Current Fungal Infection Reports

, Volume 6, Issue 3, pp 178–191 | Cite as

Azole-Resistant Invasive Aspergillosis: Relationship to Agriculture

  • Christen Rune Stensvold
  • Lise Nistrup Jørgensen
  • Maiken Cavling Arendrup
Clinical Lab Issues (M Pfaller, Section Editor)


Azole resistance in Aspergillus fumigatus has been increasingly reported particularly over the last decade. Two routes of acquisition are described: selection of resistance during long term azole therapy in the clinical setting, and primary acquisition of resistant isolates from the environment due to the considerable use of azole fungicides in agriculture and for material preservation. Three specific resistance genotypes have been found in azole naïve patients. Two of these have also been found in the environment and are characterized by a tandem repeat in the promoter region of the target gene coupled with point mutation(s) in CYP51A (TR34/L98H and TR46/Y121F/T289A). In the third a single target enzyme alteration (G432S) is found. These resistant “environmental” strains have been detected in many West-European countries as well as in the Asia-Pacifics. Noticeably, these two continents account for the highest fungicide use in the global perspective (37 % and 24 %, respectively). Among the 25 azole fungicides, five have been associated with the potential to select for the TR34/L98H genotype; three of these are among those most frequently used. Although the number of antifungal fungicide compounds and classes available is impressive compared to the armamentarium in human medicine, azoles will remain the most important group in agriculture due to superior field performance and significant resistance in fungal pathogens to other compounds. Hence, further spread of environmental resistant Aspergillus genotypes may occur and will depend on the fitness of each resistant phenotype and the pattern of azole fungicide use.


Azole resistance Aspergillus Fungicide Agriculture CYP51 



Dr. M.C. Arendrup has received research grants from Astellas, Gilead, MSD and Pfizer, been advisor or consultant for Gilead, MSD and Pfizer and received speakers honorarium for talks from Astellas, Gilead, MSD and Pfizer.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Christen Rune Stensvold
    • 1
  • Lise Nistrup Jørgensen
    • 2
  • Maiken Cavling Arendrup
    • 1
  1. 1.Unit of Mycology and Parasitology, Department of Microbiological Surveillance and ResearchStatens Serum InstitutCopenhagenDenmark
  2. 2.Department of Integrated Pest Management, Faculty of Agricultural SciencesAarhus UniversitySlagelseDenmark

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