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Isolation of Culturable Yeasts and Molds from Soils to Investigate Fungal Population Structure
Published on: May 27, 2022
[Azole-resistant invasive aspergillosis].
Jan W van der Linden1, Adilia Warris, Jos W van der Meer
1Universitair Medisch Centrum St. Radboud, Afd. Medische Microbiologie, Nijmegen, The Netherlands. j.vanderlinden@mmb.umcn.nl
Nederlands Tijdschrift Voor Geneeskunde
|January 7, 2010
Summary
Triazole-resistant Aspergillus fumigatus causes invasive aspergillosis in immunocompromised patients. This resistance complicates treatment, necessitating alternative antifungal strategies and highlighting potential environmental sources of resistance.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Medicine
Background:
- Invasive aspergillosis is a serious fungal infection, particularly in immunocompromised individuals.
- Medical azoles (itraconazole, voriconazole) are standard treatments for invasive aspergillosis.
- Emergence of azole resistance in Aspergillus fumigatus poses a significant clinical challenge.
Observation:
- Two cases of invasive pulmonary aspergillosis caused by medical triazole-resistant Aspergillus fumigatus are presented.
- Case 1: A patient with chronic granulomatous disease developed pulmonary aspergillosis despite itraconazole prophylaxis; the isolate was azole-resistant and treated successfully with caspofungin.
- Case 2: A patient with acute lymphoid leukemia developed pulmonary aspergillosis refractory to voriconazole, with dissemination to the brain; an azole-resistant isolate was identified, and despite combination therapy, the patient died.
Findings:
- Aspergillus fumigatus isolates exhibiting resistance to medical azoles were identified in both patients.
- Treatment outcomes varied, with one patient responding to caspofungin and the other succumbing to the infection despite aggressive combination therapy.
- Evidence suggests azole resistance in A. fumigatus may arise from both patient treatment and environmental exposure to agricultural azole fungicides.
Implications:
- Azole resistance in Aspergillus fumigatus complicates the management of invasive aspergillosis.
- Treatment failure in invasive aspergillosis should prompt consideration of azole resistance.
- Monitoring for and understanding the sources of azole resistance in Aspergillus fumigatus are crucial for effective patient management and public health.
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