Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021;15(3):93-103.
doi: 10.1007/s12281-021-00418-6. Epub 2021 May 19.

Emergence of Triazole Resistance in Aspergillus spp. in Latin America

Daiana Macedo  1   2 , Florencia Leonardelli  2 , Soledad Gamarra  2 , Guillermo Garcia-Effron  1   2
Affiliations
Review

Emergence of Triazole Resistance in Aspergillus spp. in Latin America

Daiana Macedo et al. Curr Fungal Infect Rep. 2021.

Abstract

Purpose of review: Azole resistance in Aspergillus spp. is becoming a public health problem worldwide. However, data about this subject is lacking in Latin American countries. This review focuses in the epidemiology and molecular mechanisms of azole resistance in Aspergillus spp. emphasizing in Latin America. Data on Aspergillus fumigatus stands out because it is the most prevalent Aspergillus spp. pathogen.

Recent findings: Azole resistance in Aspergillus spp. emergence was linked with intensive use of these antifungals both in the clinical setting and in the environment (as pesticides). Reports on azole-resistant A. fumigatus strains are being constantly published in different countries. Molecular mechanisms of resistance mainly involve substitution in the azole target (CYP51A) and/or overexpression of this gene. However, several other non-CYP51A-related mechanisms were described. Moreover, intrinsically resistant cryptic Aspergillus species are starting to be reported as human pathogens.

Summary: After a comprehensive literature review, it is clear that azole resistance in Aspergillus spp. is emerging in Latin America and perhaps it is underestimated. All the main molecular mechanisms of azole resistance were described in patients and/or environmental samples. Moreover, one of the molecular mechanisms was described only in South America. Cryptic intrinsic azole-resistant species are also described.

Keywords: Aspergillus; Latin America; Resistance; Triazole.

PubMed Disclaimer

Conflict of interest statement

Conflict of InterestMacedo Daiana, Leonardelli Florencia, Gamarra Soledad, and Garcia-Effron Guillermo declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
CYP51A-related azole resistance mechanisms. The named hot spots are based on the names suggested by Dudakova et al. (ref). ITC, itraconazole; PSC, posaconazole; VRC, voriconazole; Pan-R, pan-azole resistance; ITC-R, resistance to itraconazole alone; ITC-PSC-R, cross itraconazole-posaconazole resistance; VRC-R, voriconazole resistance. *L98H was described to be either alone or together with other substitutions
Fig. 2
Fig. 2
Distribution of the described azole resistant strains in South America
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

Refereences

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
    1. Latgé, J.P., Chamilos, G. Aspergillus fumigatus and aspergillosis in 2019. Clin. Microbiol. Rev. 2020; 33: doi:10.1128/CMR.00140-18. A good review written by one of the most renowned researcher onAspergillus fumigatus.It includes a comprehensive and actual description of the biological cycle; spectrum of disease, immune response, virulence, diagnostic tools and antifungal treatments. In adition new concepts are described.
    1. Dagenais TRT, Keller NP. Pathogenesis of Aspergillus fumigatus in invasive aspergillosis. Clin Microbiol Rev. 2009;22:447–465. doi: 10.1128/CMR.00055-08. - DOI - PMC - PubMed
    1. Gautier M, Normand AC, Ranque S. Previously unknown species of Aspergillus. Clin Microbiol Infect. 2016;22:662–669. doi: 10.1016/j.cmi.2016.05.013. - DOI - PubMed
    1. Denning DW. Invasive aspergillosis. Clin Infect Dis. 1998;26:781–805. doi: 10.1086/513943. - DOI - PubMed
    1. Morgan J, Wannemuehler KA, Marr KA, Hadley S, Kontoyiannis DP, Walsh TJ, Fridkin SK, Pappas PG, Warnock DW. Incidence of invasive aspergillosis following hematopoietic stem cell and solid organ transplantation: interim results of a prospective multicenter surveillance program. Med Mycol. 2005;43:49–58. doi: 10.1080/13693780400020113. - DOI - PubMed

LinkOut - more resources