title: Azole-resistant invasive aspergillosis in a patient with acute myeloid leukaemia in Germany.
abstract: We report the first culture-proven case of invasive aspergillosis (IA) caused by azole-resistant Aspergillus fumigatus in a patient with acute myeloid leukaemia in Germany. IA presented as breakthrough infection under posaconazole prophylaxis. Analysis of the resistance mechanism revealed the TR/L98H mutation in the cyp51A gene, which indicates an environmental origin of the strain. This case underscores the need for monitoring azole resistance in Aspergillus spp. and for routine susceptibility testing of moulds.
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany. axel.hamprecht@uk-koeln.de
authors.forename: A
authors.initials: A
authors.lastname: Hamprecht
authors.forename: D
authors.initials: D
authors.lastname: Buchheidt
authors.forename: J J
authors.initials: JJ
authors.lastname: Vehreschild
authors.forename: O A
authors.initials: OA
authors.lastname: Cornely
authors.forename: B
authors.initials: B
authors.lastname: Spiess
authors.forename: G
authors.initials: G
authors.lastname: Plum
authors.forename: T V
authors.initials: TV
authors.lastname: Halbsguth
authors.forename: N
authors.initials: N
authors.lastname: Kutsch
authors.forename: D
authors.initials: D
authors.lastname: Stippel
authors.forename: P
authors.initials: P
authors.lastname: Kahl
authors.forename: T
authors.initials: T
authors.lastname: Persigehl
authors.forename: A
authors.initials: A
authors.lastname: Steinbach
authors.forename: B
authors.initials: B
authors.lastname: Bos
authors.forename: M
authors.initials: M
authors.lastname: Hallek
authors.forename: M J
authors.initials: MJ
authors.lastname: Vehreschild
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D001232:Aspergillus fumigatus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D001393:Azoles / Q000494:pharmacology*; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics; D025141:Drug Resistance, Fungal / Q000235:genetics; D005334:Fever / Q000209:etiology; D005656:Fungal Proteins / Q000235:genetics; D005858:Germany; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D008826:Microbial Sensitivity Tests; D009154:Mutation; D016133:Polymerase Chain Reaction; D011743:Pyrimidines / Q000494:pharmacology; D017421:Sequence Analysis; D016896:Treatment Outcome; D014230:Triazoles / Q000494:pharmacology; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D005656:Fungal Proteins; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D003577:Cytochrome P-450 Enzyme System; C465526:cytochrome P-450 CYP51A, Aspergillus; D065819:Voriconazole