Clonal Expansion of Environmental Triazole Resistant Aspergillus fumigatus in Iran

Ahangarkani, Fatemeh; Badali, Hamid; Abbasi, Kiana; Nabili, Mojtaba; Khodavaisy, Sadegh; Groot, Theun de; Meis, Jacques F.

doi:10.3390/jof6040199

Cited by 17 publications

(30 citation statements)

References 42 publications

(69 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared to genotypes of resistant and wild‐type isolates obtained from other European countries, 33 isolates of the ARiA study belong to completely different genotypes, in agreement with previous data that reports a high percentage of clonal isolates 34,35 and confirming that clonal expansion is occurring at local level.…”

Section: Discussionsupporting

confidence: 91%

Azole resistance in Aspergillus isolates by different types of patients and correlation with environment ‐ An Italian prospective multicentre study (ARiA study)

Prigitano

Esposto

Grancini

et al. 2021

Mycoses

View full text Add to dashboard Cite

Background A wide range of frequency of azole‐resistance in A fumigatus in different patient populations worldwide was observed threatening to reduce therapeutic options. Objectives Estimate the prevalence of azole‐resistance, investigate the molecular mechanisms of resistance, compare the genotypes of resistant clinical isolates with those from the surrounding environment. Methods Aspergillus isolates were collected by seven Italian hospital microbiology laboratories. Strains were isolated from different clinical samples from unselected patients. The azole‐resistance was evaluated using screening test and microdilution EUCAST method. The molecular mechanism of resistance was performed sequencing the cyp51A gene. Resistant isolates were genotyped by microsatellite analysis and their profiles compared with those of azole‐resistant isolates from previous Italian studies. Results 425 Aspergillus isolates from 367 patients were analysed. The azole‐resistance rates were 4.9% and 6.6% considering all Aspergillus spp. isolates and the A fumigatus sensu stricto, respectively. All resistant isolates except one were from a single hospital. Two rare azole‐resistant species were identified: A thermomutatus and A lentulus. The predominant resistance mechanism was TR34/L98H. No correlation between the clinical resistant strains and environmental isolates from patients’ home/work/ward was observed. The analysis of the molecular correlation between the resistant clinical strains collected in the present study and those of environmental and clinical origin collected in previous Italian studies reveals a progressive diversification of azole‐resistant genotypes starting from a founder azole‐resistant genotype. Conclusions This study confirms the trend of azole‐resistance rate in Italy, showing a geographical difference. Data reinforce the importance of surveillance programmes to monitor the local epidemiological situation.

show abstract

Section: Discussionsupporting

confidence: 91%

Azole resistance in Aspergillus isolates by different types of patients and correlation with environment ‐ An Italian prospective multicentre study (ARiA study)

Prigitano

Esposto

Grancini

et al. 2021

Mycoses

View full text Add to dashboard Cite

show abstract

“…So far, both clinical and environmental samples of ARAF have been found from Europe, America, Africa, New Zealand, the Middle East, and Asia (27,(43)(44)(45)(46)(47)(48)(49)(50)(51)(52). Traditionally, the emergence of azole resistance in A. fumigatus populations was believed due to longterm clinical azole therapy.…”

mentioning

confidence: 99%

Extensive Genetic Diversity and Widespread Azole Resistance in Greenhouse Populations of Aspergillus fumigatus in Yunnan, China

Zhou

Korfanty

et al. 2021

mSphere

View full text Add to dashboard Cite

Aspergillus fumigatus is the main cause of invasive aspergillosis (IA) with a high annual global incidence and mortality rate. Recent studies have indicated an increasing prevalence of azole-resistant A. fumigatus (ARAF) strains, with agricultural use of azole fungicides as a potential contributor. China has an extensive agricultural production system and uses a wide array of fungicides for crop production, including in modern growth facilities such as greenhouses. Soils in greenhouses are among the most intensively cultivated. However, little is known about the occurrence and distribution of ARAF in greenhouse soils. Here, we investigated genetic variation and triazole drug susceptibility in A. fumigatus from greenhouses around metropolitan Kunming in Yunnan, southwest China. Abundant allelic and genotypic variations were found among 233 A. fumigatus strains isolated from nine greenhouses in this region. Significantly, ∼80% of the strains were resistant to at least one medical triazole drug, with >30% showing cross-resistance to both itraconazole and voriconazole. Several previously reported mutations associated with triazole resistance in the triazole target gene cyp51A were also found in our strains, with a strong positive correlation between the frequency of mutations at the cyp51A promoter and that of voriconazole resistance. Phylogenetic analyses of cyp51A gene sequences showed evidence for multiple independent origins of azole-resistant genotypes of A. fumigatus in these greenhouses. Evidence for multiple origins of azole resistance and the widespread distributions of genetically very diverse triazole-resistant strains of A. fumigatus in greenhouses calls for significant attention from public health agencies. IMPORTANCE The origin and prevalence of azole-resistant Aspergillus fumigatus have been attracting increasing attention from biologists, clinicians, and public health agencies. Current evidence suggests agricultural fungicide use as a major cause. In southwest China, greenhouses are used to produce large amounts of fruits, flowers, and vegetables for consumers throughout China as well as those in other countries, primarily in southeast Asia. Here, we found a very high frequency (∼80%) of triazole-resistant A. fumigatus in our sample, the highest reported so far, with a significant proportion of these strains resistant to both tested agricultural fungicides and medical triazole drugs. In addition, we found novel allelic and genotypic diversities and evidence for multiple independent origins of azole-resistant genotypes of A. fumigatus in greenhouse populations in this region. Our study calls for a systematic evaluation of the effects of azole fungicide usage in greenhouses on human health.

show abstract

“…In this study, calmodulin gene was used to identify the Aspergillus isolate, which is one of the effective genes in the accurate identification of different species in this genus. An intriguing point in our study was that the isolated A fumigatus was resistant to caspofungin based on results of in vitro assays, which show the importance of antifungal resistance among isolates of A fumigatus in Iran 20,21 . Thus, this issue can be a concern, and therefore, experimental treatments should be limited except in special cases.…”

Section: Discussionmentioning

confidence: 83%

“…An intriguing point in our study was that the isolated A fumigatus was resistant to caspofungin based on results of in vitro assays, which show the importance of antifungal resistance among isolates of A fumigatus in Iran. 20,21 Thus, this issue can be a concern, and therefore, experimental treatments should be limited except in special cases.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of pulmonary aspergillosis due to Aspergillus fumigatus in a child affected by systemic lupus erythematosus: A case report from Northeastern Iran

Kashefi

Seyedi

Zomorodian

et al. 2021

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

Clonal Expansion of Environmental Triazole Resistant Aspergillus fumigatus in Iran

Cited by 17 publications

References 42 publications

Azole resistance in Aspergillus isolates by different types of patients and correlation with environment ‐ An Italian prospective multicentre study (ARiA study)

Azole resistance in Aspergillus isolates by different types of patients and correlation with environment ‐ An Italian prospective multicentre study (ARiA study)

Extensive Genetic Diversity and Widespread Azole Resistance in Greenhouse Populations of Aspergillus fumigatus in Yunnan, China

Successful treatment of pulmonary aspergillosis due to Aspergillus fumigatus in a child affected by systemic lupus erythematosus: A case report from Northeastern Iran

Contact Info

Product

Resources

About