Clinical and Microbiological Characterization of Invasive Pulmonary Aspergillosis Caused by in China.

Invasive aspergillosis (IA) due to is associated with high mortality. In this study, we investigated the clinical and microbiological characteristics of 6 fatal cases of proven or probable IA caused by in China. Underlying immunosuppression, prior antifungal exposure, and intensive care unit (ICU) hospitalization were important risk factors for invasive infection. Phenotypic differences were observed for isolates including slower growth, reduced sporulation, and inability to grow at 48°C, compared with . ITS sequencing was unable to distinguish from , but sequencing of the , , and loci enabled reliable distinction of these closely related species. Phylogenetic analysis further confirmed that the ITS region had little variation within the section Fumigati while the gene offered the highest intraspecific discrimination. Microsatellite typing results revealed that only loci on chromosomes 1, 3, 5, and 6b generated detectable amplicons for identification. All isolates showed resistance to multiple antifungal drugs including amphotericin B (MIC range 4 to 8 μg/ml), itraconazole (MIC 2 μg/ml), voriconazole (MIC of 4-16 μg/ml), and posaconazole (MIC of 0.5-1 μg/ml). However, MECs for the echinocandin drugs ranged from 0.03-0.25, ≤0.008-0.015, and ≤0.015-0.03 μg/ml for caspofungin, micafungin, and anidulafungin, respectively. is an emerging fungal pathogen in China, causing fatal disease, and clinicians as well as laboratories should be alert to their increasing presence.