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Invasive aspergillosis due to Aspergillus section Usti: a multicenter retrospective study


Abstract

BACKGROUND

Aspergillus spp. of section Usti (A.ustus) represent a rare cause of invasive aspergillosis (IA). This multicenter study describes the epidemiology and outcome of A. ustus infections.

METHODS

Patients with A. ustus isolated from any clinical specimen were retrospectively identified in 22 hospitals from 8 countries. When available, isolates were sent for species identification (BenA/CaM sequencing) and antifungal susceptibility testing. Additional cases were identified by review of the literature. Cases were classified as proven/probable IA or no infection, according to standard international criteria.

RESULTS

Clinical report forms were obtained for 90 patients, of which 27 had proven/probable IA. Additional 45 cases were identified from literature review for a total of 72 cases of proven/probable IA. Hematopoietic cell and solid organ transplant recipients accounted for 47% and 33% cases, respectively. Only 8% patients were neutropenic at time of diagnosis. Ongoing anti-mold prophylaxis was present in 47% cases. Pulmonary IA represented 67% cases. Primary or secondary extra-pulmonary sites of infection were observed in 46% cases, with skin being affected in 28% cases. Multiple antifungal drugs were used (consecutively or in combination) in 67% cases. The 24-week mortality rate was 58%. A. calidoustus was the most frequent causal agent. Minimal inhibitory concentrations encompassing 90% isolates (MIC90) were 1, 8, >16 and 4 µg/mL for amphotericin B, voriconazole, posaconazole and isavuconazole, respectively.

CONCLUSIONS

Aspergillus ustus IA mainly occurred in non-neutropenic transplant patients and was frequently associated with extra-pulmonary sites of infection. Mortality rate was high and optimal antifungal therapy remains to be defined.

Abstract

BACKGROUND

Aspergillus spp. of section Usti (A.ustus) represent a rare cause of invasive aspergillosis (IA). This multicenter study describes the epidemiology and outcome of A. ustus infections.

METHODS

Patients with A. ustus isolated from any clinical specimen were retrospectively identified in 22 hospitals from 8 countries. When available, isolates were sent for species identification (BenA/CaM sequencing) and antifungal susceptibility testing. Additional cases were identified by review of the literature. Cases were classified as proven/probable IA or no infection, according to standard international criteria.

RESULTS

Clinical report forms were obtained for 90 patients, of which 27 had proven/probable IA. Additional 45 cases were identified from literature review for a total of 72 cases of proven/probable IA. Hematopoietic cell and solid organ transplant recipients accounted for 47% and 33% cases, respectively. Only 8% patients were neutropenic at time of diagnosis. Ongoing anti-mold prophylaxis was present in 47% cases. Pulmonary IA represented 67% cases. Primary or secondary extra-pulmonary sites of infection were observed in 46% cases, with skin being affected in 28% cases. Multiple antifungal drugs were used (consecutively or in combination) in 67% cases. The 24-week mortality rate was 58%. A. calidoustus was the most frequent causal agent. Minimal inhibitory concentrations encompassing 90% isolates (MIC90) were 1, 8, >16 and 4 µg/mL for amphotericin B, voriconazole, posaconazole and isavuconazole, respectively.

CONCLUSIONS

Aspergillus ustus IA mainly occurred in non-neutropenic transplant patients and was frequently associated with extra-pulmonary sites of infection. Mortality rate was high and optimal antifungal therapy remains to be defined.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Medical Microbiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:10 March 2020
Deposited On:27 Oct 2020 09:09
Last Modified:20 Jan 2021 07:09
Publisher:Oxford University Press
ISSN:1058-4838
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/cid/ciaa230
PubMed ID:32155262

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