The treatment of patients with cystic fibrosis or COPD with antifungal therapies may contribute to the resistance of the microorganism and exacerbate lung infection.

Given that any change in the fungus’ environment can stimulate adaptation, the start of a new treatment, the substitution of one antifungal drug for another, or even halting a treatment can be a contributing mechanism, the researchers reported. This is a real problem for doctors who have to choose between two unwelcome options in eliminating the infection: treat the fungus and increase its adaptive skills, or not treat it and allow the pathogen to settle in the lungs.

“We hypothesise that the current diagnostic tools and treatment strategies do not take into account the biology of the fungus and might result in an increased likelihood of fungal persistence in patients,” they wrote.

Researchers also reported that treatment with triazoles, a group of antifungal medications, allow the occurrence of mutations that confer resistance. Substituting one triazole-based treatment for another, or even stopping a treatment, only helps A. fumigatus become resistant, as the fungus accumulates mutations that allow it to survive multiple treatments.

“[O]ver time the fungus will become increasingly adapted to the lung environment, thereby limiting the probability of eradication. Our hypothesis challenges current management strategies, and future research should investigate the genomic dynamics during infection to understand the key factors facilitating adaptation of Aspergillus,” the research team concluded.

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