Acquired resistance to voriconazole and itraconazole in a patient with pulmonary aspergilloma

Med Mycol. 2010 Feb;48(1):197-200. doi: 10.3109/13693780902717018.

Abstract

We describe the development of resistance in an Aspergillus fumigatus strain, originally sensitive to itraconazole and voriconazole, recovered from a case of pulmonary aspergilloma treated with voriconazole. A G448S mutation on the cyp51A gene was detected by sequencing. Frequent culture and in vitro antifungal susceptibility testing is suggested for early detection of the development of multi-azole resistance in patients on long-term therapy for A. fumigatus infections.

Publication types

  • Case Reports

MeSH terms

  • Amino Acid Substitution / genetics
  • Antifungal Agents / pharmacology*
  • Antifungal Agents / therapeutic use
  • Aspergillus fumigatus / drug effects*
  • Aspergillus fumigatus / isolation & purification*
  • Cytochrome P-450 Enzyme System / genetics
  • DNA, Fungal / chemistry
  • DNA, Fungal / genetics
  • Fungal Proteins / genetics
  • Humans
  • Itraconazole / pharmacology*
  • Male
  • Middle Aged
  • Mutation, Missense
  • Pulmonary Aspergillosis / microbiology*
  • Pyrimidines / pharmacology*
  • Pyrimidines / therapeutic use
  • Sequence Analysis, DNA
  • Triazoles / pharmacology*
  • Triazoles / therapeutic use
  • Voriconazole

Substances

  • Antifungal Agents
  • DNA, Fungal
  • Fungal Proteins
  • Pyrimidines
  • Triazoles
  • Itraconazole
  • Cytochrome P-450 Enzyme System
  • cytochrome P-450 CYP51A, Aspergillus
  • Voriconazole