Emergence of Azole-Resistant Aspergillus fumigatus from Immunocompromised Hosts in India
Yubhisha Dabas1, Immaculata Xess2, Sameer Bakshi3
1Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Antimicrobial Agents and Chemotherapy
|June 13, 2018
Abstract:
This prospective study shows that the rate of azole-resistant Aspergillus fumigatus (ARAF) in an immunocompromised Indian patient population with invasive aspergillosis (IA) is low, 6/706 (0.8%). This low rate supports the continued use of voriconazole as the first line of treatment. However, the ARAF isolates from India in this study exhibited three kinds of unreported cyp51A mutations, of which two were at hot spots, G54R and P216L, while one was at codon Y431C.
Insights
The rate of azole-resistant Aspergillus fumigatus in Indian patients with invasive aspergillosis is low. This finding supports voriconazole as a primary treatment, despite new cyp51A mutations observed in resistant strains.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Invasive aspergillosis (IA) is a serious fungal infection, particularly in immunocompromised individuals.
- Azole antifungals are standard treatment, but resistance is a growing concern.
- Aspergillus fumigatus is the most common causative agent of IA.
Purpose of the Study:
- To determine the prevalence of azole-resistant Aspergillus fumigatus (ARAF) in Indian patients with IA.
- To identify novel mutations in the cyp51A gene associated with azole resistance.
- To inform antifungal treatment guidelines in the Indian subcontinent.
Main Methods:
- Prospective study design.
- Culturing and antifungal susceptibility testing of Aspergillus isolates from patients with IA.
- Molecular analysis of the cyp51A gene in resistant isolates.
Main Results:
- A low prevalence of ARAF was observed (0.8%, 6/706 patients).
- No previously reported cyp51A mutations were found in the susceptible isolates.
- Three novel cyp51A mutations were identified in the ARAF isolates: G54R, P216L, and Y431C.
Conclusions:
- The prevalence of ARAF in this Indian cohort is low, supporting voriconazole as a first-line agent.
- Novel cyp51A mutations in ARAF isolates highlight the need for ongoing surveillance.
- Further research is needed to understand the clinical impact of these new mutations.
Related Concept Videos
01:27Emerging Adulthood
715
Jeffrey Arnett's concept of emerging adulthood offers a framework to understand the unique developmental stage between adolescence and full-fledged adulthood, generally from ages 18 to 25. This period is marked by extensive exploration and shifts in identity, relationships, and career choices, a process known in psychology as role experimentation. Emerging adulthood reflects the evolving cultural expectations surrounding adulthood and the dynamic process of personal transformation during...
715
01:30Introduction Cardiac Emergencies
376
Cardiac emergencies are critical situations involving the heart that require immediate medical intervention to prevent severe complications or death. These emergencies often arise from underlying heart conditions that impair the heart's ability to function correctly.Types of Cardiac EmergenciesThe most common types of cardiac emergencies include Acute Coronary Syndrome (ACS), myocardial infarction (MI), cardiac arrest, and heart failure.Acute Coronary Syndrome (ACS)Acute Coronary Syndrome (ACS)...
376
01:22Resistivity
4.6K
When a voltage is applied to a conductor, an electrical field is generated, and charges in the conductor feel the force due to the electrical field. The current density that results depends on the electrical field and the properties of the material. In some materials, including metals at a given temperature, the current density is approximately proportional to the electrical field. In these cases, the current density can be modeled as:
4.6K
01:19Resistance
6.0K
When a current moves through any conductor, the conductor causes some level of difficulty for the current to flow. The measure of that difficulty is known as the resistance of the material and is represented by R. Every material has its own resistance. In the case of conductors, heat is emitted whenever a current passes through them. Resistance depends on the resistivity of the material. Resistivity is a characteristic of the material used to fabricate electrical components, whereas the...
6.0K
01:29Applications of GIS: Disaster Management and Emergency Response
535
Geographic Information System (GIS) technology is essential for risk identification, action prioritization, and resource optimization in critical situations like flooding and earthquakes. By integrating spatial and demographic data, GIS provides a comprehensive framework for emergency response.GIS integrates data layers, like rainfall intensity, topography, elevation profiles, and river levels, to model high-risk flood zones. These layers assess areas susceptible to flooding based on their...
535
01:16Equivalent Resistance
991
In circuit analysis, situations often arise where resistors are neither in series nor parallel configurations. To tackle such scenarios, three-terminal equivalent networks like the wye (Y) (Figure 1 (a)) or tee (T) and delta (Δ) (Figure 1 (b)) or pi (π) networks come into play. These networks offer versatile solutions and are frequently encountered in various applications, including three-phase electrical systems, electrical filters, and matching networks.
991