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2018, Cilt 48, Sayı 3, Sayfa(lar) 153-166
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Aspergillus fumigatus Complex: A New Problem in a Challenging Pathogen, Azole Resistance
Dolunay GÜLMEZ
Hacettepe Üniversitesi Tıp Fakültesi Tıbbi Mikrobiyoloji Anabilim Dalı, Ankara
Keywords: Aspergillus fumigatus, aspergillosis, azole resistance

Aspergillus is widespread in nature and this mold may cause different clinical forms of disease that affect a large group of patients, mostly immunosupressed patients. Diagnosis of aspergillosis is still challenging due to complex characteristics of the disease and the host. Sensitivity of conventional diagnostic methods is low, use of serological tests is limited to certain patient subpopulations and molecular methods are yet to be validated and standardized. Treatment mostly depends on the use of antifungals and, recommended first line therapy is azoles. Therefore, emerging azole resistance has a direct impact on outcome of aspergillosis cases. Furthermore, azoles are the only oral therapeutic options for aspergillosis and the cost of alternative treatment options are higher. Mortality rates in invasive aspergillosis and the need for surgery in chronic pulmonary aspergillosis increase, if caused by azole resistant Aspergillus. A less predicted consequence of azole resistance was the effect on diagnosis. Because culture methods are still needed to confirm the exact causative agent, possibility of decreased sensitivity of culture in case of atypical resistant phenotypes are of concern.

This review aims to summarize current information on Aspergillus and aspergillosis and, to draw attention to azole resistance that causes new challenges in an already complex pathogen. As it is the most widespread human pathogen, most of the data available are related to Aspergillus fumigatus complex.


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