Journal Article

Acquired antifungal drug resistance in <i>Aspergillus fumigatus</i>: epidemiology and detection

Susan Julie Howard and Maiken Cavling Arendrup

in Medical Mycology

Published on behalf of International Society for Human and Animal Mycology

Volume 49, issue Supplement_1, pages S90-S95
Published in print April 2011 | ISSN: 1369-3786
Published online April 2011 | e-ISSN: 1460-2709 | DOI: http://dx.doi.org/10.3109/13693786.2010.508469
Acquired antifungal drug resistance in Aspergillus fumigatus: epidemiology and detection

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  • Mycology and Fungi
  • Infectious Diseases
  • Medical Toxicology
  • Veterinary Medicine
  • Environmental Science

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Voriconazole is the recommended agent for invasive aspergillosis, with lipid amphotericin B or caspofungin as second line treatment choices. Being the only agents available in oral formulation, azoles are used in chronic infections and often over longer time periods. In addition to being used in clinical medicine, azoles are employed extensively in agriculture. Azole-resistant Aspergillus has been isolated in azole naïve patients, in azole exposed patients and in the environment. The primary underlying mechanism of resistance is as a result of alterations in the cyp51A target gene, with a variety of mutations found in clinical isolates but just one identified in a environmental strain (a point mutation at codon 98 accompanied by a tandem repeat in the promoter region). Much less is currently known about echinocandin resistance in Aspergillus, in part because susceptibility testing is not routinely performed and because the methods suffer from technical difficulties and suboptimal reproducibility. Clinical breakthrough cases have been reported however, and resistance has been confirmed in vivo. In this paper we review the current knowledge on epidemiology, susceptibility testing and underlying mechanisms involved in azole and echinocandin resistance in Aspergillus.

Keywords: Aspergillus fumigatus; echinocandin; azole; resistance

Journal Article.  3302 words. 

Subjects: Mycology and Fungi ; Infectious Diseases ; Medical Toxicology ; Veterinary Medicine ; Environmental Science

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