title: Acquired resistance to voriconazole and itraconazole in a patient with pulmonary aspergilloma.
abstract: We describe the development of resistance in an Aspergillus fumigatus strain, originally sensitive to itraconazole and voriconazole, recovered from a case of pulmonary aspergilloma treated with voriconazole. A G448S mutation on the cyp51A gene was detected by sequencing. Frequent culture and in vitro antifungal susceptibility testing is suggested for early detection of the development of multi-azole resistance in patients on long-term therapy for A. fumigatus infections.
authors.affiliation: Laboratoire de Parasitologie-Mycologie, CHU de Saint Etienne, Hôpital Nord, Saint Etienne, France.
authors.forename: Bahrie
authors.initials: B
authors.lastname: Bellete
authors.forename: Helene
authors.initials: H
authors.lastname: Raberin
authors.forename: Jerome
authors.initials: J
authors.lastname: Morel
authors.forename: Pierre
authors.initials: P
authors.lastname: Flori
authors.forename: Jamal
authors.initials: J
authors.lastname: Hafid
authors.forename: Roger Tran
authors.initials: RT
authors.lastname: Manhsung
mesh_terms: D019943:Amino Acid Substitution / Q000235:genetics; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001232:Aspergillus fumigatus / Q000187:drug effects* / Q000302:isolation & purification*; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D005656:Fungal Proteins / Q000235:genetics; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D055732:Pulmonary Aspergillosis / Q000382:microbiology*; D011743:Pyrimidines / Q000494:pharmacology* / Q000627:therapeutic use; D017422:Sequence Analysis, DNA; D014230:Triazoles / Q000494:pharmacology* / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D005656:Fungal Proteins; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D003577:Cytochrome P-450 Enzyme System; C465526:cytochrome P-450 CYP51A, Aspergillus; D065819:Voriconazole