European Confederation of Medical Mycology (ECMM) epidemiological survey on invasive infections due to Fusarium species in Europe

Tortorano, Anna Maria; Prigitano, Anna; Esposto, Maria Carmela; Arsenijevic, Valentina Arsić; Kolarovic, Jovanka; Ivanović, Dragica; Paripovic, Lejla; Klingspor, Lena; Nordøy, Ingvild; Hamal, Petr; Akdağlı, Sevtap Arıkan; Ossi, C.; Grancini, Anna; Cavanna, C.; Cascio, Giuliana Lo; Scarparo, Claudio; Candoni, A.; Caira, Morena; Drogari‐Apiranthitou, Maria

doi:10.1007/s10096-014-2111-1

Cited by 81 publications

(99 citation statements)

References 27 publications

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“…The F. andiyazi strain isolated from one patient was the first isolation from a human case that we previously reported [32]. In a recent survey conducted in Europe (involving our region as well), the FFSC was also reported to be prevalent [31]. These data support the view that regional differences exist in the distribution of Fusarium species [10].…”

Section: Discussionsupporting

confidence: 84%

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Emergence of fusarioses in a university hospital in Turkey during a 20-year period

Cilo

Al‐Hatmi

Seyedmousavi

et al. 2015

Eur J Clin Microbiol Infect Dis

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Fusarium species have started appearing increasingly as the main cause of infections, particularly in immunocompromised patients. In this study, we aimed to present the first epidemiological data from Turkey, analyze fusariosis cases that have been monitored in a university hospital during the past 20 years, identify the responsible Fusarium species, and determine antifungal susceptibilities. A total of 47 cases of fusariosis was included in the study. Fusarium isolates were identified by multilocus sequence typing (MLST). Antifungal susceptibility was tested by the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) methodology. Of the Fusarium infections, 23.4 % were superficial, 44.7 % were locally invasive, and 31.9 % were disseminated. A significant increase was observed over the years. The Fusarium fujikuroi species complex (FFSC) proved to be the most frequent agent group (17 cases; 51.5 %), followed by the Fusarium solani species complex (FSSC) (14 cases; 42.4 %), the Fusarium dimerum species complex (FDSC), and the Fusarium oxysporum species complexes (FOSC) (one case each). Amphotericin B had the highest in vitro activity against all species. Voriconazole and posaconazole showed interspecies variability across and within Fusarium species complexes. In conclusion, our data support the fact that regional differences exist in the distribution of the Fusarium species and that species-specific differences are observed in antifungal susceptibility patterns. The monitoring of local epidemiological data by determining fungal identity and susceptibility are of importance in guiding the clinical followup of patients.Electronic supplementary material The online version of this article

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Section: Discussionsupporting

confidence: 84%

“…Involvement of the skin is another important manifestation of fusariosis and can represent a primary site of infection or a manifestation of secondary metastasis in patients with disseminated fusariosis. Among immunocompromised patients, skin lesions may be the single source of diagnosis [13,31].…”

Section: Discussionmentioning

confidence: 99%

Emergence of fusarioses in a university hospital in Turkey during a 20-year period

Cilo

Al‐Hatmi

Seyedmousavi

et al. 2015

Eur J Clin Microbiol Infect Dis

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“…In vitro antifungal susceptibility testing showed that discriminating between Fusarium species complexes can indeed be important for appropriate patient treatment, as previously indicated (27). Although amphotericin B was active against all strains analyzed and was the drug of choice for all members of the FSSC and FOSC (i.e., the other antifungals tested had no or only a limited effect), our results suggest alternatives for members of the FFSC and FDSC.…”

Section: Discussionsupporting

confidence: 67%

“…However, according to in vitro testing, antifungal susceptibility profiles have been shown to vary between Fusarium species (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Correct identification to the species or species complex level may thus be crucial for patient treatment, although no in vitro-in vivo correlations have been demonstrated, and treatment is dependent on the type of infection (27). Identification to the species level is also essential for epidemiological purposes.…”

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confidence: 99%

Use of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry for Identification of Molds of the Fusarium Genus

et al. 2015

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eThe rates of infection with Fusarium molds are increasing, and a diverse number of Fusarium spp. belonging to different species complexes can cause infection. Conventional species identification in the clinical laboratory is time-consuming and prone to errors. We therefore evaluated whether matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is a useful alternative. The 289 Fusarium strains from the Belgian Coordinated Collections of Microorganisms (BCCM)/Institute of Hygiene and Epidemiology Mycology (IHEM) culture collection with validated sequence-based identities and comprising 40 species were used in this study. An identification strategy was developed, applying a standardized MALDI-TOF MS assay and an in-house reference spectrum database. In vitro antifungal testing was performed to assess important differences in susceptibility between clinically relevant species/species complexes. We observed that no incorrect species complex identifications were made by MALDI-TOF MS, and 82.8% of the identifications were correct to the species level. This success rate was increased to 91% by lowering the cutoff for identification. Although the identification of the correct species complex member was not always guaranteed, antifungal susceptibility testing showed that discriminating between Fusarium species complexes can be important for treatment but is not necessarily required between members of a species complex. With this perspective, some Fusarium species complexes with closely related members can be considered as a whole, increasing the success rate of correct identifications to 97%. The application of our user-friendly MALDI-TOF MS identification approach resulted in a dramatic improvement in both time and accuracy compared to identification with the conventional method. A proof of principle of our MALDI-TOF MS approach in the clinical setting using recently isolated Fusarium strains demonstrated its validity.

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“…is noteworthy (5,9,26); one study (6) identified only 1/6 F. solani complex when interrogated against the same Bruker library (v1.0). While analyzing Fusarium isolates to the species complex level, rather than to the individual species level may be a limitation, higher species-level discrimination may be unnecessary because susceptibility differences between members of the same species complex do not appear to be clinically relevant (26,33). Species delineation of Fusarium necessitates multilocus gene sequence typing (MLST) incorporating at least four loci, and different MLST schemes are recommended for different species complexes (3,34).…”

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confidence: 99%

Performance of Matrix-Assisted Laser Desorption Ionization−Time of Flight Mass Spectrometry for Identification of Aspergillus, Scedosporium, and Fusarium spp. in the Australian Clinical Setting

et al. 2016

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dWe developed an Australian database for the identification of Aspergillus, Scedosporium, and Fusarium species (n ‫؍‬ 28) by matrix-assisted laser desorption ionization؊time of flight mass spectrometry (MALDI-TOF MS). In a challenge against 117 isolates, species identification significantly improved when the in-house-built database was combined with the Bruker Filamentous Fungi Library compared with that for the Bruker library alone (Aspergillus, 93% versus 69%; Fusarium, 84% versus 42%; and Scedosporium, 94% versus 18%, respectively). Rapid, accurate mold identification is important due to the widening spectrum of pathogens and species-specific differences in antifungal susceptibility (1-3). Matrix-assisted laser desorption ionizationϪtime of flight mass spectrometry (MALDI-TOF MS) has proven useful, but mold identification remains challenged by the limited access to validated purpose-built databases that are necessary because of small species and strain representations in commercial libraries (4-16).Given the prior poor performance of the Bruker Filamentous Fungi Library v1.0 (Bruker Daltonics, Bremen, Germany) for mold identification using the manufacturer-recommended broth-based protein extraction methods (in our laboratory Ͼ50% of isolates were not identified; internal data) and because the geographic generalizability of in-house-built databases is not yet known, we hypothesized that a MS library of molds relevant to our region (17-21) will improve identification. Here, we constructed an in-house database containing 117 strains (see Table S1 in the supplemental material) covering 28 species of Aspergillus, Scedosporium, and Fusarium encountered in Australia. Challenge isolates (also n ϭ 117; 21 species) comprising 55 Aspergillus, 45 Fusarium, and 17 Scedosporium clinical strains (Table 1) were then used to assess the performance of the Bruker library alone versus that of the Bruker library supplemented with the in-house library for species identification.All isolates were identified using phenotypic methods (22) with definitive identification by DNA sequencing of the internal transcribed spacer (ITS) (all isolates), ␤-tubulin (Aspergillus and Scedosporium spp.), and partial elongation factor-1alpha (EF-1␣) (to identify Fusarium to the species complex level) gene regions (23)(24)(25)(26). Sequence data were analyzed against the Centraalbureau voor Schimmelkultures (http://www.cbs.knaw.nl/Collections /BioloMICSSequences.aspx?fileϭall), International Society for Human and Animal Mycology ITS (http://its.mycologylab.org/), and Fusarium-ID (http://www.fusariumdb.org/index.php) databases, and species were assigned using published criteria (27).Protein extraction for MALDI-TOF MS was performed as previously described (11). The Bruker bacterial test standard (Bruker Daltonics) was used for calibration and Aspergillus ustus CBS 261.67T scoring of Ն2.00 was required for quality extraction and spectra acceptability (11). The in-house database was constructed using published protocols (11, 28) with 20 to 25 quality spe...

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European Confederation of Medical Mycology (ECMM) epidemiological survey on invasive infections due to Fusarium species in Europe

Cited by 81 publications

References 27 publications

Emergence of fusarioses in a university hospital in Turkey during a 20-year period

Emergence of fusarioses in a university hospital in Turkey during a 20-year period

Use of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry for Identification of Molds of the Fusarium Genus

Performance of Matrix-Assisted Laser Desorption Ionization−Time of Flight Mass Spectrometry for Identification of Aspergillus, Scedosporium, and Fusarium spp. in the Australian Clinical Setting

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