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Leksuwankun S, Plongla R, Eamrurksiri N, Torvorapanit P, Phongkhun K, Langsiri N, Meejun T, Srisurapanont K, Thanakitcharu J, Lerttiendamrong B, Thongkam A, Manothummetha K, Chuleerarux N, Moonla C, Worasilchai N, Chindamporn A, Permpalung N, Nematollahi S. Needs assessment of a pythiosis continuing professional development program. PLoS Negl Trop Dis 2024; 18:e0012004. [PMID: 38408109 PMCID: PMC10919846 DOI: 10.1371/journal.pntd.0012004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/07/2024] [Accepted: 02/16/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Pythiosis is a rare disease with high mortality, with over 94% of cases reported from Thailand and India. Prompt diagnosis and surgery improves patient outcomes. Therefore, continuing professional development (CPD) is essential for early recognition. However, a needs assessment related to a pythiosis CPD program has not been performed. OBJECTIVES We conducted a needs assessment to develop a pythiosis CPD program. PATIENTS/METHODS We conducted a survey study with 267 King Chulalongkorn Memorial Hospital residents (141 internal medicine (IM) residents and 126 surgery residents). A 30-item survey consisting of a knowledge assessment, demographic section, and an attitudes portion was distributed both electronically and via paper. The data was analyzed with descriptive and inferential statistics. RESULTS Sixty-seven percent completed the survey (110/141 IM residents, 70/126 surgery residents). The mean score [95% confidence interval] on the knowledge assessment was 41.67% [39.64%-43.69%] across all objectives. The three domains with the highest scores were pythiosis risk factors (67.22% correct), microbiologic characteristics (50.83%), and radiographic interpretation (50.56%). The three domains with the lowest scores were laboratory investigation (15.00%), epidemiology (29.17%), and symptomatology (30.83%). Most participants noted that the program should be online with both synchronous and asynchronous sessions, with a preferred length of 60-90 minutes per session. CONCLUSION The pythiosis CPD program should emphasize education regarding symptomatology, laboratory investigation, and epidemiology, all of which are critical for the early detection of pythiosis to decrease mortality from this devastating disease. Most respondents felt this program was necessary and should be implemented in a virtual blended format.
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Affiliation(s)
- Surachai Leksuwankun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rongpong Plongla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nathanich Eamrurksiri
- Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pattama Torvorapanit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kasidis Phongkhun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nattapong Langsiri
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanaporn Meejun
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jaedvara Thanakitcharu
- Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | | | - Achitpol Thongkam
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kasama Manothummetha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nipat Chuleerarux
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida, United States of America
| | - Chatphatai Moonla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Navaporn Worasilchai
- Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
- Research Unit of Medical Mycology Diagnosis, Chulalongkorn University, Bangkok, Thailand
| | - Ariya Chindamporn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nitipong Permpalung
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Saman Nematollahi
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, United States of America
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Yolanda H, Lohnoo T, Rujirawat T, Yingyong W, Kumsang Y, Sae-Chew P, Payattikul P, Krajaejun T. Selection of an Appropriate In Vitro Susceptibility Test for Assessing Anti- Pythium insidiosum Activity of Potassium Iodide, Triamcinolone Acetonide, Dimethyl Sulfoxide, and Ethanol. J Fungi (Basel) 2022; 8:1116. [PMID: 36354883 PMCID: PMC9692648 DOI: 10.3390/jof8111116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 02/12/2024] Open
Abstract
The orphan but highly virulent pathogen Pythium insidiosum causes pythiosis in humans and animals. Surgery is a primary treatment aiming to cure but trading off losing affected organs. Antimicrobial drugs show limited efficacy in treating pythiosis. Alternative drugs effective against the pathogen are needed. In-house drug susceptibility tests (i.e., broth dilution, disc diffusion, and radial growth assays) have been established, some of which adapted the standard protocols (i.e., CLSI M38-A2 and CLSI M51) designed for fungi. Hyphal plug, hyphal suspension, and zoospore are inocula commonly used in the drug susceptibility assessment for P. insidiosum. A side-by-side comparison demonstrated that each method had advantages and limitations. Minimum inhibitory and cidal concentrations of a drug varied depending on the selected method. Material availability, user experience, and organism and drug quantities determined which susceptibility assay should be used. We employed the hyphal plug and a combination of broth dilution and radial growth methods to screen and validate the anti-P. insidiosum activities of several previously reported chemicals, including potassium iodide, triamcinolone acetonide, dimethyl sulfoxide, and ethanol, in which data on their anti-P. insidiosum efficacy are limited. We tested each chemical against 29 genetically diverse isolates of P. insidiosum. These chemicals possessed direct antimicrobial effects on the growth of the pathogen in a dose- and time-dependent manner, suggesting their potential application in pythiosis treatment. Future attempts should focus on standardizing these drug susceptibility methods, such as determining susceptibility/resistant breakpoints, so healthcare workers can confidently interpret a result and select an effective drug against P. insidiosum.
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Affiliation(s)
- Hanna Yolanda
- Program in Translational Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Department of Parasitology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta 14440, Indonesia
| | - Tassanee Lohnoo
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Thidarat Rujirawat
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Wanta Yingyong
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Yothin Kumsang
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pattarana Sae-Chew
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Penpan Payattikul
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Theerapong Krajaejun
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Use of different stains for microscopic evaluation for the diagnosis of Pythium keratitis. Indian J Med Microbiol 2022; 40:521-524. [PMID: 36041948 DOI: 10.1016/j.ijmmb.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy of various staining techniques for detection of Pythium in keratitis cases. METHODS Data of nineteen consecutive culture-positive cases of Pythium keratitis were retrospectively analysed. Corneal scrapings and corneal buttons (in the cases which underwent therapeutic penetrating keratoplasty [TPK]) were sent for microbiological and histopathological examination. The direct smears were stained with Potassium hydroxide and calcofluor white (KOH + CFW), Gram and Iodine-Potassium Iodide-Sulphuric Acid (IKI-H2SO4) stains. The corneal buttons were stained with Gomori's Methanamine Silver (GMS), Periodic Acid-Schiff (PAS) and Iodine-Potassium Iodide-Sulphuric Acid (IKI-H2SO4) stains. The positivity of various stains in detecting Pythium was studied. RESULTS Gram and KOH + CFW staining from smear was done in 16 out of 19 (84.2%) cases. KOH + CFW and Gram stains were suggestive of Pythium in 10 (62.5%) and 7 (43.8%) cases, respectively. IKI-H2SO4 staining in scraping samples was positive for Pythium in all the 4 (100%) cases in which it was performed. Half corneal buttons were positive for Pythium with IKI-H2SO4 stain as well as GMS stain in all the 18 cases that underwent TPK (100%). PAS stain showed weak to faint pink staining of Pythium filaments in 7 out of 18 cases (38.9%). CONCLUSION IKI-H2SO4 stain followed by KOH + CFW stain detects Pythium filaments most accurately in corneal scraping samples from keratitis patients, although the differences were not statistically significant. The positivity of the stains depends on astute observation by an experienced ocular microbiologist and pathologist.
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Elshafie NO, Hanlon J, Malkawi M, Sayedahmed EE, Guptill LF, Jones-Hall YL, Santos AP. Nested PCR Detection of Pythium sp. from Formalin-Fixed, Paraffin-Embedded Canine Tissue Sections. Vet Sci 2022; 9:vetsci9080444. [PMID: 36006359 PMCID: PMC9412607 DOI: 10.3390/vetsci9080444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Pythium insidiosum is a waterborne fungus-like organism commonly present in tropical and subtropical areas that causes a disease named pythiosis in dogs and other animals. This disease can cause inflammatory lesions on the skin and gastrointestinal tract and, if left untreated, may be fatal. Because this mold lacks the distinctive features of true fungi, it requires specific treatment. Diagnosis of pythiosis is commonly achieved by microscope visualization after staining the tissue sections (histopathology). Although some stains highlight hyphae, these techniques are challenging to distinguish P. insidiosum from other fungi. Our study aimed to develop a molecular technique (nested PCR) to specifically detect P. insidiosum DNA in biopsy specimens to aid in diagnosing this organism. Archived biopsies from 26 dogs suspected of pythiosis were examined by histopathology with special stains and tested by the novel nested PCR. Agreement between histopathology and nested PCR occurred in 18/26 cases. The microscopic examination identified hyphae consistent with Pythium sp. in 57.7% of the samples, whereas the nested PCR detected P. insidiosum DNA in 76.9% of samples, aiding in the sensitivity of the diagnosis of pythiosis in dogs. Using this combination of techniques, we report 20 canine cases of pythiosis over 18 years in Indiana and Kentucky, an unexpectedly high incidence for temperate climatic regions. Thus, we recommend using our nested PCR test in addition to the microscopic examination to increase the sensitivity of the diagnosis. Abstract Pythium insidiosum is an infectious oomycete affecting dogs that develop the cutaneous or gastrointestinal form of pythiosis with a poor prognosis. If left untreated, pythiosis may be fatal. This organism is not a true fungus because its cell wall and cell membrane lack chitin and ergosterol, respectively, requiring specific treatment. Identifying the organism is challenging, as a hematoxylin and eosin (H&E) stain poorly stain the P. insidiosum hyphae and cannot be differentiated conclusively from other fungal or fungal-like organisms (such as Lagenidium sp.) morphologically. Our study aimed to develop a nested PCR to detect P. insidiosum and compare it with the traditional histopathologic detection of hyphae. Formalin-fixed, paraffin-embedded (FFPE) tissue scrolls from 26 dogs with lesions suggesting the P. insidiosum infection were assessed histologically, and DNA was extracted from the FFPE tissue sections for nested PCR. Agreement between the histologic stains, (H&E), periodic acid–Schiff (PAS), and/or Grocott methenamine silver (GMS) and the nested PCR occurred in 18/26 cases. Hyphae consistent with Pythium sp. were identified via histopathology in 57.7% of the samples, whereas the nested PCR detected P. insidiosum in 76.9% of samples, aiding in the sensitivity of the diagnosis of pythiosis in dogs. Using this combination of techniques, we report 20 canine cases of pythiosis over 18 years in Indiana and Kentucky, an unexpectedly high incidence for temperate climatic regions. Using a combination of histopathology evaluation and nested PCR is recommended to aid in the accurate diagnosis of pythiosis.
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Affiliation(s)
- Nelly O. Elshafie
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Jessica Hanlon
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Mays Malkawi
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Ekramy E. Sayedahmed
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Lynn F. Guptill
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Yava L. Jones-Hall
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Andrea P. Santos
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
- Correspondence:
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Pythiosis in a patient with Acute Myeloid Leukemia: Diagnosis and clinical course. J Mycol Med 2022; 32:101279. [DOI: 10.1016/j.mycmed.2022.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/24/2022]
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Severe skin and soft tissue pythiosis acquired in a hot sp. Travel Med Infect Dis 2022; 48:102349. [DOI: 10.1016/j.tmaid.2022.102349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/25/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022]
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Yolanda H, Krajaejun T. Global Distribution and Clinical Features of Pythiosis in Humans and Animals. J Fungi (Basel) 2022; 8:jof8020182. [PMID: 35205934 PMCID: PMC8879638 DOI: 10.3390/jof8020182] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 01/27/2023] Open
Abstract
Pythiosis is a difficult-to-treat infectious disease caused by Pythium insidiosum. The condition is unfamiliar among healthcare workers. Manifestation of pythiosis is similar to other fungal infections, leading to misdiagnosis and delayed treatment. The geographical extent of pythiosis at a global scale is unclear. This study aimed to analyze the clinical information recorded in the scientific literature to comprehensively project epidemiological characteristics, clinical features, and future trends of pythiosis. From 1980 to 2021, 4203 cases of pythiosis in humans (n = 771; 18.3%) and animals (primarily horse, dog, and cow; n = 3432; 81.7%), with an average of 103 cases/year, were recruited. Pythiosis case reports significantly increased in the last decade. Pythiosis spanned 23 tropical, subtropical, and temperate countries worldwide. Some patients acquired pythiosis from a trip to an endemic country. Strikingly, 94.3% of human cases were in India and Thailand, while 79.2% of affected animals were in the U.S.A. and Brazil. Clinical features of pythiosis varied. Vascular and ocular pythiosis were only observed in humans, whereas cutaneous/subcutaneous and gastrointestinal infections were predominant in animals. Mortality depended on host species and clinical forms: for example, none in patients with ocular pythiosis, 0.7% in cows with a cutaneous lesion, 26.8% in humans with vascular disease, 86.4% in dogs with gastrointestinal pathology, and 100% in several animals with disseminated infection. In summary, this study reports up-to-date epidemiological and clinical features of pythiosis in humans and animals. It increases awareness of this life-threatening disease, as the illness or outbreak can exist in any country, not limited to the endemic areas.
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Affiliation(s)
- Hanna Yolanda
- Program in Translational Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
- Department of Parasitology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta 14440, Indonesia
| | - Theerapong Krajaejun
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Correspondence: ; Tel.: +662-201-1452
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Chitasombat MN, Jongkhajornpong P, Lekhanont K, Krajaejun T. Recent update in diagnosis and treatment of human pythiosis. PeerJ 2020; 8:e8555. [PMID: 32117626 PMCID: PMC7036273 DOI: 10.7717/peerj.8555] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Human pythiosis is an infectious condition with high morbidity and mortality. The causative agent is the oomycete microorganism Pythium insidiosum. The pathogen inhabits ubiquitously in a wet environment, and direct exposure to the pathogen initiates the infection. Most patients with pythiosis require surgical removal of the affected organ, and many patients die from the disease. Awareness of pythiosis among healthcare personnel is increasing. In this review, we summarized and updated information on the diagnosis and treatment of human pythiosis. Vascular and ocular pythiosis are common clinical manifestations. Recognition of the typical clinical features of pythiosis is essential for early diagnosis. The definitive diagnosis of the disease requires laboratory testing, such as microbiological, serological, molecular, and proteomic assays. In vascular pythiosis, surgical intervention to achieve the organism-free margin of the affected tissue, in combination with the use of antifungal drugs and P. insidiosum immunotherapy, remains the recommended treatment. Ocular pythiosis is a serious condition and earliest therapeutic penetrating keratoplasty with wide surgical margin is the mainstay treatment. Thorough clinical assessment is essential in all patients to evaluate the treatment response and detect an early sign of the disease recurrence. In conclusion, early diagnosis and proper management are the keys to an optimal outcome of the patients with pythiosis.
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Affiliation(s)
- Maria Nina Chitasombat
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Passara Jongkhajornpong
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Theerapong Krajaejun
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Worasilchai N, Leelahavanichkul A, Permpalung N, Kuityo C, Phaisanchatchawan T, Palaga T, Reantragoon R, Chindamporn A. Antigen host response differences between the animal-type strain and human-clinical Pythium insidiosum isolates used for serological diagnosis in Thailand. Med Mycol 2019; 57:519-522. [PMID: 30165659 DOI: 10.1093/mmy/myy072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/20/2018] [Accepted: 07/28/2018] [Indexed: 11/13/2022] Open
Abstract
The detection of Pythium insidiosum-specific-immunoglobulin-G antibody (Pi-Ab) with enzyme-linked immunosorbent assay (ELISA) test depends on the source of antigen. In this study, the Pi-Ab levels in 140 serum samples from patients with pythiosis were evaluated by ELISA using antigens from 10 P. insidiosum clinical isolates in comparison with antigen from the equine-standard-type strain. The ELISA values (EVs), calculated from antibody levels from serum of patients with pythiosis or other infections versus healthy controls, were significantly higher in the test with clinical-isolates antigen than the standard-equine-type strain (6.0 ± 2.6 vs 4.0 ± 1.7, respectively; P < .0001). ELISA with antigen from human source might be more proper diagnosis test.
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Affiliation(s)
- N Worasilchai
- Interdisciplinary Program, Medical Microbiology, Graduate school, Chulalongkorn University, Bangkok, Thailand
| | - A Leelahavanichkul
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - N Permpalung
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - C Kuityo
- Interdisciplinary Program, Medical Microbiology, Graduate school, Chulalongkorn University, Bangkok, Thailand
| | - T Phaisanchatchawan
- Interdisciplinary Program, Medical Microbiology, Graduate school, Chulalongkorn University, Bangkok, Thailand
| | - T Palaga
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - R Reantragoon
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Immunology and Immune-mediated diseases, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - A Chindamporn
- Division of Mycology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Immunological Diagnosis of Fungal Disease in Animals. Fungal Biol 2019. [DOI: 10.1007/978-3-030-18586-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Monitoring Anti-Pythium insidiosum IgG Antibodies and (1→3)-β-d-Glucan in Vascular Pythiosis. J Clin Microbiol 2018; 56:JCM.00610-18. [PMID: 29848566 DOI: 10.1128/jcm.00610-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/22/2018] [Indexed: 11/20/2022] Open
Abstract
Despite aggressive treatment, vascular pythiosis has a mortality rate of 40%. This is due to delays in diagnosis and a lack of effective monitoring tools. To overcome this drawback, serum beta-d-glucan (BG) and P. insidiosum-specific antibody (Pi-Ab) were examined as potential monitoring markers in vascular pythiosis. A prospective cohort study of vascular pythiosis patients was carried out from January 2010 to July 2016. Clinical information and blood samples were collected and evaluated by the BG and Pi-Ab assays. Linear mixed-effect models were used to compare BG and Pi-Ab levels. The in vitro susceptibility test was performed with all P. insidiosum isolates from culture-positive cases. A total of 50 patients were enrolled: 45 survived and 5 died during follow-up. The survivors had a significantly shorter time to medical care (P < 0.0001) and a significantly shorter waiting time to the first surgery (P < 0.0001). There were no differences in BG levels among the groups at diagnosis (P = 0.33); however, BG levels among survivors were significantly lower than those of the deceased group at 0.5 months (P < 0.0001) and became undetectable after 3 months. Survivors were able to maintain an enzyme-linked immunosorbent assay (ELISA) value (EV) of Pi-Ab above 8, whereas the EV among deceased patients was less than 4. In vitro susceptibility results revealed no synergistic effects between itraconazole and terbinafine. This study showed that BG and Pi-Ab are potentially valuable markers to monitor the disease after treatment initiation. An unchanged BG level at 2 weeks after surgery should prompt an evaluation for residual disease.
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Pythium Insidiosum Keratitis: Histopathology and Rapid Novel Diagnostic Staining Technique. Cornea 2017; 36:1124-1132. [DOI: 10.1097/ico.0000000000001244] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Tondolo JSM, Loreto ÉS, Ledur PC, Jesus FPK, Silva TM, Kommers GD, Alves SH, Santurio JM. Chemically induced disseminated pythiosis in BALB/c mice: A new experimental model for Pythium insidiosum infection. PLoS One 2017; 12:e0177868. [PMID: 28542438 PMCID: PMC5438141 DOI: 10.1371/journal.pone.0177868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/04/2017] [Indexed: 01/09/2023] Open
Abstract
Pythiosis is a severe and life-threatening disease that affects humans and various animal species. We report a model of vascular/disseminated pythiosis occurring after subcutaneous inoculation of 2 x 104Pythium insidiosum zoospores/mL in immunocompromised BALB/c mice. For this model, we carried out two rounds of experiments. First, we evaluated two protocols of immunosuppression before inoculation: cyclophosphamide at 150 mg/kg (CYP group) and cyclophosphamide 200 mg/kg plus hydrocortisone acetate at 250 mg/kg (CYP+HCA group). It was not possible to obtain mortality in the CYP group; however, the combination of CYP+HCA altered disease outcomes, with mortality rates reaching 60%. Second, we used the CYP+HCA immunosuppression protocol to analyze the histological and immunological statuses triggered by disease. When we inoculated immunocompetent mice with P. insidiosum zoospores, self-healing occurred via increased levels of IL-2, IFN-γ and IL-17A, which are characteristic of the Th1/Th17 cytokine response. For infected and immunosuppressed mice, the cytokine profiles showed high levels of IL-10, IL-6 and TNF-α. Increased IL-10 values are related to fungal infection susceptibility and led us to speculate that infection may be established through suppression of the host immune response. In addition, histopathological evaluation of the kidneys and liver demonstrated the presence of hyphae and the cellular findings suggested an acute vascular inflammation that mimics vascular/disseminated pythiosis in humans. This is the first murine model for pythiosis that is useful both for understanding the pathogenesis of this disease and for evaluating new treatment approaches.
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Affiliation(s)
- Juliana S. M. Tondolo
- Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Farmacologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Érico S. Loreto
- Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Farmacologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
- Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Pauline C. Ledur
- Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Farmacologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Francielli P. K. Jesus
- Instituto de Química, Programa de Pós-Graduação em Química Orgânica, Laboratório de Processos Tecnológicos e Catálise, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Taiara M. Silva
- Departamento de Patologia, Programa de Pós-Graduação em Medicina Veterinária, Centro de Ciências Rurais, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Glaucia D. Kommers
- Departamento de Patologia, Laboratório de Patologia Veterinária, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Sydney H. Alves
- Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Janio M. Santurio
- Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Farmacologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
- * E-mail:
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Development of an Anti-Elicitin Antibody-Based Immunohistochemical Assay for Diagnosis of Pythiosis. J Clin Microbiol 2016; 54:43-8. [PMID: 26719582 DOI: 10.1128/jcm.02113-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pythiosis is an emerging and life-threatening infectious disease of humans and animals living in tropical and subtropical countries and is caused by the fungus-like organism Pythium insidiosum. Antifungals are ineffective against this pathogen. Most patients undergo surgical removal of the infected organ, and many die from advanced infections. Early and accurate diagnosis leads to prompt management and promotes better prognosis for affected patients. Immunohistochemical assays (IHCs) have been developed using rabbit antibodies raised against P. insidiosum crude extract, i.e., culture filtrate antigen (CFA), for the histodiagnosis of pythiosis, but cross-reactivity with pathogenic fungi compromises the diagnostic performance of the IHC. Therefore, there is a need to improve detection specificity. Recently, the elicitin protein, ELI025, was identified in P. insidiosum, but it was not identified in other human pathogens, including true fungi. The ELI025-encoding gene was successfully cloned and expressed as a recombinant protein in Escherichia coli. This study aims to develop a new IHC using the rabbit anti-ELI025 antibody (anti-ELI) and to compare its performance with the previously reported anti-CFA-based IHC. Thirty-eight P. insidiosum histological sections stained positive by anti-ELI-based and anti-CFA-based IHCs indicating 100% detection sensitivity for the two assays. The anti-ELI antibody stained negative for all 49 negative-control sections indicating 100% detection specificity. In contrast, the anti-CFA antibody stained positive for one of the 49 negative controls (a slide prepared from Fusarium-infected tissue) indicating 98% detection specificity. In conclusion, the anti-ELI based IHC is sensitive and specific for the histodiagnosis of pythiosis and is an improvement over the anti-CFA-based assay.
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15
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In Vitro Synergism between Azithromycin or Terbinafine and Topical Antimicrobial Agents against Pythium insidiosum. Antimicrob Agents Chemother 2016; 60:5023-5. [PMID: 27216049 DOI: 10.1128/aac.00154-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/15/2016] [Indexed: 11/20/2022] Open
Abstract
We describe here in vitro activity for the combination of azithromycin or terbinafine and benzalkonium, cetrimide, cetylpyridinium, mupirocin, triclosan, or potassium permanganate. With the exception of potassium permanganate, the remaining antimicrobial drugs were active and had an MIC90 between 2 and 32 μg∕ml. The greatest synergism was observed for the combination of terbinafine and cetrimide (71.4%). In vivo experimental evaluations will clarify the potential of these drugs for the topical treatment of lesions caused by Pythium insidiosum.
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16
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Vilela R, Viswanathan P, Mendoza LA. A biochemical screening approach to putatively differentiate mammalian pathogenic Oomycota species in the clinical laboratory. J Med Microbiol 2015; 64:862-868. [PMID: 26293112 DOI: 10.1099/jmm.0.000111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The report of four novel mammalian pathogenic species of the genus Lagenidium prompted us to study the use of biochemical assays to differentiate the Oomycota mammalian pathogens Pythium insidiosum and Lagenidium spp. We investigated the reaction of 23 Lagenidium and eight Pythium species in various biochemical assays. Because the morphological features of the Oomycota species are similar to those of species in the Entomophthoramycota and Mucormycota, five fungal species with coenocytic hyphae were also included. We found that mammalian and plant isolates of Pythium spp. all hydrolysed sucrose, but Lagenidium species and the fungal strains did not. In addition, both Pythium spp. and Lagenidium spp. were found to be maltose-positive, whereas fungal strains did not hydrolyse this sugar. The fungal species and thermo-sensitive Lagenidium giganteum and Lagenidium humanum were urease-negative, but the mammalian Lagenidium spp. and Pythium spp. hydrolysed urea within 24 h. These findings suggest these assays can be used for the presumptive differentiation of mammalian Oomycota species in the laboratory.
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Affiliation(s)
- Raquel Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI 48824, USA.,Superior Institute of Medicine, Belo Horizonte, Brazil.,Faculty of Pharmacy, Universidade Federal of Minas Gerais, Belo Horizonte, Brazil
| | - Poorna Viswanathan
- Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA
| | - Leonel A Mendoza
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI 48824, USA.,Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA
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17
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Combat-Related Pythium aphanidermatum Invasive Wound Infection: Case Report and Discussion of Utility of Molecular Diagnostics. J Clin Microbiol 2015; 53:1968-75. [PMID: 25832301 DOI: 10.1128/jcm.00410-15] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/26/2015] [Indexed: 11/20/2022] Open
Abstract
We describe a 22-year-old soldier with 19% total body surface area burns, polytrauma, and sequence- and culture-confirmed Pythium aphanidermatum wound infection. Antemortem histopathology suggested disseminated Pythium infection, including brain involvement; however, postmortem PCR revealed Cunninghamella elegans, Lichtheimia corymbifera, and Saksenaea vasiformis coinfection. The utility of molecular diagnostics in invasive fungal infections is discussed.
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18
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Lerksuthirat T, Lohnoo T, Inkomlue R, Rujirawat T, Yingyong W, Khositnithikul R, Phaonakrop N, Roytrakul S, Sullivan TD, Krajaejun T. The elicitin-like glycoprotein, ELI025, is secreted by the pathogenic oomycete Pythium insidiosum and evades host antibody responses. PLoS One 2015; 10:e0118547. [PMID: 25793767 PMCID: PMC4368664 DOI: 10.1371/journal.pone.0118547] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/20/2015] [Indexed: 12/31/2022] Open
Abstract
Pythium insidiosum is a unique oomycete that can infect humans and animals. Patients with a P. insidiosum infection (pythiosis) have high rates of morbidity and mortality. The pathogen resists conventional antifungal drugs. Information on the biology and pathogenesis of P. insidiosum is limited. Many pathogens secrete proteins, known as effectors, which can affect the host response and promote the infection process. Elicitins are secretory proteins and are found only in the oomycetes, primarily in Phytophthora and Pythium species. In plant-pathogenic oomycetes, elicitins function as pathogen-associated molecular pattern molecules, sterol carriers, and plant defense stimulators. Recently, we reported a number of elicitin-encoding genes from the P. insidiosum transcriptome. The function of elicitins during human infections is unknown. One of the P. insidiosum elicitin-encoding genes, ELI025, is highly expressed and up-regulated at body temperature. This study aims to characterize the biochemical, immunological, and genetic properties of the elicitin protein, ELI025. A 12.4-kDa recombinant ELI025 protein (rELI025) was expressed in Escherichia coli. Rabbit anti-rELI025 antibodies reacted strongly with the native ELI025 in P. insidiosum’s culture medium. The detected ELI025 had two isoforms: glycosylated and non-glycosylated. ELI025 was not immunoreactive with sera from pythiosis patients. The region near the transcriptional start site of ELI025 contained conserved oomycete core promoter elements. In conclusion, ELI025 is a small, abundant, secreted glycoprotein that evades host antibody responses. ELI025 is a promising candidate for development of diagnostic and therapeutic targets for pythiosis.
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Affiliation(s)
- Tassanee Lerksuthirat
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Molecular Medicine Program, Multidisciplinary Unit, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Tassanee Lohnoo
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ruchuros Inkomlue
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thidarat Rujirawat
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Molecular Medicine Program, Multidisciplinary Unit, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Wanta Yingyong
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rommanee Khositnithikul
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Narumon Phaonakrop
- Proteomics Research Laboratory, Genome Institute, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Sittiruk Roytrakul
- Proteomics Research Laboratory, Genome Institute, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Thomas D. Sullivan
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Theerapong Krajaejun
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
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19
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Kirzhner M, Arnold SR, Lyle C, Mendoza LL, Fleming JC. Pythium insidiosum: A Rare Necrotizing Orbital and Facial Infection. J Pediatric Infect Dis Soc 2015; 4:e10-3. [PMID: 26407370 DOI: 10.1093/jpids/piu015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 02/03/2014] [Indexed: 11/13/2022]
Abstract
Pythium insidiosum, also known as "swamp cancer," has been long known for its destructive effects on plants and animals. Infections with this fungus-like organism typically occur in temperate, tropical, and subtropical regions [ 1]. Human infection with P insidiosum, although exceedingly rare, is characterized by invasion of the cornea, cutaneous, subcutaneous, and orbital tissues with eosinophilic, tumor-like masses demonstrating arterial tropism [ 1, 2]. In most cases, patients have a history of recent exposure to wet environments [ 1]. If left untreated, P insidiosum is fatal, because it is an angioinvasive organism that leads to thrombosis and tissue ischemia. Reports of most human cases are from Thailand, with only 4 well documented orbital cases to date in the United States and Australia [ 1, 3, 4].
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Affiliation(s)
- Maria Kirzhner
- Department of Ophthalmology, University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis
| | - Sandra R Arnold
- Department of Pediatrics, Division of Infectious Diseases, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis
| | - Cari Lyle
- Department of Ophthalmology, University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis
| | - Leonel L Mendoza
- Biomedical Laboratory Diagnostics, Microbiology and Molecular Genetics, Michigan State University, East Lansing
| | - James C Fleming
- Department of Ophthalmology, University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis
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20
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Lelievre L, Borderie V, Garcia-Hermoso D, Brignier AC, Sterkers M, Chaumeil C, Lortholary O, Lanternier F. Imported pythium insidiosum keratitis after a swim in Thailand by a contact lens-wearing traveler. Am J Trop Med Hyg 2014; 92:270-3. [PMID: 25535313 DOI: 10.4269/ajtmh.14-0380] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 30-year-old woman with a history of contact lens wear and exposure to swimming pool water in Thailand presented with a non-responsive, progressive corneal ulcer of the right eye. Confocal microscopy evidenced septate linear branching structures, raising suspicion of fungal keratitis. She was promptly treated with topical antibiotics and both topical and intravenous caspofungin plus voriconazole. Worsening of the clinical picture after 1 month of intensive medical therapy led to a large therapeutic penetrating keratoplasty being performed. Corneal cultures grew a mold-like organism, which was identified by sequencing as Pythium insidiosum, an aquatic oomycete. After 4 years of follow-up, the graft exhibits no infection relapse, but graft transparency has been lost after two rejection episodes. Keratoplasty combined with antifungal treatment may offer a cure to P. insidiosum keratitis, although long-term preservation of corneal transparency is difficult to obtain.
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Affiliation(s)
- Lucie Lelievre
- Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, APHP, Paris, France; Fédération de Pathologie Infectieuse Oculaire, Centre de Recherche Institut de la Vision, UMR S 968 Inserm/UPMC/CHNO des Quinze-Vingts, Paris, France; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Paris, France; Service de Microbiologie, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Vincent Borderie
- Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, APHP, Paris, France; Fédération de Pathologie Infectieuse Oculaire, Centre de Recherche Institut de la Vision, UMR S 968 Inserm/UPMC/CHNO des Quinze-Vingts, Paris, France; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Paris, France; Service de Microbiologie, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Dea Garcia-Hermoso
- Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, APHP, Paris, France; Fédération de Pathologie Infectieuse Oculaire, Centre de Recherche Institut de la Vision, UMR S 968 Inserm/UPMC/CHNO des Quinze-Vingts, Paris, France; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Paris, France; Service de Microbiologie, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Anne C Brignier
- Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, APHP, Paris, France; Fédération de Pathologie Infectieuse Oculaire, Centre de Recherche Institut de la Vision, UMR S 968 Inserm/UPMC/CHNO des Quinze-Vingts, Paris, France; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Paris, France; Service de Microbiologie, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Margaret Sterkers
- Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, APHP, Paris, France; Fédération de Pathologie Infectieuse Oculaire, Centre de Recherche Institut de la Vision, UMR S 968 Inserm/UPMC/CHNO des Quinze-Vingts, Paris, France; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Paris, France; Service de Microbiologie, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Christine Chaumeil
- Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, APHP, Paris, France; Fédération de Pathologie Infectieuse Oculaire, Centre de Recherche Institut de la Vision, UMR S 968 Inserm/UPMC/CHNO des Quinze-Vingts, Paris, France; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Paris, France; Service de Microbiologie, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Olivier Lortholary
- Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, APHP, Paris, France; Fédération de Pathologie Infectieuse Oculaire, Centre de Recherche Institut de la Vision, UMR S 968 Inserm/UPMC/CHNO des Quinze-Vingts, Paris, France; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Paris, France; Service de Microbiologie, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Fanny Lanternier
- Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, APHP, Paris, France; Fédération de Pathologie Infectieuse Oculaire, Centre de Recherche Institut de la Vision, UMR S 968 Inserm/UPMC/CHNO des Quinze-Vingts, Paris, France; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Paris, France; Service de Microbiologie, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
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21
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New insights into the in vitro susceptibility of Pythium insidiosum. Antimicrob Agents Chemother 2014; 58:7534-7. [PMID: 25223997 DOI: 10.1128/aac.02680-13] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We have determined the in vitro activity of several antibacterial and antifungal drugs against Pythium insidiosum using broth microdilution (BMD), disk diffusion, and Etest methods. The largest zones of inhibition (disk diffusion) and the lowest BMD and Etest MICs were observed for azithromycin, clarithromycin, linezolid, mupirocin, doxycycline, minocycline, and tigecycline. The in vitro activities observed suggest that antibacterials, which act by inhibiting protein synthesis, are promising candidate therapies for the treatment of pythiosis.
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22
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Tondolo JSM, Loreto ÉS, Denardi LB, Mario DAN, Alves SH, Santurio JM. A simple, rapid and inexpensive screening method for the identification of Pythium insidiosum. J Microbiol Methods 2013; 93:52-4. [DOI: 10.1016/j.mimet.2013.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/05/2013] [Accepted: 02/08/2013] [Indexed: 10/27/2022]
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23
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Hoffman MA, Cornish NE, Simonsen KA. A painful thigh lesion in an immunocompromised 11-year-old boy. Pediatr Infect Dis J 2011; 30:1011, 1017-8. [PMID: 22001905 DOI: 10.1097/inf.0b013e318225b327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michelle A Hoffman
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, 982162 University of Nebraska Medical Center Omaha, NE 68114-2162, USA.
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24
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Abstract
Pythium aphanidermatum is a fungus-like plant pathogen which has never been reported as a cause of human infection. We report a case of P. aphanidermatum invasive wound infection in a 21-year-old male injured during combat operations in Afghanistan.
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25
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Franco DM, Aronson JF, Hawkins HK, Gallagher JJ, Mendoza L, McGinnis MR, Williams-Bouyer N. Systemic Pythium insidiosum in a pediatric burn patient. Burns 2010; 36:e68-71. [DOI: 10.1016/j.burns.2009.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 08/15/2009] [Indexed: 10/20/2022]
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26
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Gaastra W, Lipman LJA, De Cock AWAM, Exel TK, Pegge RBG, Scheurwater J, Vilela R, Mendoza L. Pythium insidiosum: an overview. Vet Microbiol 2010; 146:1-16. [PMID: 20800978 DOI: 10.1016/j.vetmic.2010.07.019] [Citation(s) in RCA: 219] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 02/08/2023]
Abstract
Pythium insidiosum is an oomycete pathogenic in mammals. The infection occurs mainly in tropical and subtropical areas, particularly in horses, dogs and humans. Infection is acquired through small wounds via contact with water that contains motile zoospores or other propagules (zoospores or hyphae). The disease, though described as emerging has in fact already been described since 1884. Depending on the site of entry, infection can lead to different forms of pythiosis i.e. a cutaneous, vascular, ocular, gastrointestinal and a systemic form, which is rarely seen. The infection is not contagious; no animal-animal or animal-human transmission has been reported so far. Therapy includes radical surgery, antifungal drugs, immunotherapy or a combination of these therapies. The prevention to contract the disease in endemic areas is difficult. Avoiding stagnant waters could be of help, although the presence of P. insidiosum on grass and soil in enzootic areas renders this practice useless.
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Affiliation(s)
- Wim Gaastra
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
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27
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Badenoch PR, Mills RAD, Chang JH, Sadlon TA, Klebe S, Coster DJ. Pythium insidiosumkeratitis in an Australian child. Clin Exp Ophthalmol 2009; 37:806-9. [DOI: 10.1111/j.1442-9071.2009.02135.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Development of an immunochromatographic test for rapid serodiagnosis of human pythiosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2009; 16:506-9. [PMID: 19225072 DOI: 10.1128/cvi.00276-08] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Human pythiosis is an emerging and life-threatening infectious disease caused by the fungus-like organism Pythium insidiosum. High rates of morbidity and mortality for patients with pythiosis are exacerbated by the lack of early diagnosis and an effective treatment. Here, we developed and evaluated an immunochromatographic test (ICT) for the diagnosis of human pythiosis, in comparison to a standard serological test of immunodiffusion (ID). Culture filtrate antigen of P. insidiosum was used to detect human anti-P. insidiosum antibody. Sheep anti-human immunoglobulin G-colloidal gold conjugate was used to generate an ICT signal. Thirty-three sera from patients with vascular (n = 27), ocular (n = 4), and cutaneous (n = 2) pythiosis and 181 control sera from healthy blood donors (n = 100), as well as patients with a variety of infectious (n = 56) and noninfectious (n = 25) diseases, were included in the test evaluation. The turnaround time for generating a result by the ICT was less than 30 min, while that for ID was approximately 24 h. Based on the results for all sera of pythiosis patients and the control groups, the ICT showed 88% sensitivity and 100% specificity and ID showed 61% sensitivity and 100% specificity. By both tests, false-negative results for sera from all ocular pythiosis patients were obtained. In addition, the ID test yielded false-negative results for sera from eight patients with vascular pythiosis and one patient with cutaneous pythiosis. It was concluded that the ICT is a rapid, user-friendly, and reliable serological test for the early diagnosis of vascular and cutaneous pythiosis.
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Abstract
Splendore-Hoeppli phenomenon (asteroid bodies) is the in vivo formation of intensely eosinophilic material (radiate, star-like, asteroid or club-shaped configurations) around microorganisms (fungi, bacteria and parasites) or biologically inert substances. This study presents a literature review concerning Splendore-Hoeppli reaction in the mucocutaneous diseases. It examines the histopathological features, nature and differential diagnosis of this reaction. It also discusses the mucocutaneous infections and the non-infective diseases associated with it. Available studies indicate that several mucocutaneous infections can generate Splendore-Hoeppli reaction. The fungal infections include sporotrichosis, pityrosporum folliculitis, zygomycosis, candidiasis, aspergillosis and blastomycosis. The bacterial infections include botryomycosis, nocardiosis and actinomycosis. The parasitic conditions include orbital pythiosis, strongyloidiasis, schistosomiasis and cutaneous larva migrans. In addition, Splendore-Hoeppli reaction may be seen with non-infective pathology such as hypereosinophilic syndrome and allergic conjunctival granulomas. The Splendore-Hoeppli reaction material comprises antigen-antibody complex, tissue debris and fibrin. Although the exact nature of this reaction is unknown, it is thought to be a localized immunological response to an antigen-antibody precipitate related to fungi, parasites, bacteria or inert materials. The characteristic formation of the peribacterial or perifungal Splendore-Hoeppli reaction probably prevents phagocytosis and intracellular killing of the insulting agent leading to chronicity of infection. To conclude, Splendore-Hoeppli reaction is a tell tale of a spectrum of infections and reactive conditions. The molecular pathways involved in the development of this reaction are open for future investigations.
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Affiliation(s)
- Mahmoud R Hussein
- Department of Pathology, Assir Central Hospital, King Khalid University, Abha, Kingdom of Saudi Arabia.
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30
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Antibodies in the sera of host species with pythiosis recognize a variety of unique immunogens in geographically divergent Pythium insidiosum strains. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2008; 16:330-6. [PMID: 19116305 DOI: 10.1128/cvi.00429-08] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies by Western blot analyses have shown that antibodies in the sera of host species infected by Pythium insidiosum recognized several prominent proteins expressed by this fungus-like pathogen. Although these studies have utilized sera from infected patients and relevant local strains of P. insidiosum, the results are difficult to compare because of the lack of method standardization. In an effort to resolve this issue, we have utilized standardized methodologies to evaluate six P. insidiosum strains from Asia and the Americas and 15 serum samples from cattle, cats, dogs, horses, and humans with pythiosis from the same geographical regions. Our data show that the antibodies present in these sera recognize a wide variety of unique P. insidiosum immunogenic proteins. Although some of the prominent proteins in this study have been previously reported, several others have yet to be described. For instance, a approximately 28-kDa-molecular-mass antigen was detected by the antibodies in all serum samples evaluated. However, this antigen was strongly expressed by only one of the strains evaluated. A diffuse approximately 51-kDa protein was not detected by the antibodies in the human sera; but it was recognized by the antibodies in the sera of cattle, cats, dogs, and horses. This antigen was expressed by only two of the strains investigated. Several other similar examples were also observed. The variation of the P. insidiosum protein profile identified by the antibodies in the sera evaluated indicates that some geographically diverged P. insidosum strains expressed some unique immunogens in vitro and that during natural infection (in vivo) P. insidiosum might express a broader number of antigens variably detected by individuals within the same species but especially across species.
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Krajaejun T, Sathapatayavongs B, Pracharktam R, Nitiyanant P, Leelachaikul P, Wanachiwanawin W, Chaiprasert A, Assanasen P, Saipetch M, Mootsikapun P, Chetchotisakd P, Lekhakula A, Mitarnun W, Kalnauwakul S, Supparatpinyo K, Chaiwarith R, Chiewchanvit S, Tananuvat N, Srisiri S, Suankratay C, Kulwichit W, Wongsaisuwan M, Somkaew S. Clinical and epidemiological analyses of human pythiosis in Thailand. Clin Infect Dis 2006; 43:569-76. [PMID: 16886148 DOI: 10.1086/506353] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 05/23/2006] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pythiosis is an emerging and life-threatening infectious disease in humans and animals that is caused by the pathogenic oomycete Pythium insidiosum. Human pythiosis is found mostly in Thailand, although disease in animals has been increasingly reported worldwide. Clinical information on human pythiosis is limited, and health care professionals are unfamiliar with the disease, leading to underdiagnosis, delayed treatment, and poor prognosis. METHODS To retrospectively study the clinical and epidemiological features of human pythiosis, we analyzed clinical data from patients with pythiosis diagnosed during the period of January 1985 through June 2003 at 9 tertiary care hospitals throughout Thailand. RESULTS A total of 102 cases of human pythiosis were documented nationwide. A substantial proportion (40%) of cases occurred in the last 4 years of the 18-year study interval. Clinical presentations fell into 4 groups: cutaneous/subcutaneous cases (5% of cases), vascular cases (59%), ocular cases (33%), and disseminated cases (3%). Almost all patients with cutaneous/subcutaneous, vascular, and disseminated pythiosis (85%) had underlying thalassemia-hemoglobinopathy syndrome. Most ocular cases (84%) were associated with no underlying disease. A majority of the patients were male (71%), were aged 20-60 years (86%), and reported an agricultural occupation (75%). Regarding treatment outcomes, all patients with disseminated infection died; 78% of patients with vascular disease required limb amputation, and 40% of these patients died; and 79% of patients with ocular pythiosis required enucleation/evisceration. CONCLUSIONS Here, we report, to our knowledge, the largest case study of human pythiosis. The disease has high rates of morbidity and mortality. Early diagnosis and effective treatment are urgently needed to improve clinical outcomes. Because P. insidiosum is distributed worldwide and can infect healthy individuals, an awareness of human pythiosis should be promoted in Thailand and in other countries.
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Affiliation(s)
- Theerapong Krajaejun
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Pupaibool J, Chindamporn A, Patarakul K, Suankratay C, Sindhuphak W, Kulwichit W. Human pythiosis. Emerg Infect Dis 2006; 12:517-8. [PMID: 16710978 PMCID: PMC3291453 DOI: 10.3201/eid1203.051044] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Vanittanakom N, Supabandhu J, Khamwan C, Praparattanapan J, Thirach S, Prasertwitayakij N, Louthrenoo W, Chiewchanvit S, Tananuvat N. Identification of emerging human-pathogenic Pythium insidiosum by serological and molecular assay-based methods. J Clin Microbiol 2004; 42:3970-4. [PMID: 15364977 PMCID: PMC516349 DOI: 10.1128/jcm.42.9.3970-3974.2004] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Pythium insidiosum is a pathogen that causes disease in both animals and humans. Human infection is rare; however, when it does occur, most patients, especially those having underlying hemoglobinopathy syndromes, such as thalassemia, exhibit a severe form. We identified four isolates of P. insidiosum. Two were recovered from tissue biopsy specimens from thalassemic and leukemic patients, one was derived from brain tissue from a thalassemic patient, and another was isolated from a corneal ulcer from a fourth patient. Western blotting and an enzyme-linked immunosorbent assay (ELISA) were performed with a serum sample derived from one thalassemic patient. The methods used to identify the P. insidiosum isolates were based on morphology, nucleic acid sequencing, and a PCR assay. To confirm the identification, portions of the 18S rRNA genes of these four isolates were sequenced. The sequences were shown to be homologous to previously described P. insidiosum DNA sequences. In addition, PCR amplification of the internal transcribed spacer region specific for P. insidiosum was positive for all four isolates. The ELISA with the serum sample from the thalassemic patient gave a positive result from a serum dilution of 1:800. Finally, Western immunoblotting with this serum sample showed positive immunoglobulin G recognition for proteins of 110, 73, 56, 42 to 35, 30 to 28, 26, and 23 kDa. The results of this study show that both molecularly based diagnostic and serodiagnostic techniques are useful for the rapid identification of human pythiosis. The predominant antigens recognized by Western blotting may be useful in the development of a more sensitive and specific diagnostic tool for this disease.
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Affiliation(s)
- Nongnuch Vanittanakom
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
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