Azole-resistant invasive aspergillosis in a patient with acute myeloid leukaemia in Germany

A Hamprecht; D Buchheidt; J J Vehreschild; O A Cornely; B Spiess; G Plum; T V Halbsguth; N Kutsch; D Stippel; P Kahl; T Persigehl; A Steinbach; B Bos; M Hallek; M J Vehreschild

doi:10.2807/ese.17.36.20262-en

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Azole-resistant invasive aspergillosis in a patient with acute myeloid leukaemia in Germany
A Hamprecht¹ , D Buchheidt² , J J Vehreschild³ , O A Cornely^3,4 , B Spiess² , G Plum¹ , T V Halbsguth³ , N Kutsch³ , D Stippel⁵ , P Kahl⁶ , T Persigehl⁷ , A Steinbach³ , B Bos³ , M Hallek³ , M J Vehreschild³
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Affiliations: ¹ Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany ² Third Department of Internal Medicine, Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany ³ First Department of Internal Medicine, University of Cologne, Cologne, Germany ⁴ Clinical Trials Centre Cologne, ZKS Köln (BMBF 01KN1106), University of Cologne, Cologne, Germany ⁵ Department of General, Visceral and Cancer Surgery, University of Cologne, Germany ⁶ Institute of Pathology, University Hospital Cologne, Cologne, Germany ⁷ Department of Radiology, University Hospital Cologne, Cologne Germany

Correspondence:
A Hamprecht
axel.hamprecht uk-koeln.de
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Citation style for this article: Hamprecht A, Buchheidt D, Vehreschild J J, Cornely O A, Spiess B, Plum G, Halbsguth T V, Kutsch N, Stippel D, Kahl P, Persigehl T, Steinbach A, Bos B, Hallek M, Vehreschild M J. Azole-resistant invasive aspergillosis in a patient with acute myeloid leukaemia in Germany . Euro Surveill. 2012;17(36):pii=20262. https://doi.org/10.2807/ese.17.36.20262-en Received: 16 Aug 2012

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.