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Clinical and Genomic Insights into Antifungal Resistance in Aspergillus Isolates from Thailand

Summary

Researchers in Thailand identified a dangerous fungal infection caused by Aspergillus fumigatus that is resistant to azole antifungal drugs. This is the first time this specific drug-resistant strain has been found in a patient sample in Thailand, though it had been previously detected in environmental samples. The study used genetic testing to understand how the fungus developed resistance and found that it has altered genes that help it survive the antifungal medications commonly used to treat infections.

Background

Aspergillus species are major opportunistic pathogens causing invasive aspergillosis with increasing antifungal resistance worldwide. Azole resistance in Aspergillus fumigatus is mediated by mutations in cyp51A and other genes, presenting significant clinical challenges. Limited data exist on azole-resistant A. fumigatus in Thailand.

Objective

To investigate antifungal susceptibility and genomic features of Aspergillus isolates from sterile clinical specimens in Thailand. To characterize resistance mechanisms and identify cyp51A mutations in azole-resistant isolates.

Results

A. fumigatus was the most frequent species (54%), followed by A. flavus (29%). Two A. fumigatus isolates showed elevated voriconazole MICs (2-4 µg/mL), with one strain (CUAFU23) harboring the TR34/L98H mutation in cyp51A. Genomic analysis revealed distinct protein domain composition in the resistant strain compared to susceptible isolates.

Conclusion

This study provides the first evidence of a clinical A. fumigatus isolate with TR34/L98H from Thailand, marking the emergence of azole-resistant A. fumigatus in the region. Integrated antifungal susceptibility testing, molecular diagnostics, and genomic analysis are essential for guiding treatment strategies and monitoring resistance spread.
  • Published in:Microorganisms,
  • Study Type:Clinical Laboratory Study,
  • Source: PMID: 41304180, DOI: 10.3390/microorganisms13112495
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