{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T01:26:47Z","timestamp":1780363607985,"version":"3.54.1"},"reference-count":49,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T00:00:00Z","timestamp":1664323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background. Pulmonary aspergillosis is a lung infection caused by Aspergillus spp., which can cause severe illnesses in immunocompromised patients with underlying lung disease or who have asthma and inhale their spores. This study aimed to screen the antifungal susceptibility of Aspergillus spp. isolated from patients with underlying pulmonary infections and characterize the isolates using PCR and sequencing. Method. Three hundred and eighty-four sputum or bronchoalveolar lavage samples were collected and processed for the isolation and identification, and characterization of Aspergillus species and molecular amplification of the ITS1-5.8S-ITS2 region by the PCR and Sanger sequencing method. Antifungal susceptibility tests for itraconazole and voriconazole were performed using the E-test. Result. The overall results revealed that out of 384 patients, 32 (8.3%) were positive for fungal growth, including 28 (87.5%) Aspergillus spp. The highest resistance rate (100 and 44.4%) was obtained from itraconazole against A. niger and A. fumigatus. In contrast, voriconazole revealed the best activities against all tested fungi compared to itraconazole. All A. flavus were sensitive to voriconazole, while only 54.5% were sensitive to itraconazole. The MICs of E-test for Aspergillus spp were 1.6 \u00b1 1.8 and 0.6 \u00b1 0.93 for itraconazole and voriconazole, respectively. Conclusions. The prevalence of aspergillosis was high, with a significant association with underlying lung diseases. Voriconazole was the drug of choice for isolated fungi.<\/jats:p>","DOI":"10.3390\/tropicalmed7100274","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T01:23:16Z","timestamp":1664414596000},"page":"274","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Molecular Characterization and Antifungal Susceptibility of Aspergillus spp. among Patients with Underlying Lung Diseases"],"prefix":"10.3390","volume":"7","author":[{"given":"Ehssan","family":"Moglad","sequence":"first","affiliation":[{"name":"Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj P.O. Box 173, Saudi Arabia"},{"name":"Department of Microbiology, Medicinal and Aromatic Plants and Traditional Medicine Research Institute (MAPTMRI), National Center for Research, Khartoum P.O. Box 2404, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samar","family":"Saeed","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medical Laboratory Sciences, Sudan University of Science and Technology, Khartoum P.O. Box 407, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humodi","family":"Saeed","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medical Laboratory Sciences, Sudan University of Science and Technology, Khartoum P.O. Box 407, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7747-515X","authenticated-orcid":false,"given":"Hind","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medical Laboratory Sciences, Sudan University of Science and Technology, Khartoum P.O. Box 407, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwathar","family":"Salih","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medical Laboratory Sciences, Sudan University of Science and Technology, Khartoum P.O. Box 407, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2635-9383","authenticated-orcid":false,"given":"Hisham","family":"Altayb","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Faculty of Science, King Abdulaziz University, Building A 90, Jeddah P.O. Box. 80200, Saudi Arabia"},{"name":"Centre for Artificial Intelligence in Precision Medicine, King Abdulaziz University, Jeddah P.O. Box. 80200, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafa","family":"Elhag","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, College of Medicine, University of Bisha, Bisha P.O. Box 1290, Saudi Arabia"},{"name":"Department of Microbiology, Faculty of Medical Laboratory Sciences, Al-Neelain University, Khartoum P.O. Box 12702, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1183\/13993003.00583-2015","article-title":"Chronic pulmonary aspergillosis: Rationale and clinical guidelines for diagnosis and management","volume":"47","author":"Denning","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_2","first-page":"2202","article-title":"Invasive pulmonary aspergillosis and chronic pulmonary aspergillosis","volume":"10","author":"Gianella","year":"2014","journal-title":"Rev. Med. Suisse"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1378\/chest.14-0917","article-title":"Diagnosis and treatment of pulmonary aspergillosis syndromes","volume":"146","author":"Patterson","year":"2014","journal-title":"Chest"},{"key":"ref_4","first-page":"66","article-title":"The clinical presentations of pulmonary aspergillosis in children with cystic fibrosis\u2014Preliminary report","volume":"19","author":"Sands","year":"2015","journal-title":"Dev. Period Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"216","DOI":"10.4103\/1817-1737.140130","article-title":"Allergic bronchopulmonary aspergillosis: A clinical review of 24 patients: Are we right in frequent serologic monitoring?","volume":"9","author":"Natarajan","year":"2014","journal-title":"Ann. Thorac. Med."},{"key":"ref_6","first-page":"46","article-title":"Allergic bronchopulmonary aspergillosis--a clinical review","volume":"60","author":"Gupta","year":"2012","journal-title":"J. Assoc. Physicians India"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"309","DOI":"10.4103\/0970-2113.159523","article-title":"Itraconazole in chronic pulmonary aspergillosis: In whom, for how long, and at what dose?","volume":"32","author":"Maturu","year":"2015","journal-title":"Lung India"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e000155","DOI":"10.1136\/bmjresp-2016-000155","article-title":"Clinical manifestations and outcomes of pulmonary aspergillosis: Experience from Pakistan","volume":"3","author":"Iqbal","year":"2016","journal-title":"BMJ Open Respir. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"864","DOI":"10.2471\/BLT.11.089441","article-title":"Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis","volume":"89","author":"Denning","year":"2011","journal-title":"Bull. World Health Organ."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1111\/myc.12075","article-title":"Itraconazole in chronic cavitary pulmonary aspergillosis: A randomised controlled trial and systematic review of literature","volume":"56","author":"Agarwal","year":"2013","journal-title":"Mycoses"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1111\/pai.12953","article-title":"Risk Factors and impact of Allergic Bronchopulmonary Aspergillosis in P. aeruginosa negative CF Patients","volume":"29","author":"Schelstraete","year":"2018","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.rmed.2017.11.007","article-title":"Omalizumab treatment for allergic bronchopulmonary aspergillosis in young patients with cystic fibrosis","volume":"133","author":"Perisson","year":"2017","journal-title":"Respir. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1111\/cea.12459","article-title":"Allergic bronchopulmonary aspergillosis","volume":"45","author":"Knutsen","year":"2015","journal-title":"Clin. Exp. Allergy"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Overton, N.L., Brakhage, A.A., Thywi\u00dfen, A., Denning, D.W., and Bowyer, P. (2018). Mutations in EEA1 are associated with allergic bronchopulmonary aspergillosis and affect phagocytosis of Aspergillus fumigatus by human macrophages. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0185706"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"ofx040","DOI":"10.1093\/ofid\/ofx040","article-title":"Successful treatment of allergic bronchopulmonary aspergillosis with isavuconazole: Case report and review of the literature","volume":"4","author":"Jacobs","year":"2017","journal-title":"Open Forum Infectious Diseases"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S261","DOI":"10.1080\/13693780802247702","article-title":"Differences in pathogenicity and clinical syndromes due to Aspergillus fumigatus and Aspergillus flavus","volume":"47","author":"Pasqualotto","year":"2009","journal-title":"Med. Mycol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1183\/09059180.00001011","article-title":"Pulmonary aspergillosis: A clinical review","volume":"20","author":"Kousha","year":"2011","journal-title":"Eur. Respir. Rev. Off. J. Eur. Respir. Soc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4146","DOI":"10.1128\/AAC.00141-12","article-title":"Pharmacodynamics of itraconazole against Aspergillus fumigatus in an in vitro model of the human alveolus: Perspectives on the treatment of triazole resistant infection and utility of airway administration","volume":"56","author":"Sudan","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1056\/NEJMra0808853","article-title":"Aspergillosis","volume":"360","author":"Segal","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1128\/JCM.38.4.1510-1515.2000","article-title":"Identification of Aspergillus species using internal transcribed spacer regions 1 and 2","volume":"38","author":"Henry","year":"2000","journal-title":"J. Clin. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"6241","DOI":"10.1073\/pnas.1117018109","article-title":"Nuclear ribosomal internal transcribed spacer (ITS) region as a universal DNA barcode marker for Fungi","volume":"109","author":"Schoch","year":"2012","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1128\/JCM.01685-08","article-title":"Sequence-based identification of Aspergillus, fusarium, and mucorales species in the clinical mycology laboratory: Where are we and where should we go from here?","volume":"47","author":"Balajee","year":"2009","journal-title":"J. Clin. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1080\/mmy.40.1.87.109","article-title":"Utilization of the internal transcribed spacer regions as molecular targets to detect and identify human fungal pathogens","volume":"40","author":"Iwen","year":"2002","journal-title":"Med. Mycol."},{"key":"ref_24","unstructured":"Cheesbourgh, M. (2006). Medical Laboratory Manual for Tropical Countries, Cambridge University Press. [2nd ed.]."},{"key":"ref_25","first-page":"105","article-title":"Morphological identification of Aspergillus species from the soil of larkana district (Sindh, Pakistan)","volume":"1","author":"Afzal","year":"2013","journal-title":"Asian J. Agric. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e57889","DOI":"10.5812\/archcid.57889","article-title":"Comparison of E Test and Disc Diffusion Methods for Susceptibility Testing of Filamentous Fungi; Experience of a Routine Lab","volume":"13","author":"Hassan","year":"2018","journal-title":"Arch. Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1590\/S0036-46652015000700011","article-title":"Susceptibility Test for Fungi: Clinical and Laboratorial Correlations in Medical Mycology","volume":"57","author":"Melhem","year":"2015","journal-title":"Rev. Inst. Med. Trop. Sao Paulo"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"378","DOI":"10.3109\/13693786.2011.616543","article-title":"Susceptibility of 100 filamentous fungi: Comparison of two diffusion methods, Neo-Sensitabs and E-test, for amphotericin B, caspofungin, itraconazole, voriconazole and posaconazole","volume":"50","author":"Colosi","year":"2012","journal-title":"Med. Mycol."},{"key":"ref_29","first-page":"114","article-title":"A simple method of genomic DNA extraction suitable for analysis of bulk fungal strains","volume":"51","author":"Zhang","year":"2010","journal-title":"Lett. Appl. Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"White, T.J., Bruns, T.D., Lee, S.B., and Taylor, J.W. (1990). Amplification and direct sequencing of fungal ribosomal RNA Genes for phylogenetics. PCR Protocols, Academic Press.","DOI":"10.1016\/B978-0-12-372180-8.50042-1"},{"key":"ref_31","unstructured":"Hall, T.A. (1999). BioEdit: A user-friendly biological sequence alignment editor and analysis program for Windows 95\/98\/NT. Nucleic Acids Symposium Series, Information Retrieval Ltd.. Volume 41, pp. 95\u201398."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1093\/molbev\/msy096","article-title":"MEGA X: Molecular evolutionary genetics analysis across computing platforms","volume":"35","author":"Kumar","year":"2018","journal-title":"Mol. Biol. Evol."},{"key":"ref_33","first-page":"2712","article-title":"Clinico-microbiological profile of chronic pulmonary aspergillosis from a tertiary care centre in southern India","volume":"7","author":"Chawla","year":"2013","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.diii.2015.01.005","article-title":"Pulmonary aspergillosis","volume":"96","author":"Chabi","year":"2015","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1155\/2005\/759070","article-title":"Aspergillus-related lung disease","volume":"12","author":"Ryan","year":"2005","journal-title":"Can. Respir. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.patbio.2009.07.011","article-title":"Diagnosis of invasive pulmonary aspergillosis: Value of bronchoalveolar lavage galactomannan for immunocompromised patients","volume":"58","author":"Paugam","year":"2010","journal-title":"Pathol. Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"68","DOI":"10.5923\/j.microbiology.20120204.01","article-title":"Respiratory Tract Aspergillosis in the Sputum of Patients Suspected of Tuberculosis in Fako Division-Cameroon","volume":"2","author":"Anna","year":"2012","journal-title":"J. Microbiol. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"12","DOI":"10.18869\/acadpub.cmm.1.1.12","article-title":"Detection of galactomannan in bronchoalveolar lavage of the intensive care unit patients at risk for invasive aspergillosis","volume":"1","author":"Khodavaisy","year":"2015","journal-title":"Curr. Med. Mycol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1136\/thoraxjnl-2014-206291","article-title":"The clinical spectrum of pulmonary aspergillosis","volume":"70","author":"Kosmidis","year":"2015","journal-title":"Thorax"},{"key":"ref_40","first-page":"6s11","article-title":"Acute invasive pulmonary aspergillosis in chronic lung disease--A review","volume":"23","author":"Ader","year":"2006","journal-title":"Rev. Des Mal. Respir."},{"key":"ref_41","first-page":"1448","article-title":"Diagnostic Aspergillosis in the Sputum of Patients with Pulmonary Complains and Antifungals Susceptibility of Triazoles and Caspofungin Using E-Test","volume":"2","author":"Imran","year":"2015","journal-title":"Int. J. Med. Sci. Clin. Invent."},{"key":"ref_42","first-page":"581","article-title":"Diagnostic significance of Aspergillus species isolated from respiratory samples in an adult pneumology ward","volume":"49","author":"Tashiro","year":"2011","journal-title":"Med. Mycol."},{"key":"ref_43","first-page":"429","article-title":"Antifungal susceptibility of the aspergillus species by Etest and CLSI reference methods","volume":"15","author":"Badiee","year":"2012","journal-title":"Arch. Iran. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3623","DOI":"10.1128\/JCM.41.8.3623-3626.2003","article-title":"Activities of caspofungin, itraconazole, posaconazole, ravuconazole, voriconazole, and amphotericin B against 448 recent clinical isolates of filamentous fungi","volume":"41","author":"Diekema","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1001\/archopht.125.6.789","article-title":"Antimicrobial susceptibility of Fusarium, Aspergillus, and other filamentous fungi isolated from keratitis","volume":"125","author":"Lalitha","year":"2007","journal-title":"Arch. Ophthalmol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1590\/S1415-47572002000400018","article-title":"Polymorphism in the internal transcribed spacer (ITS) of the ribosomal DNA of 26 isolates of ectomycorrhizal fungi","volume":"25","author":"Gomes","year":"2002","journal-title":"Genet. Mol. Biol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1078\/072320204322881826","article-title":"Quantitative PCR Analysis of Selected Aspergillus, Penicillium and Paecilomyces Species","volume":"27","author":"Haugland","year":"2004","journal-title":"Syst. Appl. Microbiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.fgb.2005.06.007","article-title":"An oligonucleotide barcode for species identification in Trichoderma and Hypocrea","volume":"42","author":"Druzhinina","year":"2005","journal-title":"Fungal Genet. Biol."},{"key":"ref_49","first-page":"843","article-title":"Keratitis due to Aspergillus flavus: Clinical profile, molecular identification of fungal strains and detection of aflatoxin production","volume":"16","author":"Leema","year":"2010","journal-title":"Mol. Vis."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/7\/10\/274\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:41:31Z","timestamp":1760143291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/7\/10\/274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,28]]},"references-count":49,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["tropicalmed7100274"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed7100274","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,28]]}}}