Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, 215000, Jiangsu, People's Republic of China.
Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Sci Rep. 2021 Mar 24;11(1):6808. doi: 10.1038/s41598-021-86038-z.
Aspergillus species are emerging causative agents of non-dermatophyte mold onychomycosis. In this study, 48 Aspergillus isolates were obtained from patients with onychomycosis in Mashhad, Iran, during 2015-2018. The aim is to identify the Aspergillus isolates to the species level by using partial calmodulin and beta-tubulin gene sequencing and MALDI-TOF MS, and to evaluate their in vitro susceptibility to ten antifungal drugs: terbinafine, itraconazole, voriconazole, posaconazole, ravuconazole, isavuconazole, caspofungin, micafungin, anidulafungin and amphotericin B according to CLSI M38-A3. Our results indicate that A.flavus (n = 38, 79%) is the most common Aspergillus species causing onychomycosis in Mashhad, Iran. Other detected species were A. terreus (n = 3), A. tubingensis (n = 2), A. niger (n = 1), A. welwitschiae (n = 1), A. minisclerotigenes (n = 1), A. citrinoterreus (n = 1) and A. ochraceus (n = 1). Aspergillus flavus, A. terreus and A. niger isolates were correctly identified at the species level by MALDI-TOF MS, while all cryptic species were misidentified. In conclusion, A. flavus is the predominant Aspergillus species causing onychomycosis due to Aspergillus spp. in Mashhad, Iran. MALDI-TOF MS holds promise as a fast and accurate identification tool, particularly for common Aspergillus species. It is important that the current database of reference spectra, representing different Aspergillus species is expanded to increase the precision of the species-level identification. Terbinafine, posaconazole and echinocandins were in vitro most active against the studies Aspergillus isolates and terbinafine could be the first choice for treatment of onychomycosis due to Aspergillus.
曲霉菌种是引起非皮肤癣菌性甲真菌病的新兴病原体。本研究于 2015 年至 2018 年期间从伊朗马什哈德的甲真菌病患者中获得了 48 株曲霉菌株。目的是通过部分钙调蛋白和β-微管蛋白基因测序和 MALDI-TOF MS 将曲霉菌株鉴定到种水平，并根据 CLSI M38-A3 评估它们对十种抗真菌药物（特比萘芬、伊曲康唑、伏立康唑、泊沙康唑、拉夫康唑、伊曲康唑、卡泊芬净、米卡芬净、阿尼芬净和两性霉素 B）的体外敏感性。我们的结果表明，A.flavus（n=38，79%）是伊朗马什哈德引起甲真菌病最常见的曲霉菌种。其他检测到的种是 A.terreus（n=3）、A.tubingensis（n=2）、A.niger（n=1）、A.welwitschiae（n=1）、A.minisclerotigenes（n=1）、A.citrinoterreus（n=1）和 A.ochraceus（n=1）。MALDI-TOF MS 可正确鉴定 A.flavus、A.terreus 和 A.niger 分离株的种水平，而所有隐种均被误鉴定。总之，A.flavus 是导致伊朗马什哈德由于 Aspergillus spp.引起的甲真菌病的主要曲霉菌种。MALDI-TOF MS 有望成为一种快速准确的鉴定工具，特别是对于常见的曲霉菌种。重要的是，需要扩展当前的参考图谱数据库，以增加种水平鉴定的精度。特比萘芬、泊沙康唑和棘白菌素类对研究中的曲霉菌分离株最具体外活性，特比萘芬可能是治疗由于 Aspergillus 引起的甲真菌病的首选药物。
