Prevalence of azole-resistant<i>Aspergillus fumigatus</i>in the environment of Thailand

Tangwattanachuleeporn, Marut; Minarin, Nanthakan; Saichan, Saranya; Sermsri, Pornsuda; Mitkornburee, Ruthairat; Groß, Uwe; Chindamporn, Ariya; Bader, Oliver

doi:10.1093/mmy/myw090

Cited by 31 publications

(39 citation statements)

References 37 publications

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“…The isolates carrying TR 46 /Y121F/T289A allele were grouped into four csp1 subtypes: t01 (1/6), t02 (3/6), t09 (1/6) and t18 (1/6). The control isolate Af293, which was isolated from a patient with invasive aspergillosis belonged to csp1 subtype t06 and the azole resistant control isolate BUU09 belonged to the t04B csp1 subtype, which agreed with previously published results (24).…”

Section: Resultssupporting

confidence: 91%

“…Prevalence of AR Af in the UK was found to be lower than that of other European countries and Colombia (15, 17, 25–29), but higher than most Asian countries (24, 30–33), with the exception of India (29, 34). Our findings are also in close agreement with a recent UK-based environmental prevalence study in Wales, where AR Af was detected in 4.5% (30/671) of soil samples, with resistance predominantly found in urban city locations (13).…”

Section: Discussionmentioning

confidence: 67%

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Elevated prevalence of azole resistant Aspergillus fumigatus in urban versus rural environments in the United Kingdom

Sewell¹,

Zhang²,

Brackin³

et al. 2019

Preprint

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8Azole resistance in the opportunistic pathogen Aspergillus fumigatus is increasing, dominated primarily 9 by two environmentally-associated resistance alleles: TR34/L98H and TR46/Y121F/T289A. Using an 10 environmental sampling strategy across the South of England we assess the prevalence of azole resistant 11 A. fumigatus (ARAf) in soil samples collected in both urban and rural locations. We characterise the 12 susceptibility profiles of the resistant isolates to three medical azoles, identify the underlying genetic 13 basis of resistance and investigate their genetic relationships. ARAf was detected in 6.7% of the soil 14 samples, with a higher prevalence in urban (13.8%) compared to rural (1.1%) locations. Nineteen 15 isolates were confirmed to exhibit clinical breakpoints for resistance to at least one of three medical 16 azoles, with 18 isolates exhibiting resistance to itraconazole, four to voriconazole, with two also showing 17 additional elevated minimum inhibitory concentration to posaconazole. Thirteen of the resistant isolates 18 harboured the TR34/L98H resistance allele and six isolates carried TR46/Y121F/T289A allele. The 19 azole-19 resistant isolates were spread across five csp1 genetic subtypes, t01, t02, t04B, t09 and t18 with t02 the 20 predominant subtype. Our study demonstrates that ARAf can be easily isolated in the South of England, 21 especially in urban city centres, which appear to play an important role in the epidemiology of 22 environmentally-linked drug resistant A. fumigatus. 23 24

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Section: Resultssupporting

confidence: 91%

Section: Discussionmentioning

confidence: 67%

Elevated prevalence of azole resistant Aspergillus fumigatus in urban versus rural environments in the United Kingdom

Sewell¹,

Zhang²,

Brackin³

et al. 2019

Preprint

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“…Prevalence of ARAf in the UK was found to be lower than that of other European countries and Colombia (16,18,(25)(26)(27)(28)(29) but higher than most Asian countries (24,(30)(31)(32)(33), with the exception of India (29,34). Our findings are also in close agreement with a recent UK-based environmental prevalence study in Wales, where ARAf was detected in 4.5% (30/671) of soil samples, with resistance predominantly found in urban city locations (14).…”

Section: Discussionsupporting

confidence: 91%

Elevated Prevalence of Azole-Resistant Aspergillus fumigatus in Urban versus Rural Environments in the United Kingdom

Sewell

Zhang

Brackin

et al. 2019

Antimicrob Agents Chemother

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Azole resistance in the opportunistic pathogen Aspergillus fumigatus is increasing, dominated primarily by the following two environmentally associated resistance alleles: TR34/L98H and TR46/Y121F/T289A. By sampling soils across the South of England, we assess the prevalence of azole-resistant A. fumigatus (ARAf) in samples collected in both urban and rural locations. We characterize the susceptibility profiles of the resistant isolates to three medical azoles, identify the underlying genetic basis of resistance, and investigate their genetic relationships. ARAf was detected in 6.7% of the soil samples, with a higher prevalence in urban (13.8%) than rural (1.1%) locations. Twenty isolates were confirmed to exhibit clinical breakpoints for resistance to at least one of three medical azoles, with 18 isolates exhibiting resistance to itraconazole, 6 to voriconazole, and 2 showing elevated minimum inhibitory concentrations to posaconazole. Thirteen of the resistant isolates harbored the TR34/L98H resistance allele, and six isolates carried the TR46/Y121F/T289A allele. The 20 azole-resistant isolates were spread across five csp1 genetic subtypes, t01, t02, t04B, t09, and t18 with t02 being the predominant subtype. Our study demonstrates that ARAf can be easily isolated in the South of England, especially in urban city centers, which appear to play an important role in the epidemiology of environmentally linked drug-resistant A. fumigatus.

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“…Another study compared the prevalence and CYP51A mutations of clinical and environmental ARAF in different geographic areas of Germany and found a higher prevalence of TR 34 /L98H and TR 46 /Y121F/T289A isolates in the environment than in clinical isolates (4%‐15% vs 0%‐3%), whereas some other mutations, such as G54W or M220L, were only present in clinical isolates . Furthermore, except a study in which TR 46 /Y121F/T289A isolates were found in the home of patient with IA, and another one assessing eight domiciles in the Netherlands, most environmental ARAF were isolated from soil or outdoor/indoor air samples in hospitals …”

Section: Introductionmentioning

confidence: 99%

“…20 Furthermore, except a study in which TR 46 /Y121F/ T289A isolates were found in the home of patient with IA, 19 and another one assessing eight domiciles in the Netherlands, 21 most environmental ARAF were isolated from soil or outdoor/indoor air samples in hospitals. [22][23][24][25] In this study, we aimed to determine the prevalence of ARAF in azole-naïve COPD patients and their homes, and assess whether CYP51A mutations of ARAF isolates were similar in clinical and environmental reservoirs, in order to evaluate if the domestic mold environmental exposure could be a risk factor for the acquisition of ARAF isolates in these patients.…”

Section: Introductionmentioning

confidence: 99%

Emergence ofAspergillus fumigatusazole resistance in azole-naïve patients with chronic obstructive pulmonary disease and their homes

et al. 2017

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Azole-resistant Aspergillus fumigatus (ARAF) has been reported in patients with chronic obstructive pulmonary disease (COPD) but has not been specifically assessed so far. Here, we evaluated ARAF prevalence in azole-naïve COPD patients and their homes, and assessed whether CYP51A mutations were similar in clinical and environmental reservoirs. Sixty respiratory samples from 41 COPD patients with acute exacerbation and environmental samples from 36 of these patient's homes were prospectively collected. A. fumigatus was detected in respiratory samples from 11 of 41 patients (27%) and in 15 of 36 domiciles (42%). Cyp51A sequencing and selection on itraconazole medium of clinical (n = 68) and environmental (n = 48) isolates yielded ARAF detection in 1 of 11 A. fumigatus colonized patients with COPD (9%) and 2 of 15 A. fumigatus-positive patient's homes (13%). The clinical isolate had no CYP51A mutation. Two environmental isolates from two patients harbored TR /L98H mutation, and one had an H285Y mutation. Coexistence of different cyp51A genotypes and/or azole resistance profiles was detected in 3 of 8 respiratory and 2 of 10 environmental samples with more than one isolate, confirming the need for a systematic screening of all clinically relevant isolates. The high prevalence of ARAF in patients with COPD and their homes supports the need for further studies to assess the prevalence of azole resistance in patients with Aspergillus diseases in Northern France.

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Prevalence of azole-resistantAspergillus fumigatusin the environment of Thailand

Cited by 31 publications

References 37 publications

Elevated prevalence of azole resistant Aspergillus fumigatus in urban versus rural environments in the United Kingdom

Elevated prevalence of azole resistant Aspergillus fumigatus in urban versus rural environments in the United Kingdom

Elevated Prevalence of Azole-Resistant Aspergillus fumigatus in Urban versus Rural Environments in the United Kingdom

Emergence ofAspergillus fumigatusazole resistance in azole-naïve patients with chronic obstructive pulmonary disease and their homes

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