Azole Resistance in Aspergillus fumigatus: Can We Retain the Clinical Use of Mold-Active Antifungal Azoles?

Paul E Verweij, Anuradha Chowdhary, Willem J G Melchers, Jacques F Meis, Paul E Verweij, Anuradha Chowdhary, Willem J G Melchers, Jacques F Meis

Abstract

Azole resistance in Aspergillus fumigatus has emerged as a global health problem. Although the number of cases of azole-resistant aspergillosis is still limited, resistance mechanisms continue to emerge, thereby threatening the role of the azole class in the management of diseases caused by Aspergillus. The majority of cases of azole-resistant disease are due to resistant A. fumigatus originating from the environment. Patient management is difficult due to the absence of patient risk factors, delayed diagnosis, and limited treatment options, resulting in poor treatment outcome. International and collaborative efforts are required to understand how resistance develops in the environment to allow effective measures to be implemented aimed at retaining the use of azoles both for food production and human medicine.

Keywords: aspergilloma; azole fungicides; chronic pulmonary aspergillosis; emergence of azole resistance; invasive aspergillosis.

© The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Shaded areas show countries that have reported the TR34/L98H and TR46/Y121F/T289A resistance mechanism in clinical or environmental Aspergillus fumigatus isolates.

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