Aspergillus spp. and other moulds in air way samples from Danish cystic fibrosis patients

K.L. Mortensen1, M. Skov2, H.K. Johansen2, T. Pressler2, M.C. Arendrup3

Author address: 

1Statens Serum Institut, COPENHAGEN, Denmark 2Copenhagen University Hospital, COPENHAGEN, Denmark


Objectives: A six months survey was conducted in a joined collaboration between the Cystic Fibrosis (CF) Centre Copenhagen, Department of Clinical Microbiology both at Rigshospitalet, Copenhagen and Mycology Unit at Statens Serum Institut in order to determine the incidence and susceptibility pattern of Aspergillus sp. from CF airway samples. CF airway samples received in July-December 2007 for routine microbiologic investigation were examined for growth of moulds following routine procedures with two to three days of incubation and an extended incubation with final examination day five. Methods: Identification of isolates was performed by macro- and micro-morphologic characteristics. Susceptibility testing following the EUCAST microbroth dilution method for azoles and e-test diffusion for amphotericin B was performed. Azole MICs were considered elevated if higher than 1 μg/ml for itraconazole and voriconazole and if higher than 0.25 μg/ml for posaconazole based on the recently described A. fumigatus wildtype MIC distributions.1 Repeated isolates obtained within 6 months were excluded. Results: We identified 294 mould isolates from 129 CF patients. Aspergillus sp. was isolated from 121 patients. Of the isolates 243 were A. fumigatus (81%), 15 A. flavus (5%), 15 A. terreus (5%), five A. niger and one A. nidulans. Thirteen patients had more than one Aspergillus sp. (10%) and five had Aspergillus sp. plus an other mould (4%). Of non- Aspergillus moulds we identified three each of Scedopsporium sp. and Penicillium sp., two each of Paecilomyces sp., Scopolariopsis sp. and Trichoderma sp., and one Acremonium sp. Two brown moulds were not identified. Susceptibility testing was performed on 142 isolates. Five isolates had itraconazole MIC > 1 μg/ml (three A. fumigatus, one A. niger, one A. terreus. Two of the A. fumigatus isolates both had elevated posaconazole MIC of >4 μg/ml and voriconazole MIC of > 4 and 2 μg/ml, respectively. Conclusion: As reported from other CF centres2 A. fumigatus was the most prevalent mould in this six months survey among Danish CF patients. Presence of more than one mould was not uncommon. Isolates with elevated azole MIC to one or more azoles were thus detected in 4 % of the isolates which were susceptibility tested and multi-azole resistant isolates were detected. References: 1. Rodriguez-Tudela JL, Alcazar-Fuoli L, Mellado E, Alastruey-Izquierdo A, Monzon A, Cuenca-Estrella M. Epidemiological cutoffs and cross-resistance to azole drugs in Aspergillus fumigatus. Antimicrob Agents Chemother 2008;52(7):2468-2472. 2. Bakare N, Rickerts V, Bargon J, Just-Nubling G. Prevalence of Aspergillus fumigatus and other fungal species in the sputum of adult patients with cystic fibrosis. Mycoses 2003;46(1-2):19-23.

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Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)