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Amona MF, Oladele RO, Resendiz-Sharpe A, Denning DW, Kosmidis C, Lagrou K, Zhong H, Han L. Triazole resistance in Aspergillus fumigatus isolates in Africa: a systematic review. Med Mycol 2022; 60:6652216. [PMID: 35906879 DOI: 10.1093/mmy/myac059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Emergence of triazole resistance has been observed in Aspergillus fumigatus over the past decade including in Africa. This review summarizes the current published data on the epidemiology and reported mechanisms of triazole-resistant Aspergillus fumigatus (TRAF) in both environmental and clinical isolates from Africa. Searches on databases Medline, PubMed, HINARI, Science Direct, Scopus and Google Scholar on triazole resistance published between 2000 and 2021 from Africa were performed. Isolate source, antifungal susceptibility using internationally recognized methods, cyp51A mechanism of resistance and genotype were collected. Eleven published African studies were found that fitted the search criteria; these were subsequently analyzed. In total this constituted of 1686 environmental and 46 clinical samples. A TRAF prevalence of 17.1% (66/387) and 1,3% (5/387) was found in respectively environmental and clinical settings in African studies. Resistant to itraconazole, voriconazole, and posaconazole was documented. Most of the triazole-resistant isolates (30/71, 42.25%) were found to possess the TR34/L98H mutation in the cyp51A-gene; fewer with TR46/Y121F/T289A (n = 8), F46Y/M172V/E427K (n = 1), G54E (n = 13), and M172V (n = 1) mutations. African isolates with the TR34/L98H, TR46/Y121F/T289A and the G54E mutations were closely related and could be grouped in one of two clusters (cluster-B), whereas the cyp51A-M172V mutation clustered with most cyp51A- WT strains (cluster-A). A single case from Kenya shows that TR34/L98H from environmental and clinical isolates are closely related. Our findings highlight that triazole resistance in environmental and clinical A. fumigatus is a cause for concern in a number of African countries. There is need for epidemiological surveillance to determine the true burden of the problem in Africa.
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Affiliation(s)
- Modeste Fructueux Amona
- Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Republic of Congo.,Research Center and Study of Infectious and Tropical Pathologies, Oyo, Republic of Congo
| | - Rita Okeoghene Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Agustin Resendiz-Sharpe
- Department of Microbiology, Laboratory of Clinical Bacteriology and Mycology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Imaging and Pathology, Biomedical MRI, KU Leuven, Leuven, Belgium
| | - David W Denning
- Manchester Fungal Infection Group, the University of Manchester and Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chris Kosmidis
- National Aspergillosis Centre, Manchester University Foundation Trust, UK, and Manchester Academic Health Science Centre, the University of Manchester, Manchester, UK
| | - Katrien Lagrou
- Department of Microbiology, Laboratory of Clinical Bacteriology and Mycology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Hanying Zhong
- Department for Disinfection and Infection Control, Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Li Han
- Department for Disinfection and Infection Control, Chinese PLA Center for Disease Control and Prevention, Beijing, China
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