Iterative breakthrough invasive aspergillosis due to TR(34) /L98H azole-resistant Aspergillus fumigatus and Emericella sublata in a single hematopoietic stem cell transplant patient

F. S. De Fontbrune (1, 2) , B. Denis (3, 2) , M. Meunier (1) , D. Garcia-Hermoso (4, 5) , S. Bretagne (2, 6, 5, 4) , Alexandre Alanio (4, 2, 6)

1 Service d'hématologie greffe [Saint-Louis]
2 UPD7 - Université Paris Diderot - Paris 7
3 Service de maladies infectieuses et tropicales [Saint-Louis]
4 Mycologie moléculaire
5 CNRMA - Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire
6 Laboratoire de Parasitologie-Mycologie [CHU Saint Louis, Paris]

We report 3 consecutive episodes of invasive aspergillosis in a single hematopoietic stem cell transplant patient successively attributed to TR(34) /L98H azole-resistant Aspergillus fumigatus and to a first occurrence of invasive Emericella sublata infection. This case illustrates potential selection of resistant molds during antifungal therapy in hematological patient.

Keywords: Adult; Antifungal Agents; Aspergillus fumigatus; azole resistance; Azoles; breakthrough infection; Cytochrome P-450 Enzyme System; DNA; Fungal; Drug Resistance; Emericella; Emericella sublata; Fatal Outcome; Female; Fungal Proteins; Hematopoietic Stem Cell Transplantation; Humans; invasive aspergillosis; Invasive Pulmonary Aspergillosis; Microbial Sensitivity Tests; Promoter Regions; Genetic

Domains: Life Sciences [q-bio]; Mycology

F. S. De Fontbrune, B. Denis, M. Meunier, D. Garcia-Hermoso, S. Bretagne, et al.. Iterative breakthrough invasive aspergillosis due to TR(34) /L98H azole-resistant Aspergillus fumigatus and Emericella sublata in a single hematopoietic stem cell transplant patient. Transplant Infectious Disease, 2014, 16 (4), pp.687--691. ⟨10.1111/tid.12231⟩. ⟨pasteur-01405245⟩