Title：Rare/Cryptic Aspergillus Species Infections and Importance of Antifungal Susceptibility Testing

标题：罕见/隐秘曲霉菌感染及抗真菌敏感性检测的重要性

Authors: Tsang C. C., Tang J. Y. M., Ye H., et al.

Journal:Mycoses,

2020, 63(12): 1283-1298

Background/背景

The number of patients infected with Aspergillus rose dramatically in recent years. However, studies on the clinical spectrum and antifungal susceptibilities of non-classical (non-fumigatus, non-flavus, non-niger, and non-terreus) pathogenic Aspergillus species are very limited.

近年来，感染曲霉菌的患者数量显著增加。然而，对于非典型（非fumigatus、非flavus、非niger和非terreus）病原曲霉菌种的临床谱系和抗真菌药物敏感性研究非常有限。

Objectives/目标

We examined the clinical spectrum and antifungal susceptibilities of 34 non-duplicated, non-classical Aspergillus isolates collected from Hong Kong, Shenzhen, and Shanghai.

研究团队旨在检查从中国香港、深圳和上海收集的34种非重复、非典型曲霉菌分离株的临床谱系和抗真菌药物敏感性。

Methods/方法

The Aspergillus isolates were identified by internal transcribed spacer, partial BenA, and partial CaM sequencing and phylogenetic analyses. Susceptibility testing against eight antifungals was performed following the European Committee for Antimicrobial Susceptibility Testing's methodology.

通过内部转录间隔区（ITS）、部分BenA和部分CaM测序以及系统发育分析对曲霉菌分离株进行鉴定。根据欧洲抗微生物药物敏感性测试委员会的方法，对八种抗真菌药物进行了敏感性测试。

Results/结果

The 34 Aspergillus isolates were identified as 14 different rare/cryptic species of four sections (Flavi [n = 8], Nidulantes [n = 8], Nigri [n = 17], and Restricti [n = 1]). Except for one patient whose clinical history could not be retrieved, 72.7% of the remaining patients had underlying conditions predisposing them to Aspergillus infections. The most common diseases were pulmonary infections (n = 15), followed by skin/nail infections (n = 6), chronic otitis externa and/or media (n = 5), wound infections (n = 2), and mastoiditis/radiation necrosis (n = 1), with three cases of colonization. Five patients died during hospitalization due to the infection, and two others died within five years due to chronic pulmonary aspergillosis. Antifungal susceptibility testing showed that these isolates had different susceptibility profiles compared to classical Aspergillus species. Most isolates were susceptible or wild-type to amphotericin B. The minimum inhibitory concentrations for all three echinocandins were also low.

这些曲霉菌分离株被鉴定为四个部分中的14种不同的稀有/隐秘种类：Flavi（8种）、Nidulantes（8种）、Nigri（17种）和Restricti（1种）。在剩余的患者中，72.7%的患者具有易患曲霉菌感染的潜在条件。最常见的疾病是肺部感染（15例），其次是皮肤/指甲感染（6例），慢性外耳炎和/或中耳炎（5例），伤口感染（2例）和乳突炎/放射性坏死（1例），其中有三例为定植。入院期间有五名患者因感染而死亡，另有两名患者在五年后因慢性肺曲霉病去世。抗真菌药物敏感性测试显示，这些分离株与典型曲霉菌种相比具有不同的敏感性谱。大多数分离株对两性霉素B敏感或野生型。所有三种棘白菌素的最低有效浓度也很低。

Conclusion/结论

Susceptibility testing should be performed for infections due to these rare/cryptic Aspergillus species to guide proper patient management.

由于这些稀有/隐秘曲霉菌种的感染具有不同的药物敏感性谱，因此应该进行敏感性测试以指导患者的正确管理。

Relevant Compounds and CAS Numbers/相关化合物及CAS号

The following are the antifungal drugs mentioned in the article and their corresponding CAS numbers:

以下是文献中提到的几种抗真菌药物及其对应的CAS号：

1. Amphotericin B (两性霉素B) - CAS号: 1397-89-3

2. Voriconazole (伏立康唑) - CAS号: 137234-62-9

3. Itraconazole (伊曲康唑) - CAS号: 84625-61-6

4. Posaconazole (泊沙康唑) - CAS号: 171228-49-2

5. Caspofungin (卡泊芬净) - CAS号: 179463-17-3

6. Micafungin (米卡芬净) - CAS号: 235114-32-6

7. Anidulafungin (阿尼芬净) - CAS号: 166663-25-8

8. Fluconazole (氟康唑) - CAS号: 86386-73-4