Article 2026-04-22 under-review v1

A novel Erg3 T208I substitution mediates triazole resistance in Talaromyces marneffei clinical isolates from HIV/AIDS patients in southern China

Z
Zheng Yanqing The Fourth People’s Hospital of Nanning
T
Tang Xike The Fourth People’s Hospital of Nanning
P
Pang Xiaofeng The Fourth People’s Hospital of Nanning
F
Fang Yinmei The Fourth People’s Hospital of Nanning
M
Mo Lida The Fourth People’s Hospital of Nanning
L
Luo Xiaolu The Fourth People’s Hospital of Nanning
X
Xiao Manqi The Fourth People’s Hospital of Nanning

Abstract

Talaromyces marneffei (T. marneffei) is a life-threatening dimorphic fungus endemic to southern China and Southeast Asia, with triazole resistance emerging as a critical clinical challenge in immunocompromised populations, particularly HIV/AIDS patients. This study aimed to characterize the molecular mechanisms underlying triazole resistance in clinical T. marneffei isolates from HIV/AIDS patients in China. Antifungal susceptibility testing was performed via broth microdilution according to CLSI M27-A4 guidelines. Whole-genome sequencing (WGS) and Sanger sequencing were used to identify genetic mutations associated with resistance, with a focus on ergosterol biosynthesis genes Erg3 and cyp51B. Sequence conservation analysis was conducted for candidate mutation sites. All four isolates exhibited cross-resistance to fluconazole and voriconazole, with markedly elevated minimum inhibitory concentrations (MICs) compared to the wild-type strain. WGS and sanger sequencing identified a novel heterozygous Erg3 c.1195G > A substitution (p.T208I) in three resistant isolates. The T208 residue is highly conserved in T. marneffei and other pathogenic fungi. This is the first report of an Erg3 T208I substitution linked to cross-resistance to fluconazole and voriconazole in T. marneffei, expanding the known genetic mechanisms of antifungal resistance in this pathogen.

Citation Information

@article{zhengyanqing2026,
  title={A novel Erg3 T208I substitution mediates triazole resistance in Talaromyces marneffei clinical isolates from HIV/AIDS patients in southern China},
  author={Zheng Yanqing and Tang Xike and Pang Xiaofeng and Fang Yinmei and Mo Lida and Luo Xiaolu and Xiao Manqi},
  journal={Scientific Reports},
  year={2026},
  doi={https://doi.org/10.21203/rs.3.rs-9153081/v1}
}
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