title: Exploring azole antifungal drug resistance in Aspergillus fumigatus with special reference to resistance mechanisms.
abstract: Aspergillus fumigatus, a ubiquitously distributed opportunistic pathogen, is the global leading cause of aspergillosis. Azole antifungals play an important role in the management of aspergillosis. However, over a decade, azole resistance in A. fumigatus isolates has been increasingly reported with variable prevalence worldwide and it is challenging the effective management of aspergillosis. The high mortality rates observed in patients with invasive aspergillosis caused by azole-resistant A. fumigatus (ARAF) isolates pose serious challenges to the clinical microbiologist for timely identification of resistance and appropriate therapeutic interventions. The majority of ARAF isolates contain alterations in the cyp51A gene; however, there have been increasing reports on non-cyp51A mutations contributing to azole resistant phenotypes. This review highlights the emergence and various mechanisms implicated in the development of azole resistance in A. fumigatus. We further present recent developments related to the environmental route in the emergence of ARAF isolates and discuss the therapeutic options available.
authors: Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
authors: Anuradha
authors: A
authors: Chowdhary
authors: Cheshta
authors: C
authors: Sharma
authors: Ferry
authors: F
authors: Hagen
authors: Jacques F
authors: JF
authors: Meis
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy; D001232:Aspergillus fumigatus / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity; D001393:Azoles / Q000627:therapeutic use*; D002784:Cholesterol / Q000378:metabolism; D003577:Cytochrome P-450 Enzyme System / Q000096:biosynthesis / Q000235:genetics*; D025141:Drug Resistance, Fungal / Q000235:genetics*; D005656:Fungal Proteins / Q000096:biosynthesis / Q000235:genetics*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D009154:Mutation; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D005656:Fungal Proteins; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D003577:Cytochrome P-450 Enzyme System; D002784:Cholesterol; C465526:cytochrome P-450 CYP51A, Aspergillus; C465527:cytochrome P-450 CYP51B, Aspergillus; D065819:Voriconazole
keywords: Aspergillus fumigatus; TR34/L98H mutation; TR46/Y121F/T289A mutation; aspergillosis; environment; non-cyp51A mutation; resistance mechanism