A Case Of Mucormycosis Caused By Lichtheimia And Related Clinical Study

Objective: to analyze and summarize the epidemiology,the underlying cause,pathogenic species,clinical manifestation pathological features,diagnosis and treatment of Lichthe-imia fungal infection so as to deepen the understanding of the disease.Methods: We report1 case caused by Lichtheimia ornata,and then analyzed The morphology and molecular biol-ogy of the pathogen.33 cases infected by Lichtheimia which were reported from 2003 to 2016 were retrospectively analyzed and summarized.Results: A 17 year-old female patient who had numbness discomfort and swelling of right facial and high fever for 3 days after diagnosed of severe aplastic anemia 40+ days and had allogeneic hematopoietic stemcell tran-splantation 9 days.Brain CT and MRI showed signs of brain abscess.Alarge number of thick and aseptate hyphae were obtained by direct microscopic examination of the eye and the nas-al secretions.and sporangium which has simple branches and pear shape were observed by microscope.We can see the white and filamentous colony and the obvious cirul-ar sporangiaand rhizoid staghorn giant cells after cultured 1 weeks SDA 28 ?by the 3D microscope,Thequalitative test of fungal Dglucan was positive,and the level of the quantitat-ive test of fungal D-glucan was 59.23pg/ml.The pathogen was identified as Lichtheimia orn-ata by usingpolymerase chain reaction of fungal DNA followed by sequencing ITS genes and having ph-ylogenetic analysis.This case of Lichtheimia infection caused by L.ornata is the second ca-ses of clinical cases reported in the world.The patient was died due to the severe lesion of pars encephalica after about 30 days treatment with amphotericin B and caspof-ungin after tr-eating with voriconazole for about 2 weeks.Among 33 reported patients of Lichtheimia infe-ction,24 were male and 9 female.Geographical distribution:13 cases(39.39%)came from Fr-ance,Spain and Egypt each had 4 cases,accounted for 12.12%,and 2 cases(6.06%)were from Russia and Hongkong individually,only 1 case(3.03%)was each in the Unite-d States,Gr-eece,Japan,Germany,Denmark,Turkey,Australia and China.Age distribution:In addition to1cases had unknown age,these cases had an average of(42.3±1.5)yea-rs old,and with amedian age of 45 years(range,4 years to 84 years).Hematologic malignancies(12 cases [36.36%])were the most commom underlying disease,including 7 cases of acute leukemia,3cases of lymphoma,2 cases of severe aplastic naemia.And neutrophils was def-iciency in 14 cases(42.42%).7 patients(21.21%)infected of the cutaneous and muscle tiss-ue,while 5 p-atients(15.15%)infected due to organ transplantation,5 patients(5.15%)with dia-betes,1 ca-se(3.03%)on the basic of breast cancer,1 case(3.03%)infected on a HIV infection,1 case(3.03%)hapend on a patient who had acute ischemia of lower limb,and the lase case(3.3%)infected on the basic of malnutrition and alcoholism.Except 7 cases of skin infection and 1case of acute ischemic amputation of the lower limb,other 13 patients all had immunolog-ic inadequacy or decreased.Distribution of affect: lung involvement(8 ca-ses[24.24%]),skin lesions(14 cases [42.42%]);disseminated(4 cases[12.12%]),nasal brain involveme-nt(4 cases [12.12%]),other parts(including stomach and kidney)were 3 cases(9.09%).Pathogenic bacteria:16 cases(48.48%)caused by Lichtheimia corymbifera,15 cases(45.45%)by Lichtheimia ramosa,and Lichtheimia ornata caused 2 cases(6.06%).In addition to 1 cases of treat-ment was unknown,30/33(90.91% cases)treated with systemic antifungal treatment,28cases(84.85%)applica-tion of amphotericin B,13 cases(39.39%)treated with azole antifungal drugs.12/33 cases(36.36%)treated with surgical treatment,including surgical debridement(9 cases)and resection of local tissue(3 cases).In addition,some cases infected with bacterial and virus treated withmeropenem,vancomycin and ganciclovir and so on.20/33 cases(60.61%)were cured,and 11 patients(33.33%)including 3 cases of lung type,3 cases of nasal type,3 cases of skin type and 2 cases of disseminated type were died of this dis-ease,except 2 cases(6.06%)werelost to followup.Conclusion: 1.The infection of Lichtheimia are mainly in Europe and followed in Asia and Africa,but other regions are rare.2.In clinical,Lichtheimia corymbifera and Lichtheimia ramosa are the most common pathogens,the muormycosis is ca-used by Lichthei-mia ornata is relatively rare,so far,there are only 2 cases of muormycosis caused by Lich-theimia in the world.3.The primary risk factor of Lichtheimia infection for human is hematological diseases(HM)and decreased neutrophils,the second factor is the bar-rier damage(not the diabetic that is the common risk factors in other mucormycosis)that ca-used by skin trauma.Because of the clinical sample limited,what is the unique biology mode or others of the fungi invasion,it is need more clinical and laboratory research to further verify.The morbidity,the incidence area and the clinical types of mucormycosis infected b-y Lichtheimiaare still not clear.4.The clinical manifestation of Lichtheimia infection is related to the locat-ion of infection,and the differential diagnosis mainly depends on the examina-tion of fungi'smicroscopy examination and culture,or doing some imaging examination if necessary.5.Timely and rational of systematic application of antifungal agents combined with surgical debri-dement or surgical resection is a better choice for treatment.For those who has poor body condition should treatment primary disease actively to short the treatment time and improve-the prognosis of patients.6.clinicians should enhance the understanding of this disease.Bact-eriological,mycological and histopathological examination should be performed promptly when encountered mucormycosis lesions.At the time,giving empirical antifungal therapy and timely adjusting the treatment plan according to the inspection results to enable patients to getearly correct diagnosis and treatment,and finally improving the prognosis and r-educing themortality rate.