eThe use of molecular identification techniques has revealed an increasing number of new species within Aspergillus section Terrei. We phenotyped a set of 26 clinical isolates that showed genetic differences from Aspergillus terreus sensu stricto by analyzing sequences from PCR-amplified -tubulin and calmodulin genes and the internal transcribed spacer region. Since the isolates were phylogenetically and morphologically different from all of the members of Aspergillus section Terrei, they are described here as a new species, Aspergillus citrinoterreus, so named because it produces a diffusible yellowish pigment in agar. A. citrinoterreus isolates were significantly more susceptible to itraconazole, voriconazole, and posaconazole than A. terreus sensu stricto isolates were; in contrast, the amphotericin B MICs for both species were high. A. citrinoterreus was found in clinical samples from patients with proven or probable invasive aspergillosis and colonized patients, none of whom had hematological malignancies as predisposing conditions. However, they did have other underlying conditions such as chronic obstructive pulmonary disease, cirrhosis, and cancer or had received a solid organ transplants and presented not only with invasive pulmonary aspergillosis but also with mediastinitis. A. citrinoterreus isolates were detected for the first time in 2002. In all cases of invasive aspergillosis, A. citrinoterreus was found to be a copathogen, mostly with A. fumigatus.
Invasive aspergillosis affects patients with hematological and nonhematological conditions such as chronic obstructive pulmonary disease (COPD) (1-3). Most cases of invasive aspergillosis are caused by Aspergillus fumigatus and A. flavus. A. terreus is the third most common cause of invasive aspergillosis and a particularly prevalent microorganism in some geographic areas (4-8).Molecular tools can provide an accurate picture of the epidemiology of invasive aspergillosis and have revealed the presence of cryptic Aspergillus species frequently missed by conventional techniques (9-11). The number of newly described species within the section Terrei has grown during the last few years and includes A. alabamensis, A. allahabadii, A. ambiguous, A. aureoterreus, A. carneus, A. floccosus, A. hortai, A. microcysticus, A. neoafricanus, A. neoindicus, A. niveus, A. pseudoterreus, and A. terreus sensu stricto (12). To date, most of these species, with the exception of A. terreus sensu stricto, have not been reported to cause invasive aspergillosis in humans.We previously used molecular techniques to identify a set of Aspergillus section Terrei isolates collected from clinical samples from patients admitted to a general teaching hospital (13). Most of the isolates were identified as A. terreus sensu stricto, but a clade of isolates showed some remarkable genetic differences. The isolates comprising the clade have been phenotypically characterized and are reported here as representatives of a proposed new species within Aspergillus section Terrei, namely, Asperg...