[The Current Status of Drug-resistant Aspergillus]

Med Mycol J. 2016;57(3):J103-12. doi: 10.3314/mmj.16.001.
[Article in Japanese]


Aspergillus spp. are important fungi because of the high mortality associated with aspergillosis. However, we have only three classes of anti-aspergillus drugs available; and only two drugs, itraconazole (ITCZ) and voriconazole (VRCZ), are available as oral agents in Japan. If azole-resistant Aspergillus causes chronic aspergillosis, we cannot treat such patients with oral azoles on an outpatient basis. As is the case with foreign countries, we found the existence of azole-resistant Aspergillus fumigatus in clinical settings in Japan. Resistance was attributed to mutations of the target protein (CYP51A). Additionally, we also found that long-term itraconazole treatment induced G54 substitution in CYP51A, causing itraconazole-resistance. Although there are few resistant Aspergillus strains existing in Japan now, we have to continue to find such resistant isolates, which are spreading worldwide.

Publication types

  • Review

MeSH terms

  • Antifungal Agents / pharmacology*
  • Aspergillus fumigatus / drug effects*
  • Aspergillus fumigatus / isolation & purification
  • Cytochrome P-450 Enzyme System / genetics
  • Drug Resistance, Fungal / genetics*
  • Fungal Proteins / genetics
  • Humans
  • Itraconazole / pharmacology*
  • Japan
  • Mutation
  • Pulmonary Aspergillosis / microbiology*
  • Voriconazole / pharmacology*


  • Antifungal Agents
  • Fungal Proteins
  • Itraconazole
  • Cytochrome P-450 Enzyme System
  • cytochrome P-450 CYP51A, Aspergillus
  • Voriconazole