The DOI matches its Crossref record; 91 of the 91 references it cites were found in a registry or an index.
Clinical implications of globally emerging azole resistance in Aspergillus fumigatus
Open accessAbstract
Aspergillus fungi are the cause of an array of diseases affecting humans, animals and plants. The triazole antifungal agents itraconazole, voriconazole, isavuconazole and posaconazole are treatment options against diseases caused by Aspergillus . However, resistance to azoles has recently emerged as a new therapeutic challenge in six continents. Although de novo azole resistance occurs occasionally in patients during azole therapy, the main burden is the aquisition of resistance through the environment. In this setting, the evolution of resistance is attributed to the widespread use of azole-based fungicides. Although ubiquitously distributed, A. fumigatus is not a phytopathogen. However, agricultural fungicides deployed against plant pathogenic moulds such as Fusarium , Mycospaerella and A. flavus also show activity against A. fumigatus in the environment and exposure of non-target fungi is inevitable. Further, similarity in molecule structure between azole fungicides and antifungal drugs results in cross-resistance of A. fumigatus to medical azoles. Clinical studies have shown that two-thirds of patients with azole-resistant infections had no previous history of azole therapy and high mortality rates between 50% and 100% are reported in azole-resistant invasive aspergillosis. The resistance phenotype is associated with key mutations in the cyp51A gene, including TR 34 /L98H, TR 53 and TR 46 /Y121F/T289A resistance mechanisms. Early detection of resistance is of paramount importance and if demonstrated, either with susceptibility testing or through molecular analysis, azole monotherapy should be avoided. Liposomal amphotericin B or a combination of voriconazole and an echinocandin are recomended for azole-resistant aspergillosis. This article is part of the themed issue ‘Tackling emerging fungal threats to animal health, food security and ecosystem resilience’.
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1 retracted
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Self-citationAneuploidy and Isochromosome Formation in Drug-Resistant Candida albicans
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Emergence of Azole Resistance in Aspergillus fumigatus and Spread of a Single Resistance Mechanism
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Azole resistance in Aspergillus fumigatus: a side-effect of environmental fungicide use?
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Cited by
Worldwide emergence of resistance to antifungal drugs challenges human health and food security
Fisher, M. C., Hawkins, N. J., Sanglard, D., & Gurr, S. J. (2018) · Science · doi:10.1126/science.aap7999 · Cited by 1,555
Self-citationEnvironmental Hotspots for Azole Resistance Selection of Aspergillus fumigatus , the Netherlands
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Self-citationTriazole resistance surveillance in Aspergillus fumigatus
Resendiz Sharpe, A., Lagrou, K., Meis, J. F., Chowdhary, A., Lockhart, S. R., Verweij, P. E., & on behalf of the ISHAM/ECMM Aspergillus Resistance Surveillance working group (2018) · Medical Mycology · doi:10.1093/mmy/myx144 · Cited by 150
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Metadata
- Authors
- Meis, J. F., Chowdhary, A., Rhodes, J. L., Fisher, M. C., & Verweij, P. E.
- Venue
- Philosophical Transactions of the Royal Society B: Biological Sciences
- Publisher
- The Royal Society
- Published
- 2016-12-05
- Volume
- 371
- Issue
- 1709
- Pages
- 20150460
- ISSN
- 0962-8436 (ISSN-L)
- 1471-2970
- OpenAlex
- W2535481478
- Cited by
- 308
- References
- 91
- FWCI
- 23.52
- Type
- journal article
- Language
- en
- Open access
- bronze
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