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Airway persistence by the emerging multi-azole-resistant Rasamsonia argillacea complex in cystic fibrosis

Alireza Abdolrasouli1, Amelia C Bercusson1, Johanna L Rhodes2

  • 1Fungal Pathogens Laboratory, National Heart and Lung Institute, Imperial College London, London, UK.

Mycoses
|April 28, 2018
PubMed

Insights

Rasamsonia argillacea complex infections in cystic fibrosis (CF) patients show variable clinical impact. Antifungal susceptibility testing revealed resistance to azoles but susceptibility to echinocandins, with some patients experiencing lung function decline.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Pulmonology

Background:

  • Rasamsonia argillacea complex (RAC) infections are increasingly reported in clinical settings.
  • Cystic fibrosis (CF) is a significant underlying condition associated with RAC colonization.
  • The clinical significance and antifungal susceptibility of RAC in CF patients require further investigation.

Purpose of the Study:

  • To investigate the clinical impact of RAC colonization in CF patients.
  • To determine the antifungal susceptibility profile of RAC isolates from CF patients.
  • To explore the persistence and genotypic characteristics of RAC in CF airways.

Main Methods:

  • Observational cohort study of CF patients with RAC in respiratory samples.
  • Identification and antifungal susceptibility testing (MICs for azoles, MECs for echinocandins) of 8 RAC isolates from 6 patients.
  • Genotyping of RAC isolates to assess persistence.

Main Results:

  • All 8 RAC isolates exhibited high Minimum Inhibitory Concentrations (MICs) to voriconazole and posaconazole, and low Minimum Effective Concentrations (MECs) to echinocandins.
  • Four out of six patients experienced lung function decline around the time of RAC isolation.
  • Three patients died within 3 years of RAC isolation; only one of two treated patients responded to antifungal therapy.

Conclusions:

  • RAC colonization in CF airways can be persistent, with similar genotypes observed.
  • The clinical impact of RAC in CF is variable, ranging from driving clinical decline to acting as a marker of disease severity or having no obvious impact.
  • RAC isolates demonstrate intrinsic resistance to azoles and susceptibility to echinocandins, guiding potential therapeutic strategies.
Keywords:
Rasamsonia argillacea species complexantifungal susceptibility testingcystic fibrosisgenotypingoutcome

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