Rose-Anne Lavergne

First description of azole-resistant Aspergillus fumigatus due to TR46/Y121F/T289A mutation in France

ABSTRACT Azole resistance in Aspergillus fumigatus is an emerging public health concern. Recently, a novel fungicide-driven mutation in the cyp51A gene and its promoter, TR46/Y121F/T289A, leading to high-level resistance to voriconazole has been identified in The Netherlands, Belgium, Germany, Denmark, Tanzania, and India in both clinical and environmental samples. Here we report the first description of A. fumigatus carrying this mutation in France, in a cystic fibrosis patient, underlining the need for extensive monitoring of Aspergillus resistance.

Multiple Fungicide-Driven Alterations in Azole-Resistant Aspergillus fumigatus, Colombia, 2015

To the Editor: We read with interest the report by van der Linden et al. about the prevalence of azole-resistant Aspergillus fumigatus isolates from 19 countries, including 2 from the Americas (Brazil and the United States) (1). Recent reports have suggested a link between use of fungicides in agricultural practices and the presence of triazole-resistant A. fumigatus among azole-naive persons (2). These resistant strains harbored the TR34/L98H and TR46/Y121F/T289A mutations in the CYP51A gene and its promoter region. These novel mechanisms of resistance have been reported both in environmental and clinical samples in Europe, Asia, and Africa, suggesting a broad geographic spread. However, clinical isolates from 22 states in the United States (3) and a few isolates from Latin America (1,4) failed to show any fungicide-driven resistance in A. fumigatus in these continents, even though use of pesticides is a widespread practice in the Americas. Colombia was ranked fourth in the world in 2010 for the use of pesticides, reportedly using 14.5 tons/1,000 ha, 30% of which were fungicides (5). Among the fungicides approved by Colombia’s regulatory agency, the Colombian Agricultural Institute (6), tebuconazole and difenoconazole are largely used in the flower industry, more specifically in Cundinamarca, where 60% of Colombia’s flowers are produced.

Azole-resistant Aspergillus fumigatus harboring TR34/L98H, TR46/Y121F/T289A and TR53 mutations related to flower fields in Colombia.

Resistance to triazoles in Aspergillus fumigatus has been reported in azole-naive patients in Europe, Asia, Australia and North America. This resistance has been linked to fungicide-driven mutations in the cyp51A gene and its promoter region. We investigated the presence of environmental azole-resistant A. fumigatus strains related to the use of azole fungicides in Colombia. Soil samples were collected from flower beds, flower fields and public gardens from the outskirts, suburbs and city centre of Bogotá. Out of the 86 soil samples taken, 17 (19.8%) grew A. fumigatus of whom eight (9.3%) contained 40 strains able to grow on azole-containing itraconazole and/or voriconazole supplemented media. All but one triazole-resistant strains were isolated from soil samples collected from flower fields and flower beds (39/40). Importantly, the majority had the TR46/Y121F/T289A, TR34/L98H, and TR53 molecular resistance mechanisms and one azole resistant strain had a wild-type cyp51A gene. Soil samples from flower fields and beds contained 4 azole fungicides (penconazole, difenoconazole, tetraconazole and tebuconazole) above the limit of detection. Our findings underline the need for extensive investigations to determine azole-resistant A. fumigatus prevalence in both clinical and environmental samples in other regions of Latin America.

PCR-based detection of A. fumigatus and absence of azole resistance due to TR34/L98H in a french multicenter cohort of 137 patients with fungal rhinosinusitis

Fungal rhinosinusitis (FRS) has a worldwide distribution, comprises distinct clinical entities but is mostly due to Aspergillus among which Aspergillus fumigatus plays a major role in European countries. Although, there is accumulating evidence for the emergence of environmentally acquired‐azole resistance in A. fumigatus (such as TR34/L98H) in various clinical settings, there is few data for patients with FRS. In this study, we aimed to investigate the prevalence of A. fumigatus azole resistance due to TR34/L98H in a multicentre cohort of patients with FRS. One hundred and thirty‐seven patients with FRS admitted between 2002 and 2016 at four French medical centres were retrospectively enrolled. Clinical and mycological findings were collected. Aspergillus fumigatus and the TR34/L98H alteration conferring azole resistance were investigated directly from clinical samples using the commercial CE‐IVD marked MycoGENIE® A. fumigatus real‐time PCR assay. Fungal ball was the more frequent clinical form (n = 118). Despite the presence of fungal hyphae at direct microscopic examination, mycological cultures remained negative for 83 out of the 137 patients (60.6%). The PCR assay proved to be useful allowing the identification of A. fumigatus and etiological diagnosis in 106 patients (77.4%) compared with 44 patients (32.1%) when using culture as the reference method. Importantly, neither TR34 nor L98H alterations were evidenced.

Identification of cryptic Candida species by MALDI-TOF mass spectrometry, not all MALDI-TOF systems are the same: focus on the C. parapsilosis species complex ☆

Data about the performance of MALDI-TOF mass spectrometry against cryptic Candida species are limited. According to our findings within the C. parapsilosis species complex, microbiologists should be aware that the choice of the instrument is critical for accurate species identification due to the risk of misidentification in the clinical setting.

Rapid diagnostic tests relying on antigen detection from stool as an efficient point of care testing strategy for giardiasis and cryptosporidiosis? Evaluation of a new immunochromatographic duplex assay

Microscopy is the gold standard for the diagnosis of gastrointestinal parasites but is time-consuming and dependent on operator skills. Rapid diagnostic tests represent alternative methods but most evaluations have been conducted on a limited number of samples preventing their implementation in the clinical setting. We evaluated a new CE-IVD marked immunochromatographic assay (Crypto/Giardia K-SeT®, Coris Bioconcept) for the detection of G. intestinalis and Cryptosporidium spp. in 2 phases (retrospective and prospective) on a set of 482 stool samples including rare Cryptosporidium species. Besides G. intestinalis, this test could represent a rapid and reliable alternative to the modified Ziehl-Neelsen staining for the diagnosis of cryptosporidiosis (sensitivity/specificity were 89.2%/99.3% and 86.7%/100% for G. intestinalis and Cryptosporidium resp.), reducing diagnostic delays. Such strategy would also be time-saving by avoiding wet mount microscopy and concentrations steps, being particularly appropriate for laboratories having little expertise in microscopy or not able to implement molecular diagnostic methods.

Photo Quiz: A Cutaneous Lesion in a 66-Year-Old Traveler Returning from Thailand

A 66-year-old male patient was referred to the dermatology department at our hospital in June 2013 for a single cutaneous lesion located in the back of his left leg. Recent empirical treatment with oral and topical antibiotics had been ineffective. On examination, the lesion (1 cm in diameter),