{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:23:31Z","timestamp":1791933811203,"version":"4.3.4"},"reference-count":53,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004160","name":"Mazandaran University of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004160","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cystic fibrosis (CF), an inherited autosomal recessive disorder, is linked with high morbidity and mortality rates due to bacteria, filamentous, yeast and black yeast\u2010like fungi colonisation in the upper respiratory tract. Although <jats:italic>Candida<\/jats:italic> species are the most common fungi isolated from CF patients, azole\u2010resistant <jats:italic>Aspergillus fumigatus<\/jats:italic> (ARA<jats:italic>f<\/jats:italic>) is a big concern for invasive aspergillosis. Notably, the exact prevalences of <jats:italic>Aspergillus<\/jats:italic> species and the prevalence of ARA<jats:italic>f<\/jats:italic> isolates among Iranian CF patients have yet to be previously reported and are unknown. We aimed to investigate the prevalence of ARA<jats:italic>f<\/jats:italic> isolates in CF patients among Iranian populations by focusing on molecular mechanisms of the mutations in the target gene.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The 1\u2009year prospective study recovered 120 sputum samples from 103 CF patients. Of these, 55.1% (86\/156) yielded <jats:italic>Aspergillus<\/jats:italic> species, screened for ARA<jats:italic>f<\/jats:italic> using plates containing itraconazole (4\u2009mg\/L) and voriconazole (1\u2009mg\/L). According to the CLSI\u2010M38 guidelines, antifungal susceptibility testing was performed using the broth microdilution method. In all phenotypically resistant isolates, the target of azole agents, the <jats:italic>cyp<\/jats:italic>51A gene, was sequenced to detect any possible single nucleotide polymorphisms (SNP) mediating resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 120 samples, 101 (84.2%) were positive for filamentous fungi and yeast\u2010like relatives, with 156 fungal isolates. The most common colonising fungi were <jats:italic>Aspergillus<\/jats:italic> species (55.1%, 86\/156), followed by <jats:italic>Candida<\/jats:italic> species (39.8%, 62\/156), <jats:italic>Exophiala<\/jats:italic> species (3.8%, 6\/156) and <jats:italic>Scedosporium<\/jats:italic> species (1.3%, 2\/156). Forty out of 86 (46.5%) were identified for section <jats:italic>Fumigati<\/jats:italic>, 36 (41.9%) for section <jats:italic>Flavi<\/jats:italic>, 6 (7%) for section <jats:italic>Nigri<\/jats:italic> and 4 (4.6%) for section <jats:italic>Terrei<\/jats:italic>. Fourteen out of 40 <jats:italic>A<\/jats:italic>. <jats:italic>fumigatus<\/jats:italic> isolates were phenotypically resistant. The overall proportion of ARA<jats:italic>f<\/jats:italic> in total fungal isolates was 9% (14\/156). <jats:italic>cyp51A<\/jats:italic> gene analysis in resistant isolates revealed that 13 isolates harboured G448S, G432C, T289F, D255E, M220I, M172V, G138C, G54E and F46Y mutations and one isolate carried G448S, G432C, T289F, D255E, M220I, G138C, G54E and F46Y mutations. Additionally, this study detects two novel <jats:italic>cyp<\/jats:italic>51A single\u2010nucleotide polymorphisms (I242V and D490E).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study first investigated ARA<jats:italic>f<\/jats:italic> isolates in Iranian CF patients. Due to a resistance rate of up to 9%, it is recommended that susceptibility testing of <jats:italic>Aspergillus<\/jats:italic> isolates from CF patients receiving antifungal treatment be a part of the routine diagnostic workup. However, extensive multicentre studies with a high volume of CF patients are highly warranted to determine the impact of ARA<jats:italic>f<\/jats:italic> on CF patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13791","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T08:23:33Z","timestamp":1725611013000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["High Prevalence of Azole\u2010Resistant <i>Aspergillus fumigatus<\/i> Among Iranian Cystic Fibrosis Patients: Should We Be Concerned?"],"prefix":"10.1111","volume":"67","author":[{"given":"Azadeh","family":"Bandegani","sequence":"first","affiliation":[{"name":"Department of Medical Mycology, School of Medicine Mazandaran University of Medical Sciences  Sari Iran"},{"name":"Invasive Fungi Research Center, Communicable Diseases Institute Mazandaran University of Medical Sciences  Sari 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 Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narges","family":"Vaseghi","sequence":"additional","affiliation":[{"name":"Department of Pathobiology, Science and Research Branch Islamic Azad University  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8039-4991","authenticated-orcid":false,"given":"Sadegh","family":"Khodavaisy","sequence":"additional","affiliation":[{"name":"Department of Medical Parasitology and Mycology, Faculty of Public Health Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atefeh","family":"Fakharian","sequence":"additional","affiliation":[{"name":"Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD) Shahid Beheshti University of Medical Sciences  Tehran 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