Recent Advances and Future Perspectives in Mitigating Invasive Antifungal-Resistant Pathogen Aspergillus fumigatus in Africa

Abstract

Purpose of Review Azole resistance in Aspergillus fumigatus is an emerging public health issue with global distribution and has been linked to use in agricultural and horticultural settings. In 2022, the World Health Organization (WHO) created a fungal pathogen priority list, and A. fumigatus was listed as a critical pathogen. Currently, Africa lacks effective surveillance systems for this emerging threat, mostly due to lack of capacity and diagnostics to determine azole resistance in routine clinical settings. This review aims to address and improve on the current diagnostic tools and future perspective strategies in tackling clinical and environmental antifungal-resistant (AFR) A. fumigatus in Africa. We emphasized on the importance of early diagnosis and misdiagnosis associated with aspergillosis caused by Aspergillus sp., cross talk between clinical and environmental, mode of action and resistance mechanism, collaborative one health approach, and future perspectives for AFR A. fumigatus management strategies. Recent Findings Early diagnosis and effective management of invasive aspergillosis are critical. On the continent, very few laboratories routinely conduct antifungal susceptibility testing on Aspergillus species. Where this occurs, it is culture-based in vitro antifungal susceptibility testing. Drug repurposing and the need for a non-culture-based molecular method (PCR) are critical. Summary Enhancing promising future perspectives of non-cultured approaches such as whole-genome sequencing, CRISPR/Cas9, and RNAi-mediated technologies to complement the culture-based approach as important strategies to mitigate and overcome emerging issues of AFR A. fumigatus in Africa.

Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

“…Resistance to azoles has been reported in other studies [107] [108] [133] [136]. Consequently, the resistance of Aspergillus species is a public health problem that requires urgent attention due to its impact on poor treatment outcomes [25] [137]. A common resistance mechanism of Aspergillus fumigatus is a combination of mutations in the gene cyp51A (TR34/L98H) [128].…”