Aspergillusspecies in Iceland: species distribution andcyp51Amutation testing in a 7.5-year clinical isolate collection

Abstract

AbstractIntroduction.Among challenges in diagnosing and treating aspergillosis areAspergillusspecies identification, which can inform therapeutic choices, and detection of antifungal resistance. Increasing rates of triazole resistance have been reported for the most common species,Aspergillus fumigatus.Methods.A collection of clinicalAspergillusisolates cultured during 2014–2021, previously identified morphologically, were tested with the AsperGenius qPCR-kit for identification ofA. fumigatusandAspergillus flavusand the presence of acyp51Amutation encoding azole resistance (TR34/L98H and Y121F/T289A); other species were identified with calmodulin sequencing.Results.Identification of the 312 isolates (224 patients) tested revealed 19 species in nineAspergillussections. Rare or cryptic species were identified in 48 isolates (44 patients). Thirty-one isolates had been assigned an incorrect species name when initially cultured. The TR34/L98H and Y121F/T289A mutations were not found in any of the 202A. fumigatusisolates tested.Discussion.In this first study on clinicalAspergillusisolates in Iceland the proportion of cryptic and rare species was on par with findings from other countries. In contrast, unlike other studies we did not find the most common azole resistance-related mutations inA. fumigatus, possibly due to the absence of significant environmental antifungal pressure in the local agriculture.