[37, 40, 42] Superficial infections can occur in patients suffering from an immunosuppressive disorder, such as leukaemia or HIV, but also in premature infants and apparently healthy adult persons.[42, 45-52] They are characterised by rapidly developing extensive tissue necrosis leading to purple to black discolouration of the skin.[45, 53] In individual cases Angiogenesis inhibitor involvement

of deeper tissue, leading to necrotising fasciitis and cellulitis, has also been reported.[40, 46, 54] In the most severe cases, cutaneous infections can progress to disseminated disease, especially in immunocompromised patients and premature infants.[47, 55] In premature infants, Lichtheimia infections furthermore commonly affect the gastrointestinal tract,[56] often resembling necrotising enterocolitis.[57] Since most studies on mucormycosis do not examine the type of infection on a species-specific level, it is hard to assess the incidence of

different types of infections for Lichtheimia. Only two studies include more detailed information about infections with Lichtheimia species. The study of Alvarez et al. included seven cases of Lichtheimia infections with pulmonary infection and infections of the sinuses as the most important presentations (6 of 7 cases).[22] Only one additional study focused on species-specific analysis of healthcare-associated mucormycosis. Cutaneous and pulmonary infections MAPK inhibitor were the most common types of infection representing 70% and 20% respectively.[83] However, due to the limitations of the currently available studies, e.g. low numbers of cases Ergoloid or restriction to a special patient group, no clear conclusions can be drawn about the incidence of the different types of infections and underlying conditions for the development of Lichtheimia infections. In addition to causing infections, Lichtheimia species have been implicated in the form of occupational hypersensitivity pneumonitis termed Farmer’s lung disease (FLD). Farmer’s lung disease is caused by recurrent exposure to certain microorganisms, especially

in farming personnel. The acute form is characterised by influenza-like symptoms like sweating, chills, fever, nausea and headache. The (sub)chronic form is associated with coughing and dyspnoea for up to several weeks.[58] As mentioned above, Lichtheimia species represent a major contaminant of farming material like hay and straw. The occurrence of FLD has been associated with increased numbers of L. corymbifera in the farm environment and L. corymbifera-specific antibodies in affected patients.[59] Furthermore, in vitro experiments with lung epithelial cells revealed high expression of pro-inflammatory and allergic mediators (IL-8, IL-13) after exposure to extracts of L. corymbifera.[60] These results support the role of Lichtheimia in the development of hypersensitivity pneumonia.