Multi-azole Resistance in Aspergillus Fumigatus

Int J Antimicrob Agents. 2006 Nov;28(5):450-3. doi: 10.1016/j.ijantimicag.2006.08.017. Epub 2006 Oct 10.

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

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

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

Substances

  • Antifungal Agents
  • Echinocandins
  • Fungal Proteins
  • Lipopeptides
  • Peptides, Cyclic
  • Pyrimidines
  • Thiazoles
  • Triazoles
  • Itraconazole
  • posaconazole
  • Amphotericin B
  • Cytochrome P-450 Enzyme System
  • ER 30346
  • cytochrome P-450 CYP51A, Aspergillus
  • Caspofungin
  • Voriconazole