Spergillosis were included as controls. The drugs tested included itraconazole (ITC, Lee Pharma, Hyderabad, India, and Janssen Research Foundation, Beerse, Belgium), voriconazole (VRC, Pfizer Central Research, Sandwich, Kent, United Kingdom) and posaconazole (POS, Schering-Plough, Kenilworth, NJ, USA, now Astellas). For the broth microdilution test, RPMI 1640 medium with glutamine without bicarbonate (Sigma-Aldrich, St Louis, MO, USA) buffered to pH 7 with 0.165 M 3-N-morpholinepropanesulfonic acid (Sigma) was used. Isolates were grown on potato dextrose agar for 5 days at 28uC and the inoculum was adjusted to a final density of 0.5?.5 x 104 cfu/ml by measuring 0.09?.13 OD at 540 nm using spectrophotometer. The final concentrations of the drugs were 0.03 to 16 mg/L for itraconazole and voriconazole and 0.015 to 8 mg/L for posaconazole. Drug-free and mould-free controls were included and microtitre plates were incubated at 35uC for 48 h. CLSI recommended MedChemExpress BTZ043 quality control strains, Candida krusei, ATCC6258 and Candida parapsilosis, ATCC22019 and reference strains Aspergillus fumigatus, ATCC204305 and Aspergillus flavus, ATCC204304 were included. The MIC end points were read visually which, for azoles were defined as the lowest concentration at which there was 100 inhibition of growth compared with the drug-free control wells. A. fumigatus isolates withMixed Format Real-time PCR Assay to Detect MutationsAll of the ITC+ A. fumigatus isolates were subjected to a mixedformat real-time PCR assay as described previously for detection of TR34/L98H, TR46/Y121F/T289A, M220, G54 mutations leading to triazole resistance in A. fumigatus [38].Microsatellite Genotypic AnalysisGenotyping was performed with a panel of nine short tandem repeats as described previously [39]. The genetic relatedness between Indian environmental and clinical isolates was determined 23727046 by using microsatellite typing. A total of 60 ITC+ A. fumigatus isolates which included 51 environmental (44 isolated in the Indian laboratory and 7 isolated from Indian soil TA02 samples processed in the Netherlands laboratory) and 9 clinical isolates were subjected to microsatellite typing. For phylogenetic analysis, 24 Dutch (15 clinical and 9 environmental), 8 clinical Chinese [40], 3 clinical French [18] and one clinical German [19] isolates of A. fumigatus containing the TR34/L98H genotype were tested along with the Indian isolates. In addition, 35 (22 environmental and 13 clinical) Indian, 12 environmental Dutch and 2 clinical French A. fumigatus isolates without mutations and a reference strain A. fumigatus AF293 were included in the analysis.Genetic Analysis of Microsatellite GenotypesThe composite genotype for each of the 146 strains of A. fumigatus was identified based on alleles at all nine microsatellite loci. The genotype 1527786 information was then used to identify genetic relationships among strains. Gene diversity and genotype diversity within individual samples and the relationships between samples were estimated using the population genetic analyses program GenAlEx 6.1 [41]. The relationships among alleles at different loci were examined for evidence of recombination in natural populations of this fungus, using the computer program Multilocus 2.0 (http://www.agapow.net/software/multilocus/) [42]. ResultsAzole Resistant A. fumigatus from Indiaof these analyses were used to infer the potential source(s) of the triazole-resistant clinical and environmental A. fumigatus strains in India.Acknowle.Spergillosis were included as controls. The drugs tested included itraconazole (ITC, Lee Pharma, Hyderabad, India, and Janssen Research Foundation, Beerse, Belgium), voriconazole (VRC, Pfizer Central Research, Sandwich, Kent, United Kingdom) and posaconazole (POS, Schering-Plough, Kenilworth, NJ, USA, now Astellas). For the broth microdilution test, RPMI 1640 medium with glutamine without bicarbonate (Sigma-Aldrich, St Louis, MO, USA) buffered to pH 7 with 0.165 M 3-N-morpholinepropanesulfonic acid (Sigma) was used. Isolates were grown on potato dextrose agar for 5 days at 28uC and the inoculum was adjusted to a final density of 0.5?.5 x 104 cfu/ml by measuring 0.09?.13 OD at 540 nm using spectrophotometer. The final concentrations of the drugs were 0.03 to 16 mg/L for itraconazole and voriconazole and 0.015 to 8 mg/L for posaconazole. Drug-free and mould-free controls were included and microtitre plates were incubated at 35uC for 48 h. CLSI recommended quality control strains, Candida krusei, ATCC6258 and Candida parapsilosis, ATCC22019 and reference strains Aspergillus fumigatus, ATCC204305 and Aspergillus flavus, ATCC204304 were included. The MIC end points were read visually which, for azoles were defined as the lowest concentration at which there was 100 inhibition of growth compared with the drug-free control wells. A. fumigatus isolates withMixed Format Real-time PCR Assay to Detect MutationsAll of the ITC+ A. fumigatus isolates were subjected to a mixedformat real-time PCR assay as described previously for detection of TR34/L98H, TR46/Y121F/T289A, M220, G54 mutations leading to triazole resistance in A. fumigatus [38].Microsatellite Genotypic AnalysisGenotyping was performed with a panel of nine short tandem repeats as described previously [39]. The genetic relatedness between Indian environmental and clinical isolates was determined 23727046 by using microsatellite typing. A total of 60 ITC+ A. fumigatus isolates which included 51 environmental (44 isolated in the Indian laboratory and 7 isolated from Indian soil samples processed in the Netherlands laboratory) and 9 clinical isolates were subjected to microsatellite typing. For phylogenetic analysis, 24 Dutch (15 clinical and 9 environmental), 8 clinical Chinese [40], 3 clinical French [18] and one clinical German [19] isolates of A. fumigatus containing the TR34/L98H genotype were tested along with the Indian isolates. In addition, 35 (22 environmental and 13 clinical) Indian, 12 environmental Dutch and 2 clinical French A. fumigatus isolates without mutations and a reference strain A. fumigatus AF293 were included in the analysis.Genetic Analysis of Microsatellite GenotypesThe composite genotype for each of the 146 strains of A. fumigatus was identified based on alleles at all nine microsatellite loci. The genotype 1527786 information was then used to identify genetic relationships among strains. Gene diversity and genotype diversity within individual samples and the relationships between samples were estimated using the population genetic analyses program GenAlEx 6.1 [41]. The relationships among alleles at different loci were examined for evidence of recombination in natural populations of this fungus, using the computer program Multilocus 2.0 (http://www.agapow.net/software/multilocus/) [42]. ResultsAzole Resistant A. fumigatus from Indiaof these analyses were used to infer the potential source(s) of the triazole-resistant clinical and environmental A. fumigatus strains in India.Acknowle.
