High prevalence of triazole-resistant Aspergillus fumigatus sensu stricto in an Argentinean cohort of patients with cystic fibrosis

Mycoses. 2020 Sep;63(9):937-941. doi: 10.1111/myc.13139. Epub 2020 Aug 7.


Background: Triazole resistance in Aspergillus fumigatus sensu stricto due to mutations in the cyp51A gene has been widely reported. Data from Argentina, and particularly from cystic fibrosis (CF) patients, are limited.

Objectives: To investigate the prevalence and molecular mechanisms of azole resistance in A. fumigatus sensu stricto recovered from this population.

Methods: Ninety-three A. fumigatus isolates from 50 CF patients were retrospectively analysed for azole resistance using the standard microbroth dilution method according to CLSI M38-A2 guidelines. Sequencing analysis of the cyp51A gene and its promoter region was conducted in those isolates displaying high MIC values to itraconazole, voriconazole and/or posaconazole.

Results: Overall, 14% of isolates displayed high MIC values to at least one azole. Of them, 30.7% had the mutation TR34-L98H. No mutations in the cyp51A gene or its promoter were found in the remaining non-wild-type strains. Therefore, other mechanisms associated with azole resistance can be highly prevalent in these isolates.

Conclusions: To the best of our knowledge, this is the first study in Latin America reporting azole-resistant A. fumigatus strains recovered from respiratory secretions of CF patients. Noteworthy, the prevalence of azole resistance in A. fumigatus sensu stricto in the studied Argentinean CF population is alarmingly high.

Keywords: Aspergillus fumigatus sensu stricto; Argentina; Cyp51A; azole resistance; cystic fibrosis; itraconazole; posaconazole; voriconazole.

MeSH terms

  • Adolescent
  • Adult
  • Antifungal Agents / pharmacology*
  • Argentina / epidemiology
  • Aspergillosis / epidemiology*
  • Aspergillosis / etiology
  • Aspergillus fumigatus / drug effects*
  • Aspergillus fumigatus / genetics
  • Child
  • Cystic Fibrosis / complications*
  • Cystic Fibrosis / epidemiology
  • Cystic Fibrosis / microbiology
  • Drug Resistance, Fungal / genetics
  • Humans
  • Microbial Sensitivity Tests
  • Middle Aged
  • Mutation
  • Prevalence
  • Retrospective Studies
  • Sequence Analysis, DNA
  • Sputum / microbiology
  • Triazoles / pharmacology*
  • Young Adult


  • Antifungal Agents
  • Triazoles