Aspergilli may cause various pulmonary diseases in humans, including allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), and acute invasive pulmonary aspergillosis (IPA). In addition, chronic colonization may occur in cystic fibrosis (CF). Aspergillus fumigatus represents the main pathogen, which may employ different morphotypes, for example, conidia, hyphal growth, and asexual sporulation, in the various Aspergillus diseases. These morphotypes determine the ease by which A. fumigatus can adapt to stress by antifungal drug exposure, usually resulting in one or more resistance mutations. Key factors that enable the emergence of resistance include genetic variation and selection. The ability to create genetic variation depends on the reproduction mode, including, sexual, parasexual, and asexual, and the population size. These reproduction cycles may take place in the host and/or in the environment, usually when specific conditions are present. Environmental resistance is commonly characterized by tandem repeat (TR)-mediated mutations, while in-host resistance selection results in single-resistance mutations. Reported cases from the literature indicate that environmental resistance mutations are almost exclusively present in patients with IA indicating that the risk for in-host resistance selection is very low. In aspergilloma, single-point mutations are the dominant resistance genotype, while in other chronic Aspergillus diseases, for example, ABPA, CPA, and CF, both TR-mediated and single-resistance mutations are reported. Insights into the pathogenesis of resistance selection in various Aspergillus diseases may help to improve diagnostic and therapeutic strategies.

曲霉可引起人类多种肺部疾病，包括过敏性支气管肺曲霉病（ABPA）、慢性肺曲霉病（CPA）和急性侵袭性肺曲霉病（IPA）。此外，慢性定植可能发生在囊性纤维化（CF）中。烟曲霉代表主要病原体，在各种曲霉属疾病中，其可能采用不同的形态型，例如分生孢子、菌丝生长和无性孢子形成。这些形态型决定了烟曲霉通过抗真菌药物暴露来适应应激的难易程度，通常会导致一种或多种耐药性突变。导致抗药性出现的关键因素包括遗传变异和选择。产生遗传变异的能力取决于繁殖模式，包括有性、准性和无性，以及种群规模。这些繁殖周期可能发生在宿主和/或环境中，通常是在存在特定条件时。环境抗性通常以串联重复（TR）介导的突变为特征，而宿主内抗性选择会导致单抗性突变。文献报道的病例表明，环境抗性突变几乎只存在于 IA 患者中，这表明宿主内抗性选择的风险非常低。在曲霉瘤中，单点突变是主要的抗性基因型，而在其他慢性曲霉疾病中，例如ABPA、CPA和CF，TR介导的突变和单抗性突变都有报道。深入了解各种曲霉属疾病的抗性选择发病机制可能有助于改进诊断和治疗策略。