Selection of Aspergillus fumigatus isolates carrying the G448S substitution in CYP 51A gene after long-term treatment with voriconazole in an immunocompromised patient

Laís Pontes; Caio Augusto Gualtieri Beraquet; Teppei Arai; Akira Watanabe; Maria Luiza Moretti; Angelica Zaninelli Schreiber

doi:10.1016/j.mmcr.2022.02.002

Selection of Aspergillus fumigatus isolates carrying the G448S substitution in CYP 51A gene after long-term treatment with voriconazole in an immunocompromised patient

Med Mycol Case Rep. 2022 Feb 18:36:5-9. doi: 10.1016/j.mmcr.2022.02.002. eCollection 2022 Jun.

Authors

Laís Pontes¹, Caio Augusto Gualtieri Beraquet¹, Teppei Arai², Akira Watanabe², Maria Luiza Moretti¹, Angelica Zaninelli Schreiber¹

Affiliations

¹ School of Medical Sciences - University of Campinas, Campinas, Sao Paulo, Brazil.
² Division of Clinical Research, Medical Mycology Research Center - Chiba University, Chiba, Japan.

Abstract

We present a case of a 55-year-old man with a heart transplant who acquired Invasive Aspergillosis by Aspergillus fumigatus with the focus in the kidney. During about two years of antifungal treatment, most of the time with voriconazole, it was possible to obtain nine isolates of A. fumigatus, with the same genotypic characteristics, but with an increase in MIC for several azoles. The two last isolates presented high MICs for Voriconazole (>8 μg/mL>). Sequencing of the CYP51A gene showed G448S amino acid substitution in the same two isolates. In long-term treatments with antifungals, it would be important to regularly evaluate the susceptibility of isolated strains, as resistance to azoles has been increasingly described around the world.

Keywords: Aspergillus fumigatus; Azole-resistance; Brazil; Invasive aspergillosis.

Publication types

Case Reports