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Cutaneous and Pulmonary Mucormycosis in Rag1- and Il2rg-Deficient Rats

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Cutaneous and Pulmonary Mucormycosis in Rag1- and Il2rg-Deficient Rats Comparative Medicine Vol 70, No 4 Copyright 2020 August 2020 by the American Association for Laboratory Animal Science Pages 390–395 Case Series Cutaneous and Pulmonary Mucormycosis in Rag1- and Il2rg-deficient Rats Anna E Sarfaty,* Susan R Compton, Peter C Smith, and Caroline J Zeiss Immunodeficient rats are valuable in transplantation studies, but are vulnerable to infection from opportunistic organisms such as fungi. Immunodeficient Rag1- and Il2rg-deficient (RRG) rats housed at our institution presented with dark, prolif- erative, keratinized dermal growths. Histologic and PCR results indicated that the predominant organism associated with these lesions was fungus from the family Mucoraceae, mostly of the genus Rhizopus. The Mucoraceae family of fungi are environmental saprophytes and are often found in rodent bedding. These fungi can cause invasive opportunistic infections in immunosuppressed humans and animals. We discuss husbandry practices for immunosuppressed rodents with a focus on controlling fungal contaminants. DOI: 10.30802/AALAS-CM-20-000015 Immunodeficient rodent models are valuable to transplanta- with by pulmonary and cutaneous sequelae.3,7,24 Cutaneous mu- tion studies and may accept immunogenic donor cells or tissues cormycosis typically presents with a necrotic eschar.6,24 Biopsy without rejection.18 Immunodeficient rats are often preferred to and culture are recommended, followed by surgical debride- mice, as their larger size supports more precise surgical proce- ment, antifungal therapy such as amphotericin B and azole dures and larger blood and tissue harvests.18 However, the same drugs, and resolution of any predisposing comorbidities.2,3,6,7,15,24 immunodeficiency which makes them useful transplantation Mucormycosis has rarely been reported in veterinary spe- recipients also makes them susceptible to infection from oppor- cies. Mucoraceae have been implicated in infectious keratitis in tunistic organisms such as fungi. Immunodeficient Rag1- and horses29 and in pulmonary,5 cerebral, colonic and splenic le- Il2rg-deficient (RRG) rats housed at our institution presented sions.25 In cats, Mucorales infections have been identified in with dark, proliferative, keratinized dermal growths, consistent cases of duodenal perforation,8 jejunal perforation secondary with opportunistic and percutaneous invasion of fungi from the to intestinal lymphoma,19 subcutaneous nasal granulomatous family Mucoraceae at sites of minor trauma. disease,28 and systemic disease.20 RRG rats are a cross between a Rag1-deficient and an Il2rg- Spontaneous mucormycosis has not been reported in rodents, deficient line, both on a SD/Crl background.18 The Rag1-defi- although mice10,12,26,27 and rats26 have been experimentally in- cient rats have reduced numbers of B and T cells but normal fected with this organism. Other types of fungal disease have NK cells.17 Il2rg-deficient rats have severe reductions in their been reported in both immunocompetent and immunodeficient populations of B, T, and NK cells.18 Therefore, RRG rats have rats.4,21 Pneumocystis carinii can cause interstitial pneumonia.21 almost no B, T, or NK cells, nor are they able to produce im- Aspergillus fumigatus or Aspergillus niger4 have been associated munoglobulins.18 RRG rats are able to accept human tumors, with rhinitis22,23 and tracheobronchitis.11 Blastomyces dermatiti- human hepatocytes, and skin transplants without rejection.18 dis has been identified as the cause of bronchopneumonia with The Mucoraceae are a family of fungi of the order Mucorales, multifocal pyogranulomas.4 Dermatophytosis may also occur characterized by non- or rarely septate hyphae. These fungi are in rats and is most commonly caused by Trichophyton mentagro- environmental saprophytes that can cause invasive opportu- phytes.4 Rarely, Encephalitozoon cuniculi can infect mice and rats, nistic infections in humans and animals.3,23,24 Pathogenic genera causing nonsuppurative focal lesions in the brain, kidneys, and of Mucorales include Absidia, Apophysomyces, Mucor, Rhizomu- liver.4 In immature rats, phycomycotic meningoencephalitis has cor, Lichtheimia, and Rhizopus.2,15 Human patients can contract also been reported in animals infected with this pathogen.4 opportunistic infection with these fungi during immunosup- Here, we describe the presentation and diagnosis of dermal pression, such as from hematologic malignancy, organ trans- and visceral mucormycosis in an immunocompromised rat plantation, or diabetes mellitus.2,6,9,24 Mucoraceae can also infect strain at our institution. We conclude that the risk of disease immunocompetent individuals when directly inoculated, as a from environmental saprophytes to immunocompromised labo- result of trauma such as needlesticks, stings, bites, or burns.6,15,24 ratory rodents is significant. Maintenance of these rodents with In humans, mucormycosis (infection with fungi of the order autoclaved food and bedding was sufficient to prevent recur- Mucorales) is most commonly rhino-cerebral in presentation, rence of fungal disease. Received: 19 Feb 2020. Revision requested: 01 Apr 2020. Accepted: 15 May 2020. Case Series Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut In June 2018, 2 naïve 6-mo-old male intact rats developed *Corresponding author. Email: [email protected] dark, proliferative, keratinized dermal growths. Rat no. 1 had 390 Mucormycosis in immunodeficient rats a 1 cm growth on the soft tissue of the left mandible, and por- pinworms and pelage examination was negative for fur mites. phyrin secretion was evident in his nares (Figure 1 A). Rat no. The rats were released from quarantine and transferred to col- 2 had a 1 cm lesion behind his right pinna, and a flat, crateri- ony housing on August 31, 2017. In colony housing, the 4 found- form dermal growth covered with hair on his ventral abdomen ing rats and their subsequent generations of offspring were (Figure 1 B). The rats were grooming the lesions and appeared housed in individually ventilated caging (Allentown, Allen- uncomfortable when the lesions were palpated. town PA) with unautoclaved corncob bedding (1/8 in., catalog One week later, 2 female 6-mo-old rats from the same cohort number 7092, Harlan, South Easton, MA) on a 12:12-h light:dark were found with similar growths. Rat no. 3 had a lesion on the cycle. They received ad libitum unautoclaved rodent chow (diet right muzzle, ventrolateral to the nose (Figure 1 D), and rat no. 2018, EnvigoTeklad). In both quarantine and colony housing 4 had a moist, ulcerative lesion on her dorsal neck behind the facilities, hyperchlorinated water (4 to 6 ppm) was offered ad right pinna (Figure 1 B, inset). Three unaffected female rats libitum through the racks’ integrated auto-water system. Room housed in the same cage (rats no. 5 to 7) were moved to a quar- temperature and relative humidity were maintained between antine facility. 22.2 ± 1.1 °C (72 ± 2 °F) and 50% ± 10%, respectively. Rats were In July 2018, 2 of the 3 female cage mates of rats no. 3 and maintained in accordance with the Guide for the Care and Use 4 (no. 5 and 6) developed growths. Rat no. 5 had a moist, ul- of Laboratory Animals,13 and on protocols approved by the Yale cerative 1.5 cm diameter mass at the base of her tail (Figure 1 University IACUC. Yale University is an AAALAC-accredited E), and rat no. 6 had dry, dermal lesion over her right scapula institution. (Figure 1 C inset). Their cage mate, rat no. 7, had no detectable Anatomic pathology. Gross pathologic examinations were lesions. performed on rats #1 to 7 and 9. Systemic histopathology was In August 2018, an 8-mo-old male rat (rat no. 8) presented performed on rats no. 1, 2 and 9; tail, subcutis, and muscle for with a dark, crusty dermal growth caudal to his right pinna, and rat no. 5; and skin and subcutis only for rats no. 3, 4, and 6. After a 0.5 cm diameter red-brown crusty dermal lesion near the left fixation in 10% neutral buffered formalin, all tissues underwent commissure of the mouth. He had porphyrin in both eyes. This routine paraffin processing, followed by sectioning at 5 µm and rat was euthanized by the laboratory and was not submitted for staining with Hematoxylin and Eosin (H and E), Periodic Acid necropsy. Schiff, or Gomori Methenamine Silver (Yale Mouse Research In October 2018, an adult breeding male (rat no. 9) developed Pathology Core in the Department of Comparative Medicine, 2 dark dermal plaques on his right side, measuring 1 and 1.5 cm Yale School of Medicine; mrp.yale.edu). in diameter. The nursing female and pups in the cage did not Bacterial and fungal culture. Bacterial culture was performed have lesions. on tissues from rats no. 1 and 2. Swabs from lesions were cul- Rats no. 1 to 7 and 9 were euthanized and submitted for di- tured for aerobic bacteria by streaking on blood agar and Mc- agnostic necropsy within 24 h of when the lesions were first Conkey agar plates, followed by incubation at 35 °C. Bacteria reported to veterinary staff. were identified using Gram staining and standard biochemical techniques.14,29 Fungal culture was performed on tissues from Materials and Methods rats no. 5 to 7, bedding from rat no. 9’s cage, unautoclaved bed- ding, clean autoclaved bedding with no animal exposure, and Animals. The founders of the RRG colony at our institution autoclaved bedding from lesion-free RRG rat cages. Samples consisted of 2 female and 2 male RRG rats that were received in were cultured by plating onto potato dextrose agar (Remel quarantine at our institution from Janvier Labs on July 20, 2017. Microbiology Products, Lenexa, KS) at 25 °C for 7 to 14 d. The RRG rats are the property of the TRIP platform, Nantes, France18 fungal growth was then suspended in filamentous fungi (FF) and were maintained under SPF conditions at Janvier Labs. Rats inoculating fluid and cultivated in 96 well FF-microplate un- were group housed in static microisolation cages (Allentown, der the same conditions, and read in a microSTATION (Biolog, Allentown PA) with corncob bedding (1/8 in., catalog number Hayward, CA).
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