Chapter 119 : and *

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and (and ) are environmental moulds, which include a number of species that are human pathogens. Each of these genera is described with regard to assisting in their detection and identification in the diagnostic mycology laboratory. Their taxonomic placement, description, epidemiology and transmission, clinical significance, collection, transport and specimen storage procedures, diagnostic approaches (direct microscopy, isolation, identification procedures [phenotypic, proteomic and genomic methods]), genotyping, serological testing, antimicrobial susceptibilities, and interpretation when isolated are covered. Polyphasic phylogenetic concepts and the recent “one fungus, one name” dictum have led to taxonomic rearrangements of and . Consensus to adopt the anamorph term of “Aspergillus” currently holds for members of genus, while the most notable pathogen is now termed . Both genera are soil and environmental fungi but cause a diverse range of human disease ranging from localized lung to disseminated infection. Immunocompromised individuals are especially susceptible. Identification of medically relevant members to species level still requires morphological techniques, but proteomic approaches such as matrix-assisted laser desorption time-of-flight mass spectrometry, direct antigen detection in body fluids (e.g., galactomannan), and PCR-based tools are increasingly used, especially to resolve ambiguous results. Molecular tools are essential to identify cryptic species, e.g., the complex. Antifungal susceptibility testing is helpful in invasive infection and in monitoring for drug resistance; susceptibility may vary with species. Several genotyping tools are developed for both and , while methods that employ analysis of at least one genetic locus are most useful.

Citation: Chen S, Sorrell T, Meyer W. 2015. and *, p 2030-2056. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch119
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Image of FIGURE 1

Maximum likelihood tree of pathogenic species based on internal transcribed spacer (ITS) 1 and ITS2 sequences of the rDNA gene obtained from GenBank using the program MEGA ver. 5.2 (231). Teleomorph names are given in parentheses. doi:10.1128/9781555817381.ch119.f1

Citation: Chen S, Sorrell T, Meyer W. 2015. and *, p 2030-2056. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch119
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Image of FIGURE 2

Key to representative species of . doi:10.1128/9781555817381.ch119.f2

Citation: Chen S, Sorrell T, Meyer W. 2015. and *, p 2030-2056. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch119
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Image of FIGURE 3

(A) H&E-stained section of lung showing hyphae with smooth hyaline which are septate and branch dichotomously at acute angles. (B) Colonies of on potato dextrose agar showing typical blue-green surface pigmentation with a suede-like surface consisting of a dense felt of conidiophores. (C) Conidiophores of are columnar (up to 400 × 50 μm long) but may be shorter and are uniseriate. The vesicle is conical shaped and sports a singe row of phialides on the upper two thirds. Conidia are produced in basipetal succession with long chains and are globose to subglobose. (D) Culture of . Colonies are suede-like to floccose, white, and interspersed with gray-green patches of conidia (conidiation is slow to poor). (E) Conidiophores of are short, columnar, and uniseriate. Stipes are of narrower width than those of . Vesicles are subglobose and are smaller (6 to 25 μm diameter) than those of (10 to 26 μm). (F) Culture of . Colonies are granular, flat, often with radial grooves, yellow at first but quickly becoming bright to dark yellow-green with age. (G) Biseriate head of (H) () showing cleistothecia. (I) showing biseriate head, brown stipe, and Hülle cells. doi:10.1128/9781555817381.ch119.f3

Citation: Chen S, Sorrell T, Meyer W. 2015. and *, p 2030-2056. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch119
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Image of FIGURE 4

White colonies of on Sabouraud dextrose agar (25°C) with yellow-green conidial heads. With age, the diffusible brownish-red to wine-red pigment is evident. doi:10.1128/9781555817381.ch119.f4

Citation: Chen S, Sorrell T, Meyer W. 2015. and *, p 2030-2056. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch119
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Image of FIGURE 5

Neighbor joining tree of pathogenic and species based on ITS1/2 sequences of the rDNA gene cluster obtained from GenBank using MEGA ver. 5.2. doi:10.1128/9781555817381.ch119.f5

Citation: Chen S, Sorrell T, Meyer W. 2015. and *, p 2030-2056. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch119
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Known uncommon pathogenic species

Citation: Chen S, Sorrell T, Meyer W. 2015. and *, p 2030-2056. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch119
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Characteristics of some medically important species grown on identification media

Citation: Chen S, Sorrell T, Meyer W. 2015. and *, p 2030-2056. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch119
Generic image for table

Clinical categorization of infection and major causative species

Citation: Chen S, Sorrell T, Meyer W. 2015. and *, p 2030-2056. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch119

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