Azole-resistant Aspergillus fumigatus: Epidemiology, Diagnosis, and Treatment Considerations

Invasive aspergillosis is an opportunistic infection caused by the Aspergillus species. It is a significant cause of morbidity and mortality in susceptible populations, including recipients of bone marrow and solid organ transplants. Azole antifungals have remained the first-line treatment for invasive aspergillosis for a long time; however, the advance of azole resistance in Aspergillus fumigatus, driven predominantly by extensive commercial and agricultural use of azole fungicides and environmental exposure of susceptible populations to the resistant strains, renders the traditional therapeutic approaches less effective and results in further increase in mortality. The epidemiology, molecular mechanisms of azole resistance, diagnostic approaches, and clinical implications of azole resistance in Aspergillus fumigatus sensu stricto will be discussed in this article (for ease of comprehension, the rest of this article will refer to A. fumigatus sensu stricto as A. fumigatus).