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Monzo-Gallo, Patricia
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article
Report of three azole-resistant Aspergillus fumigatus cases with TR34/L98H mutation in hematological patients in Barcelona, Spain
Abstract
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>We aimed to report the emergence of azole-resistant invasive aspergillosis in hematologic patients admitted to a tertiary hospital in Spain during the last 4 months.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Prospective, descriptive study was performed to describe and follow all consecutive proven and probable invasive aspergillosis resistant to azoles from hematological cohort during the last 4 months. All patients had fungal cultures and antifungal susceptibility or real-time PCR detection for <jats:italic>Aspergillus</jats:italic> species and real-time PCR detection for azole-resistant mutation.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Four cases of invasive aspergillosis were diagnosed in 4 months. Three of them had azole-resistant aspergillosis. Microbiological diagnosis was achieved in three cases by means of fungal culture isolation and subsequent antifungal susceptibility whereas one case was diagnosed by PCR-based aspergillus and azole resistance detection. All the azole-resistant aspergillosis presented TR34/L98H mutation. Patients with azole-resistant aspergillosis had different hematologic diseases: multiple myeloma, lymphoblastic acute leukemia, and angioimmunoblastic T lymphoma. Regarding risk factors, one had prolonged neutropenia, two had corticosteroids, and two had viral co-infection. Two of the patients developed aspergillosis under treatment with azoles.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>We have observed a heightened risk of azole-resistant aspergillosis caused by <jats:italic>A. fumigatus</jats:italic> harboring the TR<jats:sub>34</jats:sub>/L98H mutation in patients with hematologic malignancies. The emergence of azole-resistant aspergillosis raises concerns for the community, highlighting the urgent need for increased surveillance and the importance of susceptibility testing and new drugs development.</jats:p></jats:sec>