Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Parasitology and Mycology, Toulouse University Hospital, Paul Sabatier University, Toulouse, France.
Clin Infect Dis. 2021 Apr 26;72(8):1379-1385. doi: 10.1093/cid/ciaa230.
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.
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.
Clinical report forms were obtained for 90 patients, of whom 27 had proven/probable IA. An 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 antimold prophylaxis was present in 47% of cases. Pulmonary IA represented 67% of cases. Primary or secondary extrapulmonary sites of infection were observed in 46% of cases, with skin being affected in 28% of cases. Multiple antifungal drugs were used (consecutively or in combination) in 67% of 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.
Aspergillus ustus IA mainly occurred in nonneutropenic transplant patients and was frequently associated with extrapulmonary sites of infection. Mortality rate was high and optimal antifungal therapy remains to be defined.
节丛孢属 Usti 组（A. ustus）中的真菌是侵袭性曲霉病（IA）的罕见病因。本项多中心研究描述了 A. ustus 感染的流行病学和结局。
从 8 个国家的 22 家医院中，回顾性鉴定出从任何临床标本中分离出 A. ustus 的患者。当有条件时，对分离株进行种属鉴定（BenA/CaM 测序）和抗真菌药敏试验。通过文献复习确定了其他病例。根据国际标准，根据确诊/疑似 IA 或无感染进行病例分类。
共获得了 90 例患者的临床报告表，其中 27 例患有确诊/疑似 IA。通过文献复习还确定了另外 45 例病例，总共 72 例确诊/疑似 IA。造血细胞和实体器官移植受者分别占 47%和 33%的病例。诊断时仅有 8%的患者中性粒细胞减少。47%的病例中存在持续的抗真菌预防。67%的病例为肺部 IA。46%的病例有原发性或继发性肺外感染部位，28%的病例为皮肤受累。67%的病例使用了多种抗真菌药物（连续或联合使用）。24 周死亡率为 58%。A. calidoustus 是最常见的病原体。涵盖 90%分离株（MIC90）的最小抑菌浓度分别为 1、8、>16 和 4μg/mL，对应的药物分别为两性霉素 B、伏立康唑、泊沙康唑和伊曲康唑。
A. ustus 所致的侵袭性曲霉病主要发生于非中性粒细胞减少的移植患者，且常与肺外感染部位有关。死亡率较高，最佳抗真菌治疗仍有待确定。
