Widespread Lichtheimia Infection in a Patient with Extensive Burns: Opportunities for Novel Antifungal Agents

Abstract

The Mucorales fungi-formerly classified as the zygomycetes-are environmentally ubiquitous fungi, but generally rare causes of clinical infections. In the immunocompromised host, however, they can cause invasive, rapidly spreading infections that confer a high risk of morbidity and mortality, often despite surgical and antifungal therapy. Patients with extensive burn injuries are particularly susceptible to skin and soft-tissue infections with these organisms. Here, we present a case of Lichtheimia infection in a patient with extensive full-thickness burns that required significant and repeated surgical debridement successfully treated with isavuconazole and adjunctive topical amphotericin B washes. We also review the available literature on contemporary antifungal treatment for Lichtheimia species and related Mucorales fungi.

Keywords: Absidia; Burn; Isavuconazole; Lichtheimia; Mucorales.

Fig. 1

Dressing change (HD 20) prior to removal of the Integra engineered dermal substitute. Note the presence of multiple small white plaques (white arrows) on the patient’s right arm (a), right hand (b), and a magnified portion of the left arm (c)

Fig. 2

Microscopic features of the patient’s Lichtheimia spp isolate. Note the extensive branching from the stolons (A; red stars) and the distinctive conical apophysis characteristic of this genus (B; red arrow)

Fig. 3

Generational changes in the active site of short-chain systemic triazole drugs from first generation (fluconazole; green) to early second generation (voriconazole; blue) to late second generation (isavuconazole; orange)