Multi-azole resistance in Aspergillus fumigatus

• Published in: International journal of antimicrobial agents Vol. 28; no. 5; pp. 450 - 453
• Main Authors: Howard, Susan J., Webster, Ian, Moore, Caroline B., Gardiner, Rebecca E., Park, Steven, Perlin, David S., Denning, David W.
• Format: Journal Article
• Language: English
• Published: London Elsevier B.V 01.11.2006; Amsterdam Elsevier; New York, NY
• Subjects: Amphotericin B - pharmacology; Amphotericin B - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Aspergillosis; Aspergillosis - diagnosis; Aspergillosis - drug therapy; Aspergillosis - microbiology; Aspergillus; Aspergillus fumigatus; Aspergillus fumigatus - drug effects; Aspergillus fumigatus - genetics; Azole; Biological and medical sciences; Caspofungin; cyp51A; Cytochrome P-450 Enzyme System - genetics; Drug Resistance, Multiple, Fungal - genetics; Echinocandins; Fungal Proteins - genetics; Human mycoses; Humans; Infectious diseases; Itraconazole; Itraconazole - pharmacology; Itraconazole - therapeutic use; Lipopeptides; Lung Diseases, Fungal - diagnosis; Lung Diseases, Fungal - drug therapy; Lung Diseases, Fungal - microbiology; Male; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Miscellaneous mycoses; Mutation, Missense - genetics; Mycoses; Peptides, Cyclic - pharmacology; Peptides, Cyclic - therapeutic use; Pharmacology. Drug treatments; Pyrimidines - pharmacology; Pyrimidines - therapeutic use; Resistance; Thiazoles - pharmacology; Thiazoles - therapeutic use; Triazoles - pharmacology; Triazoles - therapeutic use; Voriconazole; Resistance; Aspergillus; Azole; Aspergillosis; cyp51A; Itraconazole; Mycosis; Azole derivatives; Fungi; Infection; Antifungal agent; Triazole derivatives; Fungi Imperfecti; Aspergillus fumigatus; Thallophyta
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2006.08.017

Azole resistance in Aspergillus spp. is unusual. We report a patient who received long-term treatment with itraconazole and voriconazole for bilateral chronic cavitary aspergillosis with aspergillomas whose isolates of Aspergillus fumigatus developed simultaneous resistance to itraconazole and voriconazole. A novel mutation (G138C) in the target gene ( cyp51A) encoding 14α-demethylase was detected. The patient had some response to intravenous caspofungin, which he received six times weekly, without the development of resistance over 9 months.