2025 Volume 74 Issue 1 Pages 124-132
In recent years, the number of complicated cases of chronic pulmonary aspergillosis (CPA), which develops on a background of pulmonary non-tuberculous mycobacteriosis (NTM), has increased. In this study, we examined Aspergillus spp. isolated at our hospital during the 5-year period from 2012 to 2016, the species identified by a simple identification method, and their antifungal susceptibility. A. fumigatus was the most common isolate with 102 (44.9%), followed by A. niger 66 (29.0%), A. flavus 21 (9.3%), Aspergillus (unidentified) 21 (9.3%), A. terreus 13 (5.8%) and A. nidulans 4 (1.8%). Most of the patients from whom A. fumigatus was isolated were elderly men in their 70s, and the NTM isolated at the same time was Mycobacterium avium. On the other hand, patients with A. niger isolates tended to be both males and females in their 70s and older, and M. avium and M. intracellulare were more common. Looking at these by disease, many patients were found to have isolated Aspergillus spp. against the background of pulmonary NTM disease. Most of the isolates showed good antifungal susceptibility, but we experienced one case of A. fumigatus that became resistant to ITCZ and VRCZ from a patient who developed CPA after treatment for pulmonary NTM disease. Its main resistance mechanism was a mutation of genotype M220 in the cyp51A gene. In cases of long-term use of azole antifungal drug, periodic susceptibility testing was considered necessary in consideration of the emergence of resistant strains.
