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Azole-resistant invasive aspergillosis in a patient with acute myeloid leukaemia in Germany
A Hamprecht1, D Buchheidt, J J Vehreschild
1Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany. axel.hamprecht@uk-koeln.de
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.
Insights
A German patient with acute myeloid leukemia developed invasive aspergillosis from azole-resistant Aspergillus fumigatus, despite antifungal prophylaxis. This highlights the growing threat of resistant fungal infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Hematology Oncology
Background:
- Invasive aspergillosis (IA) is a serious fungal infection, particularly in immunocompromised patients.
- Azole antifungals are standard prophylaxis and treatment for IA.
- Emergence of azole resistance in Aspergillus fumigatus poses a significant clinical challenge.
Observation:
- A case of breakthrough IA occurred in a patient with acute myeloid leukemia (AML) undergoing posaconazole prophylaxis.
- The causative agent was identified as azole-resistant Aspergillus fumigatus.
- Genetic analysis revealed the TR/L98H mutation in the cyp51A gene, suggesting an environmental source for the resistant strain.
Findings:
- This is the first reported case of culture-proven IA caused by azole-resistant Aspergillus fumigatus in Germany.
- The TR/L98H mutation is associated with reduced susceptibility to azole antifungals.
- The environmental origin of the resistant strain implies widespread environmental resistance.
Implications:
- Clinicians must be vigilant for IA caused by azole-resistant fungi, even with prophylaxis.
- Routine antifungal susceptibility testing for Aspergillus species is crucial for guiding therapy.
- Monitoring azole resistance in Aspergillus is essential to combat treatment failures and improve patient outcomes.
