title: Genetic diversity of Aspergillus species isolated from onychomycosis and Aspergillus hongkongensis sp. nov., with implications to antifungal susceptibility testing.
abstract: Thirteen Aspergillus isolates recovered from nails of 13 patients (fingernails, n=2; toenails, n=11) with onychomycosis were characterized. Twelve strains were identified by multilocus sequencing as Aspergillus spp. (Aspergillus sydowii [n=4], Aspergillus welwitschiae [n=3], Aspergillus terreus [n=2], Aspergillus flavus [n=1], Aspergillus tubingensis [n=1], and Aspergillus unguis [n=1]). Isolates of A. terreus, A. flavus, and A. unguis were also identifiable by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The 13th isolate (HKU49(T)) possessed unique morphological characteristics different from other Aspergillus spp. Molecular characterization also unambiguously showed that HKU49(T) was distinct from other Aspergillus spp. We propose the novel species Aspergillus hongkongensis to describe this previously unknown fungus. Antifungal susceptibility testing showed most Aspergillus isolates had low MICs against itraconazole and voriconazole, but all Aspergillus isolates had high MICs against fluconazole. A diverse spectrum of Aspergillus species is associated with onychomycosis. Itraconazole and voriconazole are probably better drug options for Aspergillus onychomycosis.
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong.
authors.forename: Chi-Ching
authors.initials: CC
authors.lastname: Tsang
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong; Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong.
authors.forename: Teresa W S
authors.initials: TW
authors.lastname: Hui
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong.
authors.forename: Kim-Chung
authors.initials: KC
authors.lastname: Lee
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong.
authors.forename: Jonathan H K
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong.
authors.forename: Antonio H Y
authors.initials: AH
authors.lastname: Ngan
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong.
authors.forename: Emily W T
authors.initials: EW
authors.lastname: Tam
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
authors.forename: Jasper F W
authors.initials: JF
authors.lastname: Chan
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wu
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong; Department of Pathology, Queen Elizabeth Hospital, Hong Kong.
authors.forename: Mei
authors.initials: M
authors.lastname: Cheung
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong; Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
authors.forename: Brian P H
authors.initials: BP
authors.lastname: Tse
authors.affiliation: Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
authors.forename: Alan K L
authors.initials: AK
authors.lastname: Wu
authors.affiliation: Department of Pathology, Queen Elizabeth Hospital, Hong Kong.
authors.forename: Christopher K C
authors.initials: CK
authors.lastname: Lai
authors.affiliation: Department of Pathology, Queen Elizabeth Hospital, Hong Kong.
authors.forename: Dominic N C
authors.initials: DN
authors.lastname: Tsang
authors.affiliation: Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong.
authors.forename: Tak-Lun
authors.initials: TL
authors.lastname: Que
authors.affiliation: Department of Pathology, The University of Hong Kong, Hong Kong.
authors.forename: Ching-Wan
authors.initials: CW
authors.lastname: Lam
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong. Electronic address: skplau@hku.hk.
authors.forename: Susanna K P
authors.initials: SK
authors.lastname: Lau
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong. Electronic address: pcywoo@hku.hk.
authors.forename: Patrick C Y
authors.initials: PC
authors.lastname: Woo
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology*; D001230:Aspergillus / Q000737:chemistry / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D014644:Genetic Variation; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D014009:Onychomycosis / Q000382:microbiology*; D017422:Sequence Analysis, DNA; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
chemical_list: D000935:Antifungal Agents
keywords: Aspergillus; Aspergillus hongkongensis sp. nov.; MALDI-TOF MS; Metabolic fingerprinting; Onychomycosis; Sequencing