Failure of voriconazole therapy due to acquired azole resistance in Aspergillus fumigatus in a kidney transplant recipient with chronic necrotizing aspergillosis.

Failure of voriconazole therapy due to acquired azole resistance in Aspergillus fumigatus in a kidney transplant recipient with chronic necrotizing aspergillosis.

Am J Transplant. 2018 May 22;:

Authors: Pilmis B, Garcia-Hermoso D, Alanio A, Catherinot E, Scemla A, Jullien V, Bretagne S, Lortholary O

Abstract
Invasive aspergillosis (IA) affects lungs and disseminates mostly in patients with neutropenia and/or receiving immunosuppressive and steroid therapies. Despite progress in diagnosis and therapy of IA, it is still characterized by a high mortality rate. Currently, voriconazole is considered as the standard therapy for invasive aspergillosis. Over the recent years, triazole resistant Aspergillus fumigatus isolates have emerged in the environment due to the use of fungicidal agricultural products with the risk of developing IA related to a resistant isolate. However, resistance may also develop in patient under long-term triazole therapy, particularly in the setting of chronic forms of pulmonary aspergillosis. We here describe a kidney transplant recipient who failed voriconazole therapy due to acquired resistance secondary to the appearance of a de novo mutation (Y121F) in the cyp51A gene during chronic necrotizing pulmonary aspergillosis. The infecting isolate acquired voriconazole resistance in eight months despite plasma concentrations within recommended range of the drug necessitating lobectomy in association with a new antifungal strategy consisting of liposomal amphotericin and caspofungin with a good outcome over 36 months. This article is protected by copyright. All rights reserved.

PMID: 29790292 [PubMed – as supplied by publisher]

Source: Industry