Abstract
Aspergillosis is a set of very frequent and widely distributed opportunistic diseases. Azoles are the first choice for most clinical forms. However, the distribution of azole-resistant strains is not well known around the world, especially in developing countries. The aim of our study was to determine the proportion of non-wild type strains among the clinical isolates of Aspergillus spp. To this end, the minimum inhibitory concentration of three azoles and amphotericin B (used occasionally in severe forms) was studied by broth microdilution. Unexpectedly, it was found that 8.1% of the isolates studied have a diminished susceptibility to itraconazole. This value turned out to be similar to the highest azole resistance rate reported in different countries across the world.
Highlights
Fungi of the genus Aspergillus have the capacity to cause diverse clinical pictures, from simple allergic forms to invasive aspergillosis, with a mortality rate higher than 80% in invasive forms when therapeutic measures are not applied quickly [1,2,3].The aspergillosis clinical course depends on the patients underlying condition, the species involved, and the applied treatment
Regarding the comparison of the minimal inhibitory concentration (MIC) values obtained with the epidemiological cut-off values (ECV) for each species and antifungal, isolates were obtained (14 section Fumigati and 1 section Nigri) with MIC values > ECV for itraconazol, so 8.1% of the isolates probably presented some kind of mechanism that reduced their susceptibility to this antifungal agent
All the non-wild type isolates from section Fumigati corresponded presumptively to Aspergillus fumigatus sensu stricto according to the temperature test results
Summary
The aspergillosis clinical course depends on the patients underlying condition, the species involved, and the applied treatment. This makes it essential to identify the isolates and determine the antifungal susceptibility pattern to find the possible presence of intrinsic or acquired resistance to any drug [4,5]. Phylogenetic studies integrate data of partial DNA sequences to distinguish the different species within the section Fumigati, for instance. This approach is fastidious and not convenient for rapid identification in clinical practice [6]. The sustained use of these drugs might cause antimicrobial pressure responsible for selecting non-susceptible clones [8,9]
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