Azole-resistant Aspergillus fumigatus: poultry farms and schools as sentinels in Portugal
Abstract
Background: Azole resistance in Aspergillus fumigatus (ARAf) is a growing global health threat, with environmental selection driven by agricultural fungicide use now recognised by the 2025 joint EFSA/ECDC/EMA/ECHA/EEA report. In Portugal, environmental ARAf remains under characterised, with prior reports limited to dairy and waste-sorting occupational settings. No study has simultaneously examined resistance across agricultural and educational environments.
Methods: Two cross-sectional environmental surveillance studies were conducted in Portugal using harmonised methodology (EUCAST 10.2/9.4). Study 1 included 11 primary schools in the Lisbon metropolitan area (active air sampling, electrostatic dust collectors, settled dust filters; n = 164 Aspergillus section Fumigati isolates). Study 2 included 14 poultry pavilions in Madeira Island (bedding, feed, air, workers ‘masks; n = 168 Aspergillus section Fumigati isolates). Thermotolerant isolates were screened for azole resistance (itraconazole, voriconazole, posaconazole). Resistant isolates were molecularly identified by sequencing.
Results: In schools, 151/164 isolates (92%) were thermotolerant; 28 showed potential azole resistance, 67.9% with pan-azole resistance. All were confirmed as A. fumigatus sensu stricto. In poultry farms, 168/176 isolates (95%) were thermotolerant; 7 showed potential azole resistance, all with pan-azole resistance. All were confirmed as A. fumigatus sensu stricto. Dust-based matrices (EDC/settled dust; air/bedding) were the main reservoirs in each setting.
Conclusions: These findings, from geographically and functionally distinct settings, suggest Portugal may constitute an underrecognized multi-environment hotspot for thermotolerant ARAf. The convergence of resistance in agricultural and community environments reinforces the urgency of integrated One Health surveillance encompassing non-occupational settings, in alignment with current European regulatory priorities.
Key messages: • Portugal shows high azole-resistant A. fumigatus prevalence in both schools and poultry farms, suggesting a multi-environment hotspot requiring urgent One Health surveillance.
• Pan-azole resistance in non-clinical indoor settings signals the need to expand European AMR surveillance beyond known agricultural hotspots.
Related
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- Assessment of antibacterial and antioxidant potentials of Aspergillus fumigatus crude extract, the isolated endophyte from Centella asiatica (L.) urban supported by molecular docking
- Integrative phenotypic and transcriptomic validation of an alveolar-like macrophage model reveals early host–pathogen dynamics during Aspergillus fumigatus infection
BibTeX
@article{cervantes2026azoleresistant,
title = {{Azole-resistant Aspergillus fumigatus: poultry farms and schools as sentinels in Portugal}},
author = {RWCF Cervantes and B Gomes and PMN Pena and SPC Viegas and CSC Viegas},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.808},
url = {https://doi.org/10.1093/eurpub/ckag169.808},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Azole-resistant Aspergillus fumigatus: poultry farms and schools as sentinels in Portugal
AU - RWCF Cervantes
AU - B Gomes
AU - PMN Pena
AU - SPC Viegas
AU - CSC Viegas
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.808
UR - https://doi.org/10.1093/eurpub/ckag169.808
AB - Background: Azole resistance in Aspergillus fumigatus (ARAf) is a growing global health threat, with environmental selection driven by agricultural fungicide use now recognised by the 2025 joint EFSA/ECDC/EMA/ECHA/EEA report. In Portugal, environmental ARAf remains under characterised, with prior reports limited to dairy and waste-sorting occupational settings. No study has simultaneously examined resistance across agricultural and educational environments. Methods: Two cross-sectional environmental surveillance studies were conducted in Portugal using harmonised methodology (EUCAST 10.2/9.4). Study 1 included 11 primary schools in the Lisbon metropolitan area (active air sampling, electrostatic dust collectors, settled dust filters; n = 164 Aspergillus section Fumigati isolates). Study 2 included 14 poultry pavilions in Madeira Island (bedding, feed, air, workers ‘masks; n = 168 Aspergillus section Fumigati isolates). Thermotolerant isolates were screened for azole resistance (itraconazole, voriconazole, posaconazole). Resistant isolates were molecularly identified by sequencing. Results: In schools, 151/164 isolates (92%) were thermotolerant; 28 showed potential azole resistance, 67.9% with pan-azole resistance. All were confirmed as A. fumigatus sensu stricto. In poultry farms, 168/176 isolates (95%) were thermotolerant; 7 showed potential azole resistance, all with pan-azole resistance. All were confirmed as A. fumigatus sensu stricto. Dust-based matrices (EDC/settled dust; air/bedding) were the main reservoirs in each setting. Conclusions: These findings, from geographically and functionally distinct settings, suggest Portugal may constitute an underrecognized multi-environment hotspot for thermotolerant ARAf. The convergence of resistance in agricultural and community environments reinforces the urgency of integrated One Health surveillance encompassing non-occupational settings, in alignment with current European regulatory priorities. Key messages: • Portugal shows high azole-resistant A. fumigatus prevalence in both schools and poultry farms, suggesting a multi-environment hotspot requiring urgent One Health surveillance. • Pan-azole resistance in non-clinical indoor settings signals the need to expand European AMR surveillance beyond known agricultural hotspots.
SN - 1101-1262
SN - 1464-360X
ER -