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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.

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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

References

Refereences

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