In this study, we have developed a PCR-RFLP method that can be employed to differentiate
Aspergillus species within the section
Fumigati, with the BccI polymorphisms at a 5′ region of
benA distinguishing between 285
A. fumigatus strains (clinical and environmental), 37
A. lentulus strains, and 17
N. udagawae strains and sequences examined. Although the majority of cases of invasive aspergillosis appear to be attributed to
A. fumigatus, other related and often misidentified
Aspergillus spp. have been uncovered as causes of invasive infections (
4,
5,
12); the true burden of these infections remains to be fully elucidated. However, accurate identification may have clinical relevance, as different species are not equally susceptible to antifungal drugs in vitro. For example,
A. lentulus exhibits low and variable in vitro susceptibilities to itraconazole, voriconazole, amphotericin B, and the echinocandins (
4,
7,
18). In addition, others have reported decreased in vitro susceptibilities of
A. lentulus isolates to ravuconazole, posaconazole, and terbinafine (
1).
The recognition that
Aspergillus species identification solely on the basis of morphological features is insufficient has pushed the development of molecular methods for the purpose of species identification. The current strategy of using sequenced-based identification methods relies upon the accuracy of banked sequence data together with the quality of the data generated from the unknown isolate. Once the sequence data are aligned, a homology score is used to make the identification; and this score may be influenced by the quality of the sequences, the length of the sequence data, and the software used to make the alignment. However, the use of a restriction site polymorphism within a conserved gene for species identification does not depend upon sequence quality and, most importantly, does not rely upon arbitrary cutoff homology scores. Furthermore, same-species homology score cutoff values have not been standardized to date, and there is a lack of consensus on how best to use sequence homology data to identify a species (
2). Thus, sequence homology-based methods for the identification of fungi may be approaching the “gold standard,” but a critical parameter for the determination of relatedness, the percent standard homology value, has not been standardized. Other molecular methods that do not rely on pure sequence data can complement or altogether circumvent the need for the sequencing of genetic loci.
We previously developed a molecular identification method that uncovered
A. lentulus on the basis of sequence data for five genetic loci that included β-tubulin (
benA) (
4). β-Tubulin has proven to be useful for phylogenetic relatedness studies of
Aspergillus and related species (
3-
5,
8,
11,
16), because it appears to be a slowly evolving, conserved gene with a high degree of interspecies variability. Recently, an editorial addressing the molecular identification of
Aspergillus spp. recommended the use of comparative sequence analysis of β-tubulin for species identification, once isolates are assigned to a species complex or section (e.g., the section
Fumigati) on the basis of the nuclear ribosomal internal transcribed region and/or traditional morphological identification methods (
2). We have taken this identification method a step further and simplified it by avoiding sequence-based homology caveats. The PCR-RFLP described here takes advantage of BccI restriction site polymorphisms within
benA that are unique to
A. fumigatus,
A. lentulus, and
N. udagawae. This methodology can be used together with other identification methods to confirm the identities of
A. fumigatus isolates and discriminate those isolates from
A. lentulus and
N. udagawae. However, one limitation that we encountered was the inability to distinguish
A. fumigatus from
N. fischeri and
A. fumigatus var.
ellipticus. This is not surprising, as
N. fischeri and
A. fumigatus var.
ellipticus are closely related to
A. fumigatus phylogenetically (
8) and perhaps do not warrant separate species designations.
N. fischeri has been reported to cause less than five human infections, and
A. fumigatus var.
ellipticus has not been associated with disease in humans; thus, the clinical importance of these isolates remains undefined. Another related but apparently unusual causative agent of aspergillosis,
N. pseudofischeri, which displays decreased in vitro susceptibilities to voriconazole and amphotericin B (
3), was readily identified by using BccI
benA polymorphisms (Table and Fig. ).
Other previously unknown agents of aspergillosis have emerged from the analysis of atypical
A. fumigatus clinical isolates that were reclassified by molecular identification methods (
1,
14,
18). These
A. fumigatus-related organisms include
A. arvii,
A. fumisynnematus,
A. viridinutans,
A. fumigatiaffinis, and
N. hiratsukae, which may be of some clinical importance, as several of these species display reduced susceptibilities to multiple antifungal drugs (
1,
18). Because these organisms appear to be rare etiologic agents of aspergillosis, the sequence data from these isolates are limited and not available in sufficient numbers for the robust evaluation of our
benA PCR-RFLP method at this time.
The true prevalence of these closely related, non-
A.
fumigatus organisms as causes of human disease is unknown, and we do not yet understand the potential importance of their variable in vitro susceptibility profiles. However, an increased number of studies have reported these isolates, particularly
A. lentulus, among clinical culture collections (
1,
18). The method described herein will be useful both for microbiology laboratories and for investigations evaluating the prevalence and significance of these newly described opportunistic pathogens.