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Systemic Mucormycosis Caused by Lichtheimia Ramosa in a Pregnant Cow

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Systemic Mucormycosis Caused by Lichtheimia Ramosa in a Pregnant Cow Case Report Veterinarni Medicina, 65, 2020 (11): 506–510 https://doi.org/10.17221/8/2020-VETMED Systemic mucormycosis caused by Lichtheimia ramosa in a pregnant cow Kyunghyun Lee1, Hyunju Kim1, Junhyung Sohn2, ByungJae So1, Eun-Jin Choi1* 1Animal and Plant Quarantine Agency, Gimcheon, Republic of Korea 2Veterinary Service Laboratory, Daegu, Republic of Korea *Corresponding author: [email protected] Citation: Lee K, Kim H, Sohn J, So B, Choi E (2020): Systemic mucormycosis caused by Lichtheimia ramosa in a pregnant cow. Vet Med-Czech 65, 506–510. Abstract: Mucormycosis is a life-threatening fungal disease caused by opportunistic pathogens present in the envi- ronment. This report presents a case of a Lichtheimia ramosa infection that manifested as characteristic lesions in various visceral organs of a pregnant cow in Korea. The post-mortem examination revealed the cause of death to be mucormycosis. The fungi isolated from the liver were found to be Lichtheimia spp. Analysis of the fungi using Internal Transcribed Spacer gene sequencing facilitated the identification of Lichtheimia ramosa. To the best of our knowledge, this is the first clinical case of angioinvasive mucormycosis in cattle. Keywords: cattle; fungal disease; angiovasive; Internal Transcribed Spacer Mucormycosis is a severe fungal infection that amination at a slaughterhouse. Mortal-zygomycosis mostly affects immunosuppressed individuals. In- is rarely reported in cattle. fections can be characterised by extensive angioin- Cases of zygomycosis caused by angioinvasive vasion and necrosis. Mucor includes zoonotic path- transmission from other organs along with one abort- ogens present in soil, decaying matter, and cattle ed case are among the limited number of studies that feed, such as hay (Ali and Khan 2006; Woo et al. discuss fatal fungal infections. With the exception 2008). In humans, fungi from the order Mucorales of the latter case, these incidences of disseminated cause zygomycosis more frequently than do those bovine mucormycosis were similar to the fatal hu- from the order Entomophthorales. Zygomycosis is man mucormycosis. subdivided into various infection types according In this study, a fatal case of systemic mucormy- to the distribution of the lesions (Jensen et al. 1994; cosis caused by Lichtheimia ramosa that spread Garcia-Hermoso et al. 2009). Regardless of the spe- through the alimentary system is discussed. cific type of fungal infection, zygomycosis is a fatal disease that requires an early, accurate diagnosis and treatment (Jensen et al. 1994; Garcia-Hermoso Case report et al. 2009). In humans and cattle, most cases of zy- gomycosis are caused by mucormycosis. Bovine A 31-month-old pregnant cow suddenly demon- zygomycosis usually produces focal lesions (mostly strating nasal discharge and anorexia was admit- lymphadenitis or gastric zygomycosis) and is often ted to the veterinary clinic with abnormal clinical incidentally detected during an autopsy or an ex- signs, including depression. Supported by a grant from the Animal and Plant Quarantine Agency, Ministry of Agriculture, Food and Rural Affairs, Republic of Korea (Project No. B-1543069-2019-21-02). 506 Case Report Veterinarni Medicina, 65, 2020 (11): 506–510 https://doi.org/10.17221/8/2020-VETMED She was treated for a suspected intestinal disor- divided and frozen for DNA extraction or fixed der; however, her condition did not improve, and in 10% neutral formalin for 24 h before routine wax she died. An autopsy was conducted. embedding and histologic processing. The liver tis- The following necropsy findings were observed: sue was used for the bacterial and fungal culture. the lungs were dark and swollen, and the spleen was The histopathologic examination revealed se- three times larger than the normal size. Several ir- vere lesions in the liver, rumen, reticulum, and regular yellowish, haemorrhagic foci (0.5–2.0 cm omasum. These tissues showed marked necrotic in diameter) with dark red borders were observed in changes and severe inflammatory cell infiltration the liver (Figure 1A). Similar lesions were also noted predominantly consisting of macrophages, lympho- in the rumen, reticulum, and omasum. A small num- cytes, and neutrophils. Multifocal haemorrhagic le- ber of lesions were also observed in the abomasum. sions and thrombi were also noted (Figure 1B and Tissue samples from the lungs, spleen, heart, kid- 1C). The hyphae were thin and the centre of the wall neys, rumen, reticulum, abomasum, omasum, in- was empty. Line structures that stretched irregularly testine and liver were collected. The samples were and reacted strongly with Gomori’s methenamine (A) (C) (B) (D) Figure 1. Pathological findings of bovine mucormycosis (A) The liver showing multiple black foci as well as red and irregular lesions on the cut surface. (B) The histopatho- logical appearance of the liver with diffuse haemorrhage, necrosis, severe cellular infiltrates, and thrombi and hyphae (inset) in the blood vessel. Haematoxylin and eosin (H&E) stain. (C) The histopathological appearance of the omasum with diffuse, erosive to ulcerative epithelium, severe cellu- lar infiltrates, and thrombi. H&E stain. (D) The histopatho- (B) inset logical appearance of the omasum with numerous fungal hyphae (black). Gomori’s methenamine silver (GMS) stain 507 Case Report Veterinarni Medicina, 65, 2020 (11): 506–510 https://doi.org/10.17221/8/2020-VETMED silver (GMS) stain were also observed (Figure 1D). Transcribed Spacer (ITS) primers (ITS1 and ITS4) The hyphal length ranged from 5 µm to 50 µm. (Woo et al. 2008; Woo et al. 2010b), which dem- Necrotic foci around the fungal hyphae were found onstrated bands at approximately 850 bp. The am- in the liver, rumen, reticulum, and omasum in ac- plicon was purified using a Quick Purification Kit cordance with the macroscopic findings. Thrombi (QIAGEN, Hilden, Germany), and the purified DNA were found in the affected regions of the liver, ru- was used for the direct sequencing. The B17Q226 men, and abomasum, and ulceration with inflam- sequence (633 nt) obtained by Macrogen (Seoul, mation was observed in the abomasum. Republic of Korea) was confirmed as Lichtheimia Additionally, thrombi in the blood vessels, thick- ramosa using the BLAST (basic local alignment ened alveolar walls, and mild pneumonia were ob- search tool) technology from the National Center served in the lungs. for Biotechnology Information (NCBI). This nu- The tissue samples were used for the bacterial cleotide sequence (GenBank accession number culture and viral gene amplification. As a result, MH675478) included a partial Internal Transcribed no bacteria or viruses were detected. The fungi were Spacer 1 (ITS1), a complete 5.8S ribosomal RNA, consistently cultured on a blood agar. These fungi and a partial Internal Transcribed Spacer 2 (ITS2), were subsequently transferred to potato dextrose all of which matched the Lichtheimia spp. sequences agar plates and incubated at 25 °C for 4 days. The in the NCBI GenBank database. These were identi- isolated colonies, named B17Q226, were subjected fied using the Bioedit software. The analysed nucle- to a microscopic examination and gene amplifica- otide sequence showed 93% identity with L. ramosa tion for the mould classification. Microscopically, (GQ342877). A phylogenetic tree was generated these fungi had pyriform sporangia with a coni- using neighbour-joining algorithms in MEGA v6 cal-shaped columella; pronounced apophysis; and (Tamura et al. 2013). The percent frequencies of smooth, coloured, long elliptical spores measur- the groupings were determined after a 1 000 boot- ing 2.18–3.06 µm in diameter. For the molecular strap evaluation. The phylogenetic tree showed that analysis, DNA was extracted using a DNeasy Plant this isolate (MH675478) clustered with L. ramo- Mini Kit (QIAGEN, Hilden, Germany). Polymerase sa strains (GQ342877, MG58398, FJ719386, and chain reaction (PCR) was performed using Internal FJ719406) (Figure 2). L. ramosa belongs to the fam- Figure 2. The phylogenetic tree showing the relationship of the Lichtheimia species and the L. ramosa isolate in the Internal Transcribed Spacer 1, 5.8S ribosomal RNA, and Internal Tran- scribed Spacer 2 regions. All the reference sequences are indicated by the Gen- Bank accession numbers. Dichotomocladium hesselti- nei is used as an outgroup. All Lichtheimia spp. ex. type strain sequences are marked as T. Bootstrap values greater than 500 of 1 000 replicates are indicated 508 Case Report Veterinarni Medicina, 65, 2020 (11): 506–510 https://doi.org/10.17221/8/2020-VETMED ily Lichtheimiaceae in the order Mucorales (Garcia- common gastric micro-organisms found in cattle Hermoso et al. 2009; Tamura et al. 2013). Previous (Chihaya et al. 1986). studies have shown that the ITS gene is useful for Parenteral administration of broad-spectrum an- the identification of the Lichtheimia species (Ali tibiotics over three days has been reported to cause and Khan 2006; Woo et al. 2008). gastrointestinal mycosis in cattle (Woo et al. 2010a), and the cow in the present case suffered mycotic abomasitis, hepatitis, and omasitis following the DISCUSSION antibiotic treatment for five days. In humans, mucormycosis usually occurs in pa- After examination of the gross lesions, abdom- tients with diabetes or in patients who are immu- inal foci associated with a fungal infection were nocompromised, but it can also arise in apparently found in a pregnant cow. A fungal infection and the healthy individuals (Knudtson et al. 1973; Woo et al. corresponding
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