TR34/L98H Mutation in CYP51A Gene in Aspergillus fumigatus Clinical Isolates During Posaconazole Prophylaxis: First Case in Korea.
Hyeon-Jeong LeeSung-Yeon ChoDong-Gun LeeChulmin ParkHye-Sun ChunYeon-Joon ParkPublished in: Mycopathologia (2018)
Azole resistance in Aspergillus fumigatus is an emerging problem, especially in immunocompromised patients. It has been reported worldwide, including in Asia, but has not yet been reported in Korea. Here, we report a case of invasive pulmonary aspergillosis (IPA) caused by azole-resistant A. fumigatus that developed in a hematopoietic stem cell transplantation recipient during posaconazole prophylaxis for immunosuppressive therapy of graft-versus-host diseases. We identified TR34/L98H/S297T/F495L mutation in the CYP51A gene of A. fumigatus clinical isolate obtained from bronchial washing fluid. Minimal inhibitory concentrations for itraconazole, voriconazole, and posaconazole were > 16, 1, and 4 μg/mL, respectively. While IPA improved partially under voriconazole treatment, the patient died from carbapenemase-producing Klebsiella pneumoniae bacteremia. Further epidemiological surveillance studies are warranted.
Keyphrases
- klebsiella pneumoniae
- multidrug resistant
- end stage renal disease
- escherichia coli
- candida albicans
- copy number
- newly diagnosed
- genome wide
- chronic kidney disease
- ejection fraction
- public health
- gram negative
- prognostic factors
- pulmonary hypertension
- case report
- genome wide identification
- intensive care unit
- gene expression
- cell therapy
- bone marrow
- acute respiratory distress syndrome