in dense In the nursing ward of Radboud University Medical Center, a sprawling hospital in the southeastern Netherlands, Paul Verweij is worried. Physicians and scientists are used to working with seriously ill patients. As chair of medical microbiology, it’s his job to identify dreaded pathogens so the right treatments can be prescribed.
One group of patients had serious illnesses that are common in the ICU: blood cancers, immune disorders, end-stage lung disease.But on top of these, they’re all under attack by a fast-growing, life-threatening environmental fungus known as Aspergillus fumigatus. In the past, a class of drugs called azoles have reliably cured Aspergillus, but these fungal infections are strangely resistant. Five out of every six patients are dying.
These deaths are tragic, but also very strange. It is common for organisms to develop resistance to drugs that patients take for a long time. But these patients were not taking azole drugs; the fungus was already resistant when it infected them.In his lab, Verweij could see an explanation: their Aspergillus There were new mutations, ones he hadn’t seen in his decades as a microbiologist. With help from the Dutch public health system, he looked beyond his own hospital — and found the same pattern in dead patients across the country, with an unrecognized outbreak scattered across a dozen ICUs .
Verweij realized that no single hospital could serve as a source. There must be something outside the medical system, something that exists all over the Netherlands and exerts as much mutation pressure as prescription drugs. With the help of other researchers, he identified it: a class of agrochemicals that function in the same way as azoles and are essential for growing food and flowers. Famous for its tulips, the Netherlands is the world’s leading producer of the flower. While protecting their plants from disease, Dutch farmers were unknowingly endangering the health of their neighbors.
“We’ve created a niche,” Verweij said, “where these super-resistant bugs can emerge.”
This realization occurred more than a decade ago, an event well known in a small part of medicine but rarely reported outside of it.Since then, this pattern of resistance has spread to more than 40 countries, including the US and UK; three out of five patients develop azole resistance Aspergillus die of it. Disease specialists and plant pathologists hope that the parallel development of azoles in medicine and agriculture will be a one-off. They felt that if they followed each other’s research closely, something like this would never happen again.
except it. Experts now worry that the medical community could be at risk of losing a much-needed new drug because agrichemicals are once again first to deploy a similar compound.
The looming conflict stems from the emergence of two compounds, one medicinal and one agricultural, that share a new mechanism for killing fungi: a drug, olorofim, that is passing clinical trials in humans, and the fungicide ipflufenoquin (trade name Kinoprol), which was registered with the U.S. Environmental Protection Agency last year. Ipflufenoquin is manufactured by Nisso America to control diseases of important tree crops, including almonds, apples and pears.Olorofim, developed by UK firm F2G, is a much-needed new treatment Aspergillus Valley fever affects as many as 150,000 people in the United States each year and is most dense in California, the state with the most almonds.