Citizen science reveals landscape-scale exposures to multiazole-resistant <i>Aspergillus fumigatus</i> bioaerosols
Jennifer Shelton, Johanna Rhodes, Christopher B. Uzzell, Samuel Hemmings, Amelie P. Brackin, Thomas R. Sewell, Asmaa Alghamdi, Paul S. Dyer, Mark Fraser, Andrew M. Borman, Elizabeth M. Johnson, Frédéric B. Piel, Andrew C. Singer, Matthew C. Fisher
Abstract
Using a citizen science approach, we identify a country-wide exposure to aerosolized spores of a human fungal pathogen, Aspergillus fumigatus , that has acquired resistance to the agricultural fungicide tebuconazole and first-line azole clinical antifungal drugs. Genomic analysis shows no distinction between resistant genotypes found in the environment and in patients, indicating that at least 40% of azole-resistant A. fumigatus infections are acquired from environmental exposures. Hotspots and coldspots of aerosolized azole-resistant spores were not stable between seasonal sampling periods. This suggests a high degree of atmospheric mixing resulting in an estimated per capita cumulative annual exposure of 21 days (±2.6). Because of the ubiquity of this measured exposure, it is imperative that we determine sources of azole-resistant A. fumigatus to reduce treatment failure in patients with aspergillosis.