Latin American survey on the resistance of Aspergillus fumigatus to sunburn in 12 countries, 20 laboratories.

The health problem: aspergillosis is caused by 4 of the more than 250 species of Aspergillus described so far (Aspergillus fumigatus, A. flavus, A. terreus and A. niger), and is one of the most prevalent invasive fungal diseases, with a mortality rate greater than 50%.

Immunocompromised, transplant, cancer and critically ill patients are at special risk.

New data show that people with chronic lung diseases and severe respiratory viral infections, such as those critically ill with COVID-19, are especially at risk.

Most of these infections are caused by A. fumigatus.

Aspergillosis is mainly treated with azoles, with voriconazole being the drug of choice for treatment.

However, increasing rates of resistance to azole antifungals have been reported in many parts of the world over the past decade.

Resistant A. fumigatus strains and the existence of CYP51A gene mutations have been reported in strains from Europe, Asia and the United States, with Europe recording the highest prevalence of azole-resistant A. fumigatus strains (30%). Most of the resistance to azoles is related to the presence of specific mutations of the CYP51A gene (TR34/L98H and TR46/Y121F/T289A), while 30% is associated with changes in efflux pumps, which leads to treatment failure and mortality rates of up to 90%.

Since infections typically occur through inhalation of fungal spores from the environment, the increasing use of azole fungicides in agriculture, which closely resemble those used to treat human diseases, is believed to be a major cause of the disease. emergence of resistant strains.

Knowledge of the prevalence of azole resistance is essential to be able to choose the correct treatment and develop appropriate health responses.

This knowledge will lay the foundation for early and appropriate interventions to improve patient outcomes, reduce mortality and help lower healthcare costs, which are of particular interest in resource-poor countries.

To close the knowledge gap, the proposal presented here will carry out an azole resistance survey of A. fumigatus throughout Latin America, using the current Latin American Medical Mycology Network (LAMMN) led by AI-4: Castañeda and PI-2: Meyer.