Occurrences of cryptic Aspergillus species and Talaromycesmarneffei in severe chronic pulmonary aspergillosis patients from Indonesia: a case series

Author:

AR Rozaliyani1,2*, FS Setianingrum1,2, AA Abdullah1,2, SA Azahra1,3, AEF Fatril1, HR Rosianawati4, EB Burhan2,4, DH Handayani2,4, MT Tugiran1,2, RA Adawiyah1,2, RS Syam1,2, RW Wahyuningsih1,2,5, HW Wibowo1,2, CK Kosmidis6,7, DW Denning6,7

Author address:

1Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

2Indonesia Pulmonary Mycoses Centre, Jakarta, Indonesia

3Magister Program of Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

4Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

5Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia

6Manchester Academic Health Science Centre, Division of Infection, Immunity, University of Manchester, Manchester, United Kingdom

7Manchester Fungal Infection Group, University of Manchester, Manchester, United Kingdom

Full conference title:

10th Advances Against Aspergillosis and Mucormycosis

Date: 2 February 2022

Abstract:

Purpose:

Aspergillus andTalaromycesare two closely related genera with diverse important species potentially causing disease in human. Aspergillus fumigatus is the most common species known as the etiological cause of chronic pulmonary aspergillosis. Indonesia is included as the endemic area of Talaromycesmarneffei. However, studies on the clinical spectrum and molecular profiles of cryptic species of Aspergillus and T. marneffei are limited. This study’s aim was to describe the clinical and radiological features, and molecular profiles of fungi isolated from severe chronic pulmonary aspergillosis (CPA) patients.

 

Methods:

We reviewed the culture collection of CPA patients with positive T. marneffei cultures from Parasitology Department, Universitas Indonesia from 2018-2020. Demographic, clinical features and radiological data were assessed from medical records. The species identity of isolates was determined by combined analysis of morphology of the colonies (T. marneffei), and the sequencing of ITS and beta-tubulin genes (Aspergillus spp). The Aspergillus IgG were measured using point-of-care test (immunochromatography, LDBio, France).

 

Results:

In total, four cases of T.marneffei were identified, three of them mixed with cryptic Aspergillus species. Patient’s age ranged from 42 to 75 years; all males were included. All patients were admitted to hospital with severe symptoms. Three patients had acute or massive haemoptysis and one patient had dyspnea with oxygen desaturation. History of previous tuberculosis was present in all patients. One patient with history of multi drug resistant TB was admitted to the emergency room with severe anemia (Hb: 5g/dL). This patient showed positive culture from sputum (Aspergillus fumigatus, A. tubingensis, and T. marneffei). Another patient had an aspergilloma proven by chest CT and presented with acute haemoptysis and positive fungal culture (A. aculeatus and T. marneffei). Radiological deterioration was observed in this patient with massive pleural effusion. The morphology identification had previously identified the cryptic species as A. niger. The Aspergillus IgG antibody was positive in three patients (75%) including one patient with only Tmarneffei detected in the culture. Other chronic diseases in the patients were uncontrolled diabetes, chronic obstructive pulmonary disease, and hypertension.

 

Conclusion:

This study demonstrates the clinical importance of cryptic and endemic fungi in CPA cases. Molecular identification offers precise identification of fungi to species level. Further study is required to assess the susceptibility profile of cryptic Aspergillus and the significance of T. marneffei towards better diagnosis and management of lung mycoses cases in Indonesia.

Abstract Number: 12

Conference Year: 2022

Link to conference website: https://aaam2022.org/

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