TABLE. Characteristics of seven patients from whom TR₃₄/L98H triazole-resistant Aspergillus fumigatus was isolated — California, Pennsylvania, and Virginia, 2010–2017.

State of origin	Collection year	Source	Cyp51 genotype	Age range (yrs)	Sex	Underlying disease	Known previous triazole exposure?	Previous triazole exposure description	Colonization versus infection (suspected)*	Antifungal treatment	Outcome
Pennsylvania†	2010	Sputum	TR34/L98H	20–29	F	Respiratory failure following stem cell transplant	Yes	VRC; dose and duration unknown	Infection	VRC and CAS; L-AmB and CAS	Died
Pennsylvania†	2014	BAL	TR34/L98H	40–49	M	A. fumigatus colonization following lung transplant that progressed to multifactorial pneumonia and clinical IPA	Yes	VRC, ITC; dose and duration unknown	Infection	ITC and CAS; POS and CAS; L-AmB and CAS	Died
Pennsylvania	2016	Sputum	TR34/L98H	60–69	F	Chronic IPA, sarcoidosis	Yes	VRC 200 mg/day; duration unknown	Infection	VRC; CAS	Alive at discharge
Pennsylvania	2017	BAL	TR34/L98H	80–89	F	Hydropneumothorax with history of COPD and pulmonary fibrosis	No	Inpatient hospitalization, primary care, pulmonologist and pharmacy records indicate no record of triazole or other antifungal prescriptions	Colonization	None	Died
Virginia (nonresident)	2016	Sputum	TR34/L98H	70–79	M	Acute bronchitis and lung nodules; no history of immunocompromise	No	No triazole history available or suspected before hospitalization in Virginia; patient resides in Guatemala	Colonization	None	Alive at discharge
Virginia	2016	Sputum	TR34/L98H	20–29	F	Cystic fibrosis	No	None reported in 6 months preceding isolate collection	Colonization	None	Alive at discharge
California	2017	Sputum	TR34/L98H	80–89	F	COPD, chronic heart failure, and chronic kidney disease	No	No triazole history available or suspected before hospitalization	Colonization	None	Alive at discharge

Abbreviations: BAL = bronchoalveolar lavage; CAS = caspofungin; COPD = chronic obstructive pulmonary disease; F = female; IPA = invasive pulmonary aspergillosis; ITC = itraconazole; L-AmB = liposomal amphotericin B; M = male; POS = posaconazole; VRC = voriconazole.

* Colonization versus infection indicated based on explicit description in patient medical record or by treating physician, or, if not explicitly stated, suspicion based on public health review of record.

^† Wiederhold NP, Gil VG, Gutierrez F, et al. First detection of TR₃₄ L98H and TR₄₆ Y121F T289A Cyp51 mutations in Aspergillus fumigatus isolates in the United States. J Clin Microbiol 2016;54:168–71.