Siderophore-Based Noninvasive Differentiation of Aspergillus fumigatus Colonization and Invasion in Pulmonary Aspergillosis
Status Publisher Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články
PubMed
36719229
PubMed Central
PMC10100950
DOI
10.1128/spectrum.04068-22
Knihovny.cz E-zdroje
- Klíčová slova
- Aspergillus fumigatus, colonization, invasive pulmonary aspergillosis, iron metabolism, mass spectrometry, noninvasive diagnosis, siderophore, urine analysis,
- Publikační typ
- časopisecké články MeSH
Germination from conidia to hyphae and hyphal propagation of Aspergillus fumigatus are the key pathogenic steps in the development of invasive pulmonary aspergillosis (IPA). By applying in vitro observations in a clinical study of 13 patients diagnosed with probable IPA, here, we show that the transition from colonization to the A. fumigatus invasive stage is accompanied by the secretion of triacetylfusarinine C (TafC), triacetylfusarinine B (TafB), and ferricrocin (Fc) siderophores into urine, with strikingly better sensitivity performance than serum sampling. The best-performing index, the TafC/creatinine index, with a median value of 17.2, provided 92.3% detection sensitivity (95% confidence interval [CI], 64.0 to 99.8%) and 100% specificity (95% CI, 84.6 to 100%), i.e., substantially better than the corresponding indications provided by galactomannan (GM) and β-d-glucan (BDG) serology. For the same patient cohort, the serum GM and BDG sensitivities were 46.2 and 76.9%, respectively, and their specificities were 86.4 and 63.6%, respectively. The time-dependent specific appearance of siderophores in the host's urine represents an impactful clinical diagnostic advantage in the early discrimination of invasive aspergillosis from colonization. A favorable concentration of TafC in a clinical specimen distant from a deep infection site enables the noninvasive sampling of patients suffering from IPA. IMPORTANCE The importance of this research lies in the demonstration that siderophore analysis can distinguish between asymptomatic colonization and invasive pulmonary aspergillosis. We found clear associations between phases of fungal development, from conidial germination to the proliferative stage of invasive aspergillosis, and changes in secondary metabolite secretion. The critical extracellular fungal metabolites triacetylfusarinines C and B are produced during the polarized germination or postpolarized growth phase and reflect the morphological status of the proliferating pathogen. False positivity in Aspergillus diagnostics is minimized as mammalian cells do not synthesize Aspergillus siderophore or mycotoxin molecules.
California Institute for Medical Research San Jose California USA
Department of Analytical Chemistry Palacký University Olomouc Czechia
Department of Anesthesiology and Intensive Care Medicine University Hospital Ostrava Ostrava Czechia
Department of Bacteriology and Mycology Public Health Institute in Ostrava Ostrava Czechia
Department of Hematooncology University Hospital Ostrava Ostrava Czechia
Department of Medical Microbiology Charles University Prague Czechia
Institute of Laboratory Medicine Faculty of Medicine University of Ostrava Ostrava Czechia
Institute of Microbiology of the Czech Academy of Sciences Prague Czechia
Lung Department Krnov Combined Medical Facility Krnov Czechia
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