Current Status of Azole-resistant Aspergillus fumigatus Isolates in East Asia.

Aspergillus fumigatus is a saprophytic fungus that is a major causative pathogen for aspergillosis. Only a few classes of antifungals are used for treating this life-threatening fungal infection. Azoles are the first-line drugs and are widely used for the management and prophylaxis of aspergillosis. An emerging issue is the increasing incidence of resistant isolates worldwide. In particular, environmentally derived tandem-repeat-type azole-resistant mutations, such as Cyp51A TR34/L98H, and Cyp51A TR46/Y121F/T289A, have emerged over the last decade. In particular, azole-resistant isolates were prevalent in clinical settings in European countries; many of the reports are from the Netherlands, UK, and Germany. In contrast, reports on azole-resistant A. fumigatus isolates from East Asian countries are still few and have only recently begun to increase. Herein, all literature on East Asian azole-resistant A. fumigatus isolates were reviewed, and a complete list of resistant isolates from China, Japan, Taiwan, and Korea is provided. As of this report, the total numbers of tandem-repeat-type azole-resistant isolates are 26, 3, 32, and 1 in China, Japan, Taiwan, and Korea, respectively.