Department of Infectious Diseases, Toranomon Hospitalgrid.410813.f, Tokyo, Japan.
Department of Hematology, Toranomon Hospitalgrid.410813.f, Tokyo, Japan.
Antimicrob Agents Chemother. 2022 Jan 18;66(1):e0163021. doi: 10.1128/AAC.01630-21. Epub 2021 Nov 15.
There are few reports on the clinical course of proven invasive aspergillosis (IA) due to rare/cryptic species in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. We retrospectively reviewed the electronic medical records of patients who underwent allo-HSCT between January 2012 and December 2018. Of 934 allo-HSCT recipients, 10 were diagnosed with proven IA and 61 were diagnosed with probable IA. DNA sequencing was performed in cases of proven IA, and Aspergillus could be identified to the species level in 8 of the 10 cases. Three were due to A. fumigatus, and 5 were due to rare/cryptic Aspergillus species, namely, , , A. viridinutans, A. nidulans, and A. calidoustus. In these 8 patients, no patients with IA due to A. fumigatus died, whereas 3 of the 5 with IA due to rare/cryptic species died within 12 weeks. The 2 surviving cases of IA due to rare/cryptic species were treated with surgical resection and antifungal treatment. Susceptibility testing for cryptic species in 4 cases showed an amphotericin B MIC > 1 mg/L in 3 cases, itraconazole MIC > 1 mg/L in 2 cases, and voriconazole MIC > 1 mg/L in 2 cases. In conclusion, more than half of the causative pathogens of proven IA were rare/cryptic species, so it is important to accurately identify the Aspergillus species. In addition, surgical treatment might be an important option in cases of proven IA, given the possibility that the causative organisms are azole-resistant A. fumigatus or rare/cryptic species.
在异基因造血干细胞移植（allo-HSCT）受者中，由于罕见/隐匿性物种导致的确诊侵袭性曲霉病（IA）的临床病程鲜有报道。我们回顾性分析了 2012 年 1 月至 2018 年 12 月期间接受 allo-HSCT 的患者的电子病历。在 934 例 allo-HSCT 受者中，10 例诊断为确诊 IA，61 例诊断为可能 IA。在确诊 IA 病例中进行 DNA 测序，在 10 例病例中可鉴定到 Aspergillus 物种水平，其中 3 例为 A. fumigatus，5 例为罕见/隐匿性曲霉属物种，分别为 、 、A. viridinutans、A. nidulans 和 A. calidoustus。在这 8 例患者中，没有因 A. fumigatus 导致 IA 的患者死亡，而因罕见/隐匿性物种导致 IA 的 5 例患者中有 3 例在 12 周内死亡。2 例因罕见/隐匿性物种导致的 IA 存活病例接受了手术切除和抗真菌治疗。4 例隐匿性物种的药敏试验显示，3 例两性霉素 B MIC＞1mg/L，2 例伊曲康唑 MIC＞1mg/L，2 例伏立康唑 MIC＞1mg/L。总之，超过一半的确诊 IA 的病原体为罕见/隐匿性物种，因此准确鉴定曲霉属物种非常重要。此外，鉴于致病生物可能为唑类耐药的 A. fumigatus 或罕见/隐匿性物种，手术治疗可能是确诊 IA 的重要选择。
