title: Antifungal susceptibility and phylogeny of opportunistic members of the order mucorales.
abstract: The in vitro susceptibilities of 66 molecularly identified strains of the Mucorales to eight antifungals (amphotericin B, terbinafine, itraconazole, posaconazole, voriconazole, caspofungin, micafungin, and 5-fluorocytosine) were tested. Molecular phylogeny was reconstructed based on the nuclear ribosomal large subunit to reveal taxon-specific susceptibility profiles. The impressive phylogenetic diversity of the Mucorales was reflected in susceptibilities differing at family, genus, and species levels. Amphotericin B was the most active drug, though somewhat less against Rhizopus and Cunninghamella species. Posaconazole was the second most effective antifungal agent but showed reduced activity in Mucor and Cunninghamella strains, while voriconazole lacked in vitro activity for most strains. Genera attributed to the Mucoraceae exhibited a wide range of MICs for posaconazole, itraconazole, and terbinafine and included resistant strains. Cunninghamella also comprised strains resistant to all azoles tested but was fully susceptible to terbinafine. In contrast, the Lichtheimiaceae completely lacked strains with reduced susceptibility for these antifungals. Syncephalastrum species exhibited susceptibility profiles similar to those of the Lichtheimiaceae. Mucor species were more resistant to azoles than Rhizopus species. Species-specific responses were obtained for terbinafine where only Rhizopus arrhizus and Mucor circinelloides were resistant. Complete or vast resistance was observed for 5-fluorocytosine, caspofungin, and micafungin. Intraspecific variability of in vitro susceptibility was found in all genera tested but was especially high in Mucor and Rhizopus for azoles and terbinafine. Accurate molecular identification of etiologic agents is compulsory to predict therapy outcome. For species of critical genera such as Mucor and Rhizopus, exhibiting high intraspecific variation, susceptibility testing before the onset of therapy is recommended.
authors.affiliation: CONICETa and Ramos Mejia Hospital, Parasitology Unit, Mycology Section,b Buenos Aires, Argentina.
authors.forename: Roxana G
authors.initials: RG
authors.lastname: Vitale
authors.forename: G Sybren
authors.initials: GS
authors.lastname: de Hoog
authors.forename: Patrick
authors.initials: P
authors.lastname: Schwarz
authors.forename: Eric
authors.initials: E
authors.lastname: Dannaoui
authors.forename: Shuwen
authors.initials: S
authors.lastname: Deng
authors.forename: Marie
authors.initials: M
authors.lastname: Machouart
authors.forename: Kerstin
authors.initials: K
authors.lastname: Voigt
authors.forename: Wendy W J
authors.initials: WW
authors.lastname: van de Sande
authors.forename: Somayeh
authors.initials: S
authors.lastname: Dolatabadi
authors.forename: Jacques F
authors.initials: JF
authors.lastname: Meis
authors.forename: Grit
authors.initials: G
authors.lastname: Walther
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D016000:Cluster Analysis; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D020459:Genes, rRNA; D014644:Genetic Variation; D006801:Humans; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D009090:Mucorales / Q000145:classification* / Q000187:drug effects* / Q000235:genetics; D010802:Phylogeny; D012331:RNA, Fungal / Q000235:genetics; D012335:RNA, Ribosomal / Q000235:genetics; D017422:Sequence Analysis, DNA
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D004275:DNA, Ribosomal; D012331:RNA, Fungal; D012335:RNA, Ribosomal; C065096:RNA, ribosomal, 26S
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