits set by European Commission of 10 μg/kg, being contaminated with 12.61 and 15.99 μg/kg, respectively. All the positive samples were confirmed by Orbitrap Q Exactive through their molecular weight and the corresponding fragmentation. The worldwide consumption of dried vine fruits contributed to OTA exposure in several group of consumers. In particular, considering the potential nutraceutical approach, this consumption may be represent a severe risk for healthy consumers that consider these products like healthy and salutistic for their contents in antioxidants, flavonoids, and polyphenols. Data reported in this study confirmed the need to regularly monitor mycotoxin levels in these food products and optimize the process of fruits drying in order to reduce the development of toxigenic molds.

Successful long-term terbinafine therapy in an asthmatic patient with Aspergillus sensitization and bronchiectasis

Severe asthma with fungal sensitization (SAFS) is estimated to affect ~25% of patients with poorly controlled asthma. Tri-azole therapy is effective in only 60-80% and side effects are common. We report a 25 years-old woman with severe asthma, Aspergillus sensitization and marked bronchiectasis that developed a rare Achilles-tendinopathy with both itraconazole and voriconazole. She started a trial with terbinafine as salvage therapy that led to a striking improvement and long-term control of her respiratory disease.

Characterization of patients with chronic pulmonary aspergillosis according to the new ESCMID/ERS/ECMM and IDSA guidelines

Recently, the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) in cooperation with the European Respiratory Society (ERS) and the European Confederation of Medical Mycology (ECMM) published guidelines for the diagnosis of chronic pulmonary aspergillosis (CPA). Both guidelines, however, carry significant differences. We retrospectively applied the diagnostic recommendations on a patient cohort of 71 previously diagnosed CPA patients in order to compare both guidelines. In 50 patients (70%) the diagnosis was confirmed by the diagnostic criteria of both guidelines, while nine patients (13%) fulfilled neither the ESCMID/ERS/ECMM nor the IDSA criteria. Reasons were lack of mycological evidence in respiratory samples. These patients were not tested for the presence of Aspergillus-specific IgG antibodies, which is strongly recommended by both guidelines. Seven patients did not fulfil the diagnostic criteria of the IDSA guideline, because of severe immunosuppression, while five patients didn't fulfil the diagnostic criteria of the ESCMID/ERS/ECMM guideline, because of uncommon image findings. The comparison of both guidelines highlight that the combination of a chest CT scan with the performance of an Aspergillus-specific IgG antibody assay are key diagnostic features to establish a guideline-based diagnosis of CPA.

in children, adolescents and adults by Monte Carlo simulation

The objective of this study was to investigate the cumulative fraction of response of various voriconazole dosing regimens against six Candida and six Aspergillus spp. in immunocompromised children, immunocompromised adolescents, and adults. Using pharmacokinetic parameters and pharmacodynamic data, 5000-subject Monte Carlo simulations (MCSs) were conducted to evaluate the ability of simulated dosing strategies in terms of fAUC/MIC targets of voriconazole. According to the results of the MCSs, current voriconazole dosage regimens were all effective for children, adolescents and adults against Candida albicans, Candida parapsilosis and Candida orthopsilosis. For adults, dosing regimens of 4 mg/kg intravenous every 12 h (q12h) and 300 mg orally q12h were sufficient to treat fungal infections by six Candida spp. (C. albicans, C. parapsilosis, Candida tropicalis, Candida glabrata, Candida krusei and C. orthopsilosis) and five Aspergillus spp. (Aspergillus fumigatus, Aspergillus flavus, Aspergillus terreus, Aspergillus niger and Aspergillus nidulans). However, high doses should be recommended for children and adolescents in order to achieve better clinical efficacy against A. fumigatus and A. nidulans. The current voriconazole dosage regimens were all ineffective against A. niger for children and adolescents. All voriconazole dosage regimens were not optimal against Aspergillus versicolor. This is the first study to evaluate clinical therapy of various voriconazole dosing regimens against Candida and Aspergillus spp. infections in children, adolescents and adults using MCS. The pharmacokinetic/pharmacodynamic-based dosing strategy provided a theoretical rationale for identifying optimal voriconazole dosage regimens in children, adolescents and adults in order to maximise clinical response and minimise the probability of exposure-related toxicity.

An alternative host model of a mixed fungal infection by azole susceptible and resistant Aspergillus spp strains

Aspergillus fumigatus is the most common mold involved in human infections. However, the number of non-fumigatus species able to cause disease is continuously increasing. Among them, Aspergillus lentulus is reported in hematological and cystic fibrosis patients and in those treated with corticosteroids. A. lentulus differs from A. fumigatus in some clinically relevant aspects such as virulence and antifungal susceptibility, showing high MICs to most antifungals. Previous studies proved that A. lentulus was pathogenic in immunocompromised mice, although the course of the infection was delayed compared to A. fumigatus. These differences could explain why A. lentulus is mostly found in mixed infections with A. fumigatus challenging the diagnosis and treatment. We used the alternative model host Galleria mellonella to compare virulence, host interaction, fungal burden and antifungal response when larvae were infected with A. fumigatus or A. lentulus alone, and with a mixture of both species. A. lentulus was pathogenic in G. mellonella but infected larvae did not respond to therapeutic doses of voriconazole. We were able to simultaneously detect A. fumigatus and A. lentulus by a multiplex Nested Real Time PCR (MN-PCR). Comparative analysis of larvae histological sections showed melanization of both species but presented a different pattern of immune response by haemocytes. Analysis of fungal burden and histology showed that A. lentulus survived in the G. mellonella despite the antifungal treatment in single and mixed infections. We conclude that the simultaneous presence of antifungal susceptible and resistant Aspergillus species would likely complicate the management of these infections.

Detection of Aspergillus-specific antibodies by agar gel double immunodiffusion and IgG ELISA in feline upper respiratory tract aspergillosis

Feline upper respiratory tract aspergillosis (URTA) is an emerging infectious disease. The aims of this study were: (1) to assess the diagnostic value of detection of Aspergillus-specific antibodies using an agar gel double immunodiffusion (AGID) assay and an indirect immunoglobulin G (IgG) ELISA; and (2) to determine if an aspergillin derived from mycelia of Aspergillus fumigatus, Aspergillus niger and Aspergillus flavus can be used to detect serum antibodies against cryptic Aspergillus spp. in Aspergillus section Fumigati. Sera from cats with URTA (group 1: n = 21) and two control groups (group 2: cats with other upper respiratory tract diseases, n = 25; group 3: healthy cats and cats with non-respiratory, non-fungal illness, n = 84) were tested. Isolates from cats with URTA comprised A. fumigatus (n = 5), A. flavus (n = 1) and four cryptic species: Aspergillus felis (n = 12), Aspergillus thermomutatus (Neosartorya pseudofischeri, n = 1), Aspergillus lentulus (n = 1) and Aspergillus udagawae (n = 1). Brachycephalic purebred cats were significantly more likely to develop URTA than other breeds (P = 0.013). The sensitivity (Se) of the AGID was 43% and the specificity (Sp) was 100%. At a cut-off value of 6 ELISA units/mL, the Se of the IgG ELISA was 95.2% and the Sp was 92% and 92.9% for groups 2 and 3 cats, respectively. Aspergillus-specific antibodies against all four cryptic species were detected in one or both assays. Assay Se was not associated with species identity. Detection of Aspergillus-specific antibodies by IgG ELISA has high Se and Sp for diagnosis of feline URTA.

Frequency of fungal agents identified in sinus samples from patients with clinically suspected rhinosinusitis

Fungal rhinosinusitis (FRS) is one of the most important rhinosinusoidal disorders, which involves a variety of etiological agents. We carried out a study to determine the frequency of fungal agents in sinus samples from patients with clinically suspected rhinosinusitis (RS). A total of 205 clinical samples were assessed from 174 patients with clinically suspected RS, of which 48 were positive for microscopic examination and culture, 47 were positive for direct examination but negative by culture, 4 were negative for direct examination but positive by culture, and 106 were negative for both methodologies. The main fungal agents isolated were Aspergillus spp. (32.7%), followed by Schizophyllum commune (28.8%). Sensitivity and specificity of the direct examination were 92.3% and 69.3%, respectively, and concordance between the direct examination and culture was 48.4%. This study indicated that both Aspergillus and S. commune appear to be the most important agents involved in the development of FRS.

Current status of antifungal resistance and its impact on clinical practice

Mortality linked to invasive fungal diseases remains very high despite the availability of novel antifungals and new therapeutic strategies. Candida albicans and Aspergillus fumigatus account for most invasive mycosis produced by yeast or moulds, respectively. Other Candida non-albicans are increasingly being reported and newly emerging, as well as cryptic, filamentous fungi often cause disseminated infections in immunocompromised hosts. Management of invasive fungal infections is becoming a challenge as emerging fungal pathogens generally show poor response to many antifungals. The ability of reference antifungal susceptibility testing methods to detect emerging resistance patterns, together with the molecular characterization of antifungal resistance mechanisms, are providing useful information to optimize the effectiveness of antifungal therapy. The current status of antifungal resistance epidemiology with special emphasis on the molecular resistant mechanisms that have been described in the main pathogenic fungal species are reviewed.

The indoor air as a potential determinant of the frequency of invasive aspergillosis in the intensive care

Invasive aspergillosis (IA) seems to be an emerging condition in intensive care units (ICUs). However, little attention has been given to the role of environmental factors that could increase the risk for IA in the ICU. The objective of this study was to determine the concentration of airborne fungi in three Brazilian ICUs, in an attempt to correlate fungal burden with the frequency of Aspergillus spp isolation from clinical samples of patients hospitalised in these units. During a 1-year period we quantitatively evaluated the presence of fungi in the air of three ICUs in Porto Alegre, Brazil. The quantity of fungi was correlated with environmental factors. Only one of the ICUs studied showed equal concentrations of Aspergillus conidia in the indoor air, in comparison with the outdoor environment. All cases of Aspergillus colonisation and IA cases observed during the study occurred in that particular ICU. Environmental factors have a direct influence on fungal spore concentration in the air in ICUs, as well as air filtration systems in air conditioners. Fungal contamination of the indoor air may influence the frequency of AI in ICU patients.