Abstract
We report the first culture-proven case of invasive aspergillosis (IA) caused by azole-resistant Aspergillus fumigatus in a patient with acute myeloid leukaemia in Germany. IA presented as breakthrough infection under posaconazole prophylaxis. Analysis of the resistance mechanism revealed the TR/L98H mutation in the cyp51A gene, which indicates an environmental origin of the strain. This case underscores the need for monitoring azole resistance in Aspergillus spp. and for routine susceptibility testing of moulds.
Publication types
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Case Reports
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Research Support, Non-U.S. Gov't
MeSH terms
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Adult
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Amphotericin B / therapeutic use
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Antifungal Agents / pharmacology*
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Antifungal Agents / therapeutic use
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Aspergillosis / complications*
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Aspergillosis / diagnosis*
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Aspergillosis / drug therapy
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Aspergillus fumigatus / drug effects
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Aspergillus fumigatus / genetics
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Aspergillus fumigatus / isolation & purification*
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Azoles / pharmacology*
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Cytochrome P-450 Enzyme System / genetics
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Drug Resistance, Fungal / genetics
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Fever / etiology
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Fungal Proteins / genetics
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Germany
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Humans
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Leukemia, Myeloid, Acute / complications*
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Male
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Microbial Sensitivity Tests
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Mutation
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Polymerase Chain Reaction
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Pyrimidines / pharmacology
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Sequence Analysis
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Treatment Outcome
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Triazoles / pharmacology
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Voriconazole
Substances
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Antifungal Agents
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Azoles
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Fungal Proteins
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Pyrimidines
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Triazoles
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liposomal amphotericin B
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Amphotericin B
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Cytochrome P-450 Enzyme System
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cytochrome P-450 CYP51A, Aspergillus
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Voriconazole