Submitted to: Journal of Clinical Microbiology
Publication Type: Peer reviewed journal
Publication Acceptance Date: 12/9/2008
Publication Date: 4/1/2009
Citation: Balajee, S.A., Borman, A.M., Brandt, M.E., Cano, J., Cuenca-Estrella, M., Dannaoui, E., Guarro, J., Haase, G., Kibbler, C.C., Meyer, W., O Donnell, K., Petti, C.A., Rodriguez-Tudela, J.L., Sutton, D., Velegraki, A., Wickes, B.L. 2009. Sequence-Based Identification of Aspergillus, Fusarium, and Mucorales in the Clinical Laboratory: Where Are We and Where Should We Go From Here? Journal of Clinical Microbiology. 47(4):877-884. Interpretive Summary: Invasive fungal infection caused by Aspergillus, Fusarium and members of the Mucorales account for the vast majority of life-threatening human infections caused by filamentous moulds. In this guest editorial, the advantages and limitations of using DNA sequence data from a gene called the internal spacer region of the nuclear ribosomal RNA (ITS rRNA) is critically evaluated for species and species complex level identifications in the clinical microbiology laboratory. ITS rRNA sequence data typically resolves at the level of species complex within the genera Aspergillus and Fusarium, whereas it resolves most medically important species within the Mucorales. A detailed algorithm is provided to assist clinical microbiologists in identifying human pathogenic Aspergilli, Fusaria and Mucorales to the level of species complex and/or species level. This review should be greatest interest and benefit to clinical microbiologists and infectious disease specialists.
Technical Abstract: Accurate identification of fungal species helps establish or exclude a fungal cause of disease. In the past, clinical microbiology labs were restricted to a limited array of phenotypic criteria for categorizing isolates to the species level. This scenario is shifting in favour of DNA sequence-based identification strategies. Molecular methods are rapid, yield results that are objective with data portable between labs, are more economical in the long run, and as such are ideally suited for clinical microbiology laboratories. The U.S. Centers for Disease Control and Prevention (CDC) assembled a consortium of international scientists as a working group to begin addressing these issues with the desire to support clinical laboratories in their efforts to identify fungal species using molecular methods. The following document provides an overview of molecular methods available for Aspergillus, Fusarium and the Mucorales, the advantages and limitations of these approaches, and the recommendations of this working group.