First Confirmed Description of Acremonium egyptiacum from Greece and Molecular Identification of Acremonium and Acremonium-like Clinical Isolates

<i>Acremonium</i> and the recently separated acremonium-like genera, such as <i>Sarocladium</i>, are emerging causes of opportunistic disease in humans, mainly post-traumatic infections in immunocompetent hosts, but also invasive infections in immunocompromised patients, such as those undergoing transplantation. <i>Acremonium egyptiacum</i> has emerged as the major pathogenic <i>Acremonium</i> species in humans, implicated mainly in nail but also in disseminated and organ specific infections. In this first study of acremonium-like clinical isolates in Greece, 34 isolates were identified and typed by sequencing the internal transcribed spacer, and their antifungal susceptibility was determined by a modified CLSI standard M38 3rd Edition method for filamentous fungi. <i>A. egyptiacum</i> was the primary species (18 isolates) followed by <i>Sarocladium kiliense</i> (8), <i>Acremonium charticola</i>, <i>Gliomastix polychroma</i>, <i>Proxiovicillium blochii</i>, <i>Sarocladium terricola</i>, <i>Sarocladium zeae</i>, and <i>Stanjemonium dichromosporum</i> (all with one isolate). Two isolates, each with a novel ITS sequence, possibly represent undescribed species with an affinity to <i>Emericellopsis</i>. All three <i>A. egyptiacum</i> ITS barcode types described to date were identified, with 3 being the major type. Flutrimazole, lanoconazole, and luliconazole presented the lower minimum inhibitory concentration (MIC) values against <i>A. egyptiacum</i>, with a geometric mean (GM) MIC of 2.50, 1.92, and 1.57 μg/mL, respectively. Amphotericin B, itraconazole, posaconazole, voriconazole, terbinafine, amorolfine, and griseofulvin MICs were overall high (GM 12.79-29.49 μg/mL). An analysis of variance performed on absolute values showed that flutrimazole, lanoconazole, and luliconazole were equivalent and notably lower than those of all the other drugs tested against <i>A. egyptiacum</i>. Antifungal susceptibility of the three different <i>A. egyptiacum</i> genotypes was homogeneous. Overall, the high MICs recorded for all systemically administered drugs, and for some topical antifungals against the tested <i>A. egyptiacum</i> and other acremonium-like clinical isolates, justify the routine susceptibility testing of clinical isolates.