{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:23:28Z","timestamp":1791933808842,"version":"4.3.4"},"reference-count":53,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Pulmonary aspergillosis is a common fungal infection with several clinical manifestations including invasive, allergic and chronic chest diseases. Invasive pulmonary aspergillosis (IPA) is a leading cause of death in immunocompromised patients, particularly those receiving chemotherapy and among bone marrow transplant recipients. Aspergillus fumigatus is the most prevalent causative agent and voriconazole is the first-line therapy for IPA. In this study, we report the first isolation of voriconazole-resistant A. fumigatus carrying TR46\/Y121F\/T289A mutations from an immunocompromised pregnant lady in Kuwait. The patient was successfully treated for a probable respiratory infection with caspofungin and voriconazole. The literature review from PubMed has identified itraconazole-resistant clinical and environmental A. fumigatus isolates with TR34\/L98H mutations in the cyp51A from several Middle Eastern countries including Kuwait. However, clinical A. fumigatus isolates with cyp51A TR46\/Y121F\/T289A mutations have not been reported previously from any country in the region while environmental isolates have been reported only from Iran. The source of voriconazole-resistant A. fumigatus\u00a0CYP51A TR46\/Y121F\/T289A mutant in our patient remained unknown. Surveillance for azole resistance among clinical and environmental isolates of A. fumigatus is warranted in Kuwait.<\/jats:p>","DOI":"10.3390\/jof9080784","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T01:09:01Z","timestamp":1690333741000},"page":"784","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["First Report of Azole-Resistant Aspergillus fumigatus with TR46\/Y121F\/T289A Mutations in Kuwait and an Update on Their Occurrence in the Middle East"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3270-055X","authenticated-orcid":false,"given":"Mohammad","family":"Asadzadeh","sequence":"first","affiliation":[{"name":"Department of Microbiology, College of Medicine, Kuwait University, Safat 13110, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7481-3587","authenticated-orcid":false,"given":"Khaled","family":"Alobaid","sequence":"additional","affiliation":[{"name":"Mycology Reference Laboratory, Mubarak Al-Kabeer Hospital, Ministry of Health, Jabriya 46300, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3492-4781","authenticated-orcid":false,"given":"Suhail","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Microbiology, College of Medicine, Kuwait University, Safat 13110, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Mazloum","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Jaber Al-Ahmad Hospital, Ministry of Health, South Surra 91711, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"165rv13","DOI":"10.1126\/scitranslmed.3004404","article-title":"Hidden killers: Human fungal infections","volume":"4","author":"Brown","year":"2012","journal-title":"Sci. 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