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Lancet Infect Dis. 2009 Dec;9(12):789-95. doi: 10.1016/S1473-3099(09)70265-8.

Azole resistance in Aspergillus fumigatus: a side-effect of environmental fungicide use?

Author information

1
Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. p.verweij@mmb.umcn.nl

Abstract

Invasive aspergillosis due to multi-azole-resistant Aspergillus fumigatus has emerged in the Netherlands since 1999, with 6.0-12.8% of patients harbouring resistant isolates. The presence of a single resistance mechanism (denoted by TR/L98H), which consists of a substitution at codon 98 of cyp51A and a 34-bp tandem repeat in the gene-promoter region, was found in over 90% of clinical A fumigatus isolates. This is consistent with a route of resistance development through exposure to azole compounds in the environment. Indeed, TR/L98H A fumigatus isolates were cultured from soil and compost, were shown to be cross-resistant to azole fungicides, and genetically related to clinical resistant isolates. Azoles are abundantly used in the environment and the presence of A fumigatus resistant to medical triazoles is a major challenge because of the possibility of worldwide spread of resistant isolates. Reports of TR/L98H in other European countries indicate that resistance might already be spreading.

PMID:
19926038
DOI:
10.1016/S1473-3099(09)70265-8
[Indexed for MEDLINE]

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