Research Article
Volume 9 Issue 2 - 2021
Phenotypic and Molecular Detection of Invasive Pulmonary Aspergillosis from Inpatients Children with Hematologic Cancers
Sedigheh Rafiei Tabatabaei1, Mehdi Shirdoust1, Samin Alavi2, Behnaz Lajevardi1, Farideh Shiva1, Mohamad Ali Gudarzi1, Seyedeh Mahsan Hoseini-Alfatemi1* and Somayeh Sharifynia3*
1Pediatric Infections Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
33Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
*Corresponding Author: Seyedeh Mahsan Hoseini-Alfatemi, Pediatric Infections Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran and Somayeh Sharifynia, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Received: September 05, 2021; Published:Published: January 30, 2021


Objective: Invasive pulmonary aspergillosis (IPA) is a growing concern in immunocompromised children. Data from Middle East regarding burden of children’s Aspergillus infections are scant. This study aimed to update the frequency and antifungal susceptibility profile of Aspergillus isolates obtained from children with malignant underlying diseases.

Materials/Patients/Methods: A total of 75 episodes from 60 patients with clinical presentation suggestive of IPA were recruited between January 2013 to December 2016, and clinical data were retrospectively collected. In vitro susceptibility was determined by E test method using Clinical and Laboratory Standards Institute guidelines.

Result: According to EORTC/MSG criteria, a total of 75 episodes, 16 (21.3%) and 59 (78.7%) cases with probable and possible IPA were identified, respectively. Aspergillus flavus was isolated in 7neutropenic patients showing and showed reduced susceptibility to amphotericin B. However, all isolates demonstrated susceptible profile to caspofungin (≤ 0.25 µg/ml), posaconazole (≤ 0.5 µg/ml) and voriconazole (≤ 2 µg/ml).

Conclusion: The Aspergillus species causing IPA in children with malignancies differed from those in Western countries. Our results provide useful information on local epidemiology of IPA and selection of proper empirical antifungal agent.


Keywords: Invasive Pulmonary Aspergillosis; Children, Aspergillus flavus; Neutropenia; Iran


    1. Wattier R and Ramirez-Avila L. “Pediatric Invasive Aspergillosis”. Journal of Fungi2 (2016): 19.
    2. Pfeiffer CD., et al. “Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis”. Clinical Infectious Diseases10 (2006): 1417-1727.
    3. Tsitsikas DA., et al. “Impact of the revised (2008) EORTC/MSG definitions for invasive fungal disease on the rates of diagnosis of invasive aspergillosis”. Medical Mycology5 (2012): 538-542.
    4. Badiee P and Alborzi A. “Detection of Aspergillus species in bone marrow transplant patients”. The Journal of Infection in Developing Countries08 (2010): 511-516.
    5. Badiee P., et al. “Invasive Aspergillosis in Pediatric Hematology Oncology Ward (2010).
    6. Kousha M., et al. “Pulmonary aspergillosis: a clinical review”. European Respiratory Review121 (2011): 156-174.
    7. Patterson TF., et al. “Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America”. Clinical Infectious Diseases 4 (2016): e1-e60.
    8. Sarrafzadeh SA., et al. “The accuracy of serum galactomannan assay in diagnosing invasive pulmonary aspergillosis”. Iranian Journal of Allergy, Asthma and Immunology3 (2010): 149.
    9. Diba K., et al. “Development of RFLP-PCR method for the identification of medically important Aspergillus species using single restriction enzyme MwoI”. Brazilian Journal of Microbiology2 (2014): 503-507.
    10. Barchiesi F., et al. “Effects of amphotericin B on Aspergillus flavus clinical isolates with variable susceptibilities to the polyene in an experimental model of systemic aspergillosis”. Journal of Antimicrobial Chemotherapy11 (2013): 2587-2591.
    11. Nasri T., et al. “PCR-RFLP on β-tubulin gene for rapid identification of the most clinically important species of Aspergillus”. Journal of Microbiological Methods 117 (2015): 144-147.
    12. Mohankumar M., et al. “Analysis of molecular variability among isolates of Aspergillus flavus by PCR-RFLP of the ITS regions of rDNA”. Journal of Plant Protection Research4 (2010): 446-451.
    13. Diba K., et al. “Identification of Aspergillus species using morphological characteristics”. Pakistan Journal of Medical Sciences6 (2007): 867.
    14. Martos A., et al. “Evaluation of the Etest method for susceptibility testing of Aspergillus spp. and Fusarium spp. to three echinocandins”. Medical Mycology6 (2010): 858-861.
    15. Alborzi A., et al. “Antifungal susceptibility of the aspergillus species by Etest and CLSI reference methods”. Archives of Iranian Medicine7 (2012): 429.
    16. Espinel-Ingroff A and Rezusta A. “E-test method for testing susceptibilities of Aspergillus spp. to the new triazoles voriconazole and posaconazole and to established antifungal agents: comparison with NCCLS broth microdilution method”. Journal of Clinical Microbiology6 (2002): 2101-2017.
    17. Hedayati MT., et al. “Burden of fungal infections in Iran”. The Journal of Infection in Developing Countries10 (2018): 910-918.
    18. Patterson KC and Strek ME. “Diagnosis and treatment of pulmonary aspergillosis syndromes”. CHEST Journal5 (2014): 1358-1368.
    19. Mirhendi H., et al. “Identification of pathogenic Aspergillus species by a PCR-restriction enzyme method”. Journal of Medical Microbiology11 (2007): 1568-1570.
    20. Fuller J., et al. “Caspofungin Etest endpoint for Aspergillus isolates shows poor agreement with the reference minimum effective concentration”. Journal of Clinical Microbiology2 (2010): 479-482.
    21. Nucci M., et al. “Early diagnosis of invasive pulmonary aspergillosis in hematologic patients: an opportunity to improve the outcome”. Haematologica11 (2013): 1657-1660.
    22. Khodavaysi S., et al. “Detection of galactomannan in bronchoalveolar lavage of the intensive care unit patients at risk for invasive aspergillosis”. Current Medical Mycology1 (2015): 12-17.
    23. Nosari A., et al. “Invasive aspergillosis in haematological malignancies: clinical findings and management for intensive chemotherapy completion”. American Journal of Hematology4 (2001): 231-236.
    24. Taccone FS., et al. “Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes”. Critical Care1 (2015): 7.
    25. Wheat LJ and Walsh TJ. “Diagnosis of invasive aspergillosis by galactomannan antigenemia detection using an enzyme immunoassay”. European Journal of Clinical Microbiology and Infectious Diseases4 (2008): 245-251.
    26. Klont RR., et al. “Utility of Aspergillus antigen detection in specimens other than serum specimens”. Clinical Infectious Diseases10 (2004): 1467-1474.
    27. Zanganeh E., et al. “Predominance of non-fumigatus Aspergillus species among patients suspected to pulmonary aspergillosis in a tropical and subtropical region of the Middle East”. Microbial Pathogenesis 116 (2018): 296-300.
    28. Espinel-Ingroff A and Turnidge J. “The role of epidemiological cutoff values (ECVs/ECOFFs) in antifungal susceptibility testing and interpretation for uncommon yeasts and moulds”. Revista Iberoamericana de Micología2 (2016): 63-75.
    29. Taghizadeh-Armaki M0., et al. “Genetic diversity and in vitro antifungal susceptibility of 200 clinical and environmental Aspergillus flavus isolates”. Antimicrobial Agents and Chemotherapy (2017): 00004-000017.
    30. Campoy S and Adrio JL. “Antifungals”. Biochemical Pharmacology (2016).
    31. Khodavaisy S., et al.In vitro activities of five antifungal agents against 199 clinical and environmental isolates of Aspergillus flavus, an opportunistic fungal pathogen”. Journal de Mycologie Médicale/Journal of Medical Mycology2 (2016): 116-121.
    32. Kachuei R., et al.In vitro antifungal susceptibility of clinical species belonging to Aspergillus genus and Rhizopus oryzae”. Journal de Mycologie Médicale/Journal of Medical Mycology1 (2016): 17-21.
    33. Gonçalves SS., et al.In vitro antifungal susceptibility of clinically relevant species belonging to Aspergillus section Flavi”. Antimicrobial Agents and Chemotherapy4 (2013): 1944-1947.
    34. Hoenigl M., et al. “European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) host factors and invasive fungal infections in patients with haematological malignancies”. Journal of Antimicrobial Chemotherapy (2012): dks155.
Citation: Seyedeh Mahsan Hoseini-Alfatemi and Somayeh Sharifynia., et al. “Phenotypic and Molecular Detection of Invasive Pulmonary Aspergillosis from Inpatients Children with Hematologic Cancers”. EC Pharmacology and Toxicology 9.2 (2021): 51-59.

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