Abstract
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 14alpha-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.
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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Amphotericin B / pharmacology
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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 / diagnosis
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Aspergillosis / drug therapy
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Aspergillosis / microbiology*
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Aspergillus fumigatus / drug effects*
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Aspergillus fumigatus / genetics
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Caspofungin
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Cytochrome P-450 Enzyme System / genetics
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Drug Resistance, Multiple, Fungal / genetics*
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Echinocandins
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Fungal Proteins / genetics
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Humans
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Itraconazole / pharmacology
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Itraconazole / therapeutic use
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Lipopeptides
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Lung Diseases, Fungal / diagnosis
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Lung Diseases, Fungal / drug therapy
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Lung Diseases, Fungal / microbiology*
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Male
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Microbial Sensitivity Tests
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Middle Aged
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Mutation, Missense / genetics
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Peptides, Cyclic / pharmacology
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Peptides, Cyclic / therapeutic use
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Pyrimidines / pharmacology
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Pyrimidines / therapeutic use
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Thiazoles / pharmacology
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Thiazoles / therapeutic use
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Triazoles / pharmacology*
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Triazoles / therapeutic use
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Voriconazole
Substances
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Antifungal Agents
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Echinocandins
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Fungal Proteins
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Lipopeptides
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Peptides, Cyclic
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Pyrimidines
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Thiazoles
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Triazoles
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Itraconazole
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posaconazole
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Amphotericin B
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Cytochrome P-450 Enzyme System
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ER 30346
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cytochrome P-450 CYP51A, Aspergillus
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Caspofungin
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Voriconazole