, Volume 178, Issue 5–6, pp 435–439 | Cite as

Multi-Resistant Aspergillosis due to Cryptic Species

  • Susan Julie Howard


Reports of cryptic species causing aspergillosis in humans are increasing in the literature. Cryptic species are defined as those which are morphologically indistinguishable, although their identifications can be confirmed using molecular or other techniques which continue to become more widely available in the clinical setting. Antifungal resistance has often been noted in these cases, and indeed there does appear to be a higher prevalence of reduced susceptibility in cryptic species. Many of these observations are published as individual case reports or as a small component of larger data sets, making it challenging to review and compare the data fully. This review article seeks to describe the susceptibility trends and key learning outcomes of specific cases of infections caused by cryptic species, including Aspergillus alliaceus, Aspergillus calidoustus, Aspergillus felis, Aspergillus lentulus, Aspergillus tubingensis, Aspergillus viridinutans and Neosartorya pseudofischeri. These reports highlight the clinical need for full accurate identification and susceptibility testing to guide patient care.


Aspergillus Susceptibility Resistance Sibling Cryptic Antifungal 


Conflict of interest

Susan Howard has received research grants from Astellas, support grants from Gilead, Pfizer and the Fungal Research Trust, travel grants from Astellas and Schering-Plough, equipment grants from the Fungal Research Trust, and has been paid for talks on behalf of Pfizer and Astellas.


  1. 1.
    Alastruey-Izquierdo A, et al. Population-based survey of filamentous fungi and antifungal resistance in Spain (FILPOP Study). Antimicrob Agents Chemother. 2013;57(7):3380–7.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Balajee SA, et al. Molecular identification of Aspergillus species collected for the Transplant-Associated Infection Surveillance Network. J Clin Microbiol. 2009;47(10):3138–41.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Snelders E, et al. Emergence of Azole resistance in Aspergillus fumigatus and Spread of a single resistance mechanism. PLoS Med. 2008;5(11):e219.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Howard SJ, et al. Frequency and evolution of azole resistance in Aspergillus fumigatus associated with treatment failure. Emerg Infect Dis. 2009;15(7):1068–76.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Bueid A, et al. Azole antifungal resistance in Aspergillus fumigatus: 2008 and 2009. J Antimicrob Chemother. 2010;65(10):2116–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Howard SJ, Arendrup MC. Acquired antifungal drug resistance in Aspergillus fumigatus: epidemiology and detection. Med Mycol. 2011;49(Suppl 1):S90–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Balajee SA, et al. Aspergillus lentulus sp. nov., a new sibling species of A. fumigatus. Eukaryot Cell. 2005;4(3):625–32.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Balajee SA, et al. Molecular studies reveal frequent misidentification of Aspergillus fumigatus by morphotyping. Eukaryot Cell. 2006;5(10):1705–12.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Alcazar-Fuoli L, et al. Aspergillus section Fumigati: antifungal susceptibility patterns and sequence-based identification. Antimicrob Agents Chemother. 2008;52(4):1244–51.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Zbinden A, et al. Fatal outcome after heart transplantation caused by Aspergillus lentulus. Transpl Infect Dis. 2012;14(5):E60–3.PubMedCrossRefGoogle Scholar
  11. 11.
    Alcazar-Fuoli L, et al. Species identification and antifungal susceptibility patterns of species belonging to Aspergillus section Nigri. Antimicrob Agents Chemother. 2009;53(10):4514–7.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Howard SJ, et al. Cryptic species and azole resistance in the Aspergillus niger complex. Antimicrob Agents Chemother. 2011;55(10):4802–9.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Frisvad JC, et al. Secondary metabolite profiling, growth profiles and other tools for species recognition and important Aspergillus mycotoxins. Stud Mycol. 2007;59:31–7.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Oliveri C, Torta L, Catara V. A polyphasic approach to the identification of ochratoxin A-producing black Aspergillus isolates from vineyards in Sicily. Int J Food Microbiol. 2008;127(1–2):147–54.PubMedCrossRefGoogle Scholar
  15. 15.
    Varga J, et al. Aspergillus calidoustus sp. nov., causative agent of human infections previously assigned to Aspergillus ustus. Eukaryot Cell. 2008;7(4):630–8.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Alastruey-Izquierdo A, et al. In vitro activity of nine antifungal agents against clinical isolates of Aspergillus calidoustus. Med Mycol. 2010;48(1):97–102.PubMedCrossRefGoogle Scholar
  17. 17.
    Egli A, et al. Emergence of Aspergillus calidoustus infection in the era of posttransplantation azole prophylaxis. Transplantation. 2012;94(4):403–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Pavie J, et al. Breakthrough disseminated Aspergillus ustus infection in allogeneic hematopoietic stem cell transplant recipients receiving voriconazole or caspofungin prophylaxis. J Clin Microbiol. 2005;43(9):4902–4.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Balajee SA, et al. Nonsporulating clinical isolate identified as Petromyces alliaceus (anamorph Aspergillus alliaceus) by morphological and sequence-based methods. J Clin Microbiol. 2007;45(8):2701–3.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Ozhak-Baysan B, et al. Aspergillus alliaceus and Aspergillus flavus co-infection in an acute myeloid leukemia patient. Med Mycol. 2010;48(7):995–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Jarv H, et al. Isolation of Neosartorya pseudofischeri from blood: first hint of pulmonary Aspergillosis. J Clin Microbiol. 2004;42(2):925–8.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Vinh DC, et al. Chronic invasive aspergillosis caused by Aspergillus viridinutans. Emerg Infect Dis. 2009;15(8):1292–4.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Coelho D, et al. Aspergillus viridinutans: an agent of adult chronic invasive aspergillosis. Med Mycol. 2011;49(7):755–9.PubMedGoogle Scholar
  24. 24.
    Shigeyasu C, et al. Keratomycosis caused by Aspergillus viridinutans: an Aspergillus fumigatus-resembling mold presenting distinct clinical and antifungal susceptibility patterns. Med Mycol. 2012;50(5):525–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Barrs VR, et al. Aspergillus felis sp. nov., an emerging agent of invasive aspergillosis in humans, cats, and dogs. PLoS One. 2013;8(6):e64871.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Pelaez T, et al. Invasive aspergillosis caused by cryptic Aspergillus species: a report of two consecutive episodes in a patient with leukaemia. J Med Microbiol. 2013;62(Pt 3):474–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Alvarez-Perez S, et al. Polyphasic characterization of fungal isolates from a published case of invasive aspergillosis reveals misidentification of Aspergillus felis as Aspergillus viridinutans. J Med Microbiol. 2014;63(Pt 4):617–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Department of Molecular and Clinical PharmacologyUniversity of LiverpoolLiverpoolUK
  2. 2.CLAHRC Greater Manchester, 3rd Floor Mayo BuildingSalford Royal NHS Foundation TrustSalfordUK

Personalised recommendations