title: Azole-resistant central nervous system aspergillosis.
abstract: Three patients with central nervous system aspergillosis due to azole-resistant Aspergillus fumigatus (associated with a leucine substitution for histidine at codon 98 [L98H] and a 34-base pair repeat in tandem in the promoter region) are described. The patients were treated with combination therapy or with polyenes, but all patients died. Azole resistance significantly complicates the management of aspergillosis by delaying the initiation of adequate therapy and because effective alternative antifungal drugs are lacking.
authors.affiliation: Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Jan W M
authors.initials: JW
authors.lastname: van der Linden
authors.forename: Rogier R
authors.initials: RR
authors.lastname: Jansen
authors.forename: Dorine
authors.initials: D
authors.lastname: Bresters
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Visser
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
authors.forename: Ed J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: Willem J G
authors.initials: WJ
authors.lastname: Melchers
authors.forename: Paul E
authors.initials: PE
authors.lastname: Verweij
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D001232:Aspergillus fumigatus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D001393:Azoles / Q000494:pharmacology*; D002494:Central Nervous System Infections / Q000188:drug therapy / Q000382:microbiology*; D002648:Child; D025141:Drug Resistance, Fungal / Q000235:genetics*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents; D001393:Azoles