Submitted by helenfindon on 17 January 2019
A study in Brazil, which looked at levels of anti-fungal drug resistance in 228 Aspergillus isolated from patients has found that 27% of Aspergillus fumigatus isolates showed resistance to Amphotericin B.
Aspergillosis is the most common acute invasive fungal infection, affecting 200000 people worldwide every year. In patients with underlying conditions which affect the immune system, such as organ transplant recipients or chemotherapy patients, the infection can be particularly serious and is associated with high mortality rates.
There has been good news in recent years as improved treatment and diagnostics have led to increased survival rates. However, drug resistance in Aspergillus species are being identified and are causing concern.
Resistance has been observed in patients with chronic Aspergillosis who are undergoing long term azole treatment where resistance appears to develop over time. It has also been observed in patients with acute Aspergillosis who have not had any treatment, suggesting that their infection was caused by an already resistant environmental strain.
The identification of azole resistant Aspergillus species, especially A. fumigatus and A. flavus in the Brazil study gives great cause for concern. The standard treatment for Aspergillus is currently a group of drugs called ‘azoles’ and resistance to all of these drugs is being increasingly reported. Where resistance to azoles is encountered, Amphotericin B (AmB) is often used for treatment however resistance to AmB is also rising.
Resistance to both azoles and Amphotericin B leaves clinicians with very limited treatment options. This study highlights the need for continued surveillance for resistance, the need to reduce the environmental sources of azole resistance, research to understand the mechanisms of Amphotericin B resistance and urgent work to develop new antifungal drugs.
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