Pulmonary Mucormycosis due to Lichtheimia ramosa in a Patient with HIV Infection

Abstract

Mucormycosis is increasingly common in patients with risk factors such as diabetes mellitus, neutropenia, and corticosteroid therapy. However, mucormycosis seems to be less common in patients with human immunodeficiency virus (HIV) infection compared to patients with other risk factors. Despite their lower virulence, Lichtheimia species should be regarded as emerging pathogens among Mucoralean fungi. We report a fatal case of pulmonary mucormycosis due to Lichtheimia ramosa in a 52-year-old man with an end-stage HIV infection. He had a cachectic appearance and his CD4 count was 8 cells/mm(3). The fungal infection was diagnosed based on a positive sputum culture with histopathologic confirmation. The fungus was resistant to caspofungin, anidulafungin, and voriconazole [minimum inhibitory concentration (MCI) >32 µg/ml], whereas the E test MIC values of itraconazole, posaconazole, and amphotericin B were 0.38, 0.38, and 0.5 µg/ml, respectively. Although intravenous drug use is the main risk factor for the development of mucormycosis in HIV-infected patients, it may also develop in patients with low CD4 count, opportunistic infections and/or additional diseases, such as Kaposi's sarcoma or severe immunodeficiency, as in our case.

The burden of mucormycosis in HIV-infected patients: A systematic review

“…Molecular methods provided fungal identification in just one patient. 8 Those methods provided identification of the fungus by genus (n Z 6) and species level (n Z 5). Table 2 shows the etiological agents isolated.…”

De NovoWhole-Genome Sequence and Genome Annotation of Lichtheimia ramosa

“…thermophila, L. hongkongensis ) belongs to the order of Mucorales (1). Besides L. ramosa, L. ornata and L. corymbifera are clinically relevant (1, 2, 3, 4). The virulence potential of this fungus is connected with thermotolerance (5), because other clinically nonrelevant Lichtheimia species possess a lower thermotolerance and stop growth at 42°C (1, 6).…”

Panfungal PCR assays using fresh frozen paraffin embedded tissue specimens for fungal species identification and the detection of azole-resistance mutations in the A. fumigatus cyp51A gene at a South Korean hospital

“…The Lichtheimia species (formerly known as Absidia) are currently regarded as emerging pathogens among Mucoralean fungi. [14] In the present study, the male patient identified with Lichtheimia ramose infection had a history of hepatocellular carcinoma and had undergone liver transplantation prior to infection. In addition, he was under immunosuppressive medication.…”

“…Although it is generally known to have low virulence, cases of mucormycosis due to Lichtheimia ramose in immunocompromised hosts have been reported. [14,15] Chaumont et al…”