Background: The rate of infections caused by Aspergillus
in patients with immune deficiency has increased during
the past decade. Pulmonary aspergillosis (PA) is one of the
main causes of mortality in such patients. Non-fumigatus
Aspergillus species are the leading cause of PA in countries
located in tropical and subtropical climate zones.
Bronchoalveolar lavage (BAL) specimen is one of the
useful specimens for diagnosis of PA. In this study,
Aspergillus isolated from BAL specimens of patients with
suspected PA were identified by a molecular method.
Material & Methods: In a prospective study between 2015
and 2016, a total of 150 BAL specimens was collected from
patients with pulmonary disorders and underlying
immunodeficiencies in Northeastern Iran in the Middle
East. The originating Aspergillus strains were
phylogenetically identified at the species level by analyzing
partial β-tubulin gene sequences.
Results: Of the patients, 18 (12%) had a probable IPA with
13 (8.7%) positive direct examination and 20 (13.3%)
positive culture for Aspergillus. Overall, Aspergillus
species were isolated from 10 (50%) patients with cancer, 5
(25%) patients receiving corticosteroid therapy, 3 (15%)
organ transplant recipients and 2 (10%) patients admitted to
intensive care unit (ICU). A. flavus complex was the
predominant 15 (75%) cause of probable invasive
pulmonary aspergillosis (IPA), followed by A. tubingensis
3 (15%), and 2 (10%) A. fumigates complex.
Conclusion: The distribution of Aspergillus species in
patients with PA in the tropical region of northeastern Iran
in the Middle East shows a predominance of the more non-
fumigatus Aspergillus spp. In addition, the cancer patients,
particularly with hematological malignancies showed a
relatively high incidence of IPA.

2 / Predominance of non-fumigatus Aspergillus species among patients suspected to pulmonary aspergillosis in a tropical and subtropical region