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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Microbiol. | doi: 10.3389/fmicb.2019.01677

The Emergence of rare clinical Aspergillus species in Qatar: molecular characterization and antifungal susceptibility profiles

 Husam Salah1*,  Michaela Lackner2,  Jos Houbraken3, Bart Theelen3,  Cornelia Lass-Flörl2*, Teun Boekhout3, Muna Almaslamani4 and  Saad J. Taj-Aldeen1
  • 1Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Qatar
  • 2Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Austria
  • 3Westerdijk Fungal Biodiversity Institute, Netherlands
  • 4Department of Medicine, Hamad Medical Corporation, Qatar

Aspergillus species are ubiquitous molds that infect immunocompetent and immunocompromised patients. The symptoms are diverse and range from allergic reactions, bronchopulmonary infection, and bronchitis, to invasive aspergillosis. The aim of this study was to characterize 70 Aspergillus isolates recovered from clinical specimens of patients with various clinical conditions presented at Hamad general hospital in Doha, Qatar by using molecular methods and to determine their in vitro antifungal susceptibility patterns using the Clinical and Laboratory Standards Institute (CLSI) M38-A2 reference method.
Fourteen Aspergillus species were identified by sequencing β-tubulin and calmodulin genes, including 10 rare and cryptic species not commonly recovered from human clinical specimens. Aspergillus welwitschiae is reported in this study for the first time from patients with fungal rhinosinusitis (n=6) and one patient with a lower respiratory infection. Moreover, Aspergillus pseudonomius is reported from a patient with fungal rhinosinusitis which is considered as the first report ever from clinical specimens. In addition, Aspergillus sublatus is reported for the first time from a patient with cystic fibrosis. In general, our Aspergillus strains exhibited low MIC values for most of the antifungal drugs tested. One strain of Aspergillus fumigatus showed high MECs for echinocandins and low MICs for the rest of the drugs tested. Another strain of A. fumigatus exhibited high MIC for itraconazole and categorized as non-wild type. These findings require further analysis of their molecular basis of resistance.
In conclusion, reliable identification of Aspergillus species is achieved by using molecular sequencing, especially for the emerging rare and cryptic species. They are mostly indistinguishable by conventional methods and might exhibit variable antifungal susceptibility profiles. Moreover, investigation of the antifungal susceptibility patterns is necessary for improved antifungal therapy against aspergillosis.

Keywords: Aspergillosis, Molecular idenlification, Qatar, Middle East, Antifungal susceplibility

Received: 09 May 2019; Accepted: 08 Jul 2019.

Edited by:

Hector Mora Montes, University of Guanajuato, Mexico

Reviewed by:

Orazio Romeo, University of Messina, Italy
Hamid Badali, Mazandaran University of Medical Sciences, Iran  

Copyright: © 2019 Salah, Lackner, Houbraken, Theelen, Lass-Flörl, Boekhout, Almaslamani and Taj-Aldeen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Mr. Husam Salah, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar, hosamo_2000@hotmail.com
Prof. Cornelia Lass-Flörl, Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, 6020, Tyrol, Austria, cornelia.lass-floerl@i-med.ac.at