title: Epidemiology and outcome of infections due to Aspergillus terreus: 10-year single centre experience.
abstract: Aspergillus terreus, a less common pathogen, appears to be an emerging cause of infection at our institution, the Medical University Hospital of Innsbruck. Thus the epidemiology and outcome of A. terreus infections over the past 10 years was assessed. We analysed 67 cases of proven invasive aspergillosis (IA) according to the European Organisation for Research and Treatment of Cancer/Mycoses Study Group criteria, investigated antifungal susceptibility of amphotericin B (AMB), voriconazole and caspofungin and performed molecular typing of A. terreus. Patients with proven IA caused by A. terreus (n = 32) and non-A. terreus (n = 35) were evaluated. The two groups were comparable in terms of age, gender, underlying disease, antifungal prophylaxis and duration of neutropenia (P > 0.05). Leukaemia was the most common underlying malignancy. Fungal dissemination occurred in 63% of the patients. Aspergillus terreus infections were associated with a lower response rate to AMB therapy (20%), compared with 47% for patients with non-A. terreus infections (P < 0.05). In vitro, A. terreus was found to be resistant to AMB and molecular typing discriminated between patients isolates, showing a high strain diversity with 26 distinct types (I-XXVI) identified by combination of three primers. Aspergillus terreus infections displayed evidence of AMB resistance in vitro and in vivo and were associated with a high rate of dissemination and poor outcome; A. terreus causes systemic infections of endemic character in Tyrol, Austria. The onset of A. terreus infection depends not on the degree of immunosuppression but on environmental Aspergillus spp. exposure.
authors.affiliation: Department of Hygiene, Microbiology and Social Medicine, Medical University of Innsbruck, Innsbruck, Austria. cornelia.lass-floerl@uibk.ac.at
authors.forename: Cornelia
authors.initials: C
authors.lastname: Lass-Flörl
authors.forename: Katharina
authors.initials: K
authors.lastname: Griff
authors.forename: Astrid
authors.initials: A
authors.lastname: Mayr
authors.forename: Andreas
authors.initials: A
authors.lastname: Petzer
authors.forename: Günter
authors.initials: G
authors.lastname: Gastl
authors.forename: Hugo
authors.initials: H
authors.lastname: Bonatti
authors.forename: Martin
authors.initials: M
authors.lastname: Freund
authors.forename: Gabriele
authors.initials: G
authors.lastname: Kropshofer
authors.forename: Manfred P
authors.initials: MP
authors.lastname: Dierich
authors.forename: David
authors.initials: D
authors.lastname: Nachbaur
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology*; D001230:Aspergillus / Q000235:genetics; D001317:Austria; D000077336:Caspofungin; D025141:Drug Resistance, Fungal; D054714:Echinocandins; D005260:Female; D005800:Genes, Fungal; D019337:Hematologic Neoplasms / Q000382:microbiology; D006801:Humans; D055666:Lipopeptides; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology*; D016377:Organ Transplantation; D010456:Peptides, Cyclic / Q000627:therapeutic use; D015995:Prevalence; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole