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High Prevalence of Clinical and Environmental Triazole-Resistant Aspergillus Fumigatus in Iran: Is It a Challenging Issue? Publisher Pubmed



Nabili M1 ; Shokohi T2 ; Moazeni M2 ; Khodavaisy S3, 4 ; Aliyali M5 ; Badiee P6 ; Zarrinfar H7 ; Hagen F8 ; Badali H2, 9
Authors
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Authors Affiliations
  1. 1. Mazandaran University of Medical Sciences, Sari, Iran
  2. 2. Department of Medical Mycology and Parasitology, Invasive Fungi Research Center, School of Medicine Mazandaran University of Medical Sciences, Sari, Iran
  3. 3. Department of Medical Mycology and Parasitology, Kurdistan University of Medical Sciences, Sanandaj, Iran
  4. 4. Department of Medical Mycology and Parasitology, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran
  6. 6. Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  7. 7. Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  8. 8. Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
  9. 9. Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran

Source: Journal of Medical Microbiology Published:2016


Abstract

Triazole antifungal agents are the mainstay of aspergillosis treatment. As highlighted in numerous studies, the global increase in the prevalence of triazole resistance could hamper the management of aspergillosis. In the present three-year study, 513 samples (213 clinical and 300 environmental samples) from 10 provinces of Iran were processed and screened in terms of azole resistance (4 and 1 mg l−1 of itraconazole and voriconazole, respectively), using selective plates. Overall, 150 A. fumigatus isolates (71 clinical and 79 environmental isolates) were detected. The isolates were confirmed by partial sequencing of the β-tubulin gene. Afterwards, in vitro antifungal susceptibility tests against triazole agents were performed, based on the Clinical and Laboratory Standards Institute (CLSI) M38-A2 document. The CYP51A gene was sequenced in order to detect mutations. The MIC of itraconazole against 10 (6.6%) strains, including clinical (n=3, 4.2%) and environmental (n=7, 8.8%) strains, was higher than the breakpoint and epidemiological cut-off value. Based on the findings, the prevalence of azole-resistant A. fumigatus in Iran has increased remarkablyfrom 3.3% to 6.6% in comparison with earlier epidemiological research. Among resistant isolates, TR34/L98H mutations in theCYP51A gene were the most prevalent (n=8, 80%), whereas other point mutations (F46Y, G54W, Y121F, G138C, M172V, F219C, M220I, D255E, T289F, G432C and G448S mutations) were not detected. Although the number of patients affected by azole-resistant A. fumigatus isolates was limited, strict supervision of clinical azole-resistant A. fumigatus isolates and persistent environmental screening of azole resistance are vital to the development of approaches for the management of azole resistance in human pathogenic fungi. © 2016 The Authors.
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