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临床实践中的烟曲霉相关菌种

Aspergillus fumigatus-Related Species in Clinical Practice.

作者信息

Lamoth Frédéric

机构信息

Infectious Diseases Service, Department of Medicine, and Institute of Microbiology, Lausanne University Hospital Lausanne, Switzerland.

出版信息

Front Microbiol. 2016 May 17;7:683. doi: 10.3389/fmicb.2016.00683. eCollection 2016.

Abstract

Aspergillus fumigatus is the main etiologic agent of invasive aspergillosis (IA). Other Aspergillus species belonging to the section Fumigati (A. fumigatus complex) may occasionally be the cause of IA. These strains are often misidentified, as they cannot be distinguished from A. fumigatus by conventional morphological analysis and sequencing methods. This lack of recognition may have important consequences as these A. fumigatus-related species often display some level of intrinsic resistance to azoles and other antifungal drugs. A. lentulus, A. udagawae, A. viridinutans, and A. thermomutatus (Neosartorya pseudofischeri) have been associated with refractory cases of IA. Microbiologists should be able to suspect the presence of these cryptic species behind a putative A. fumigatus isolate on the basis of some simple characteristics, such as defect in sporulation and/or unusual antifungal susceptibility profile. However, definitive species identification requires specific sequencing analyses of the beta-tubulin or calmodulin genes, which are not available in most laboratories. Multiplex PCR assays or matrix-assisted laser desorption ionization - time-of-flight mass spectrometry (MALDI-TOF MS) gave promising results for rapid and accurate distinction between A. fumigatus and other Aspergillus spp. of the section Fumigati in clinical practice. Improved diagnostic procedures and antifungal susceptibility testing may be helpful for the early detection and management of these particular IA cases.

摘要

烟曲霉是侵袭性曲霉病(IA)的主要病原体。烟曲霉属(烟曲霉复合体)中的其他曲霉物种偶尔也可能导致IA。这些菌株常常被误认,因为通过传统的形态学分析和测序方法无法将它们与烟曲霉区分开来。这种识别不足可能会产生重要后果,因为这些与烟曲霉相关的物种通常对唑类及其他抗真菌药物表现出一定程度的固有耐药性。勒图曲霉、udaagawae曲霉、绿褐曲霉和嗜热突变曲霉(假费氏新萨托菌)都与IA的难治性病例有关。微生物学家应能够根据一些简单特征,如孢子形成缺陷和/或异常的抗真菌药敏谱,怀疑在假定的烟曲霉分离株背后存在这些隐匿物种。然而,明确的物种鉴定需要对β-微管蛋白或钙调蛋白基因进行特定的测序分析,而大多数实验室都无法进行此项检测。多重PCR检测或基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)在临床实践中对于快速、准确地区分烟曲霉和烟曲霉属的其他曲霉物种给出了有前景的结果。改进的诊断程序和抗真菌药敏试验可能有助于这些特殊IA病例的早期检测和管理。

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