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Loreto ES, Tondolo JSM, Zanette RA. Treating Pythiosis with Antibacterial Drugs Targeting Protein Synthesis: An Overview. J Fungi (Basel) 2024; 10:234. [PMID: 38667905 PMCID: PMC11051233 DOI: 10.3390/jof10040234] [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: 01/22/2024] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
This review article explores the effectiveness of antibacterial drugs that inhibit protein synthesis in treating pythiosis, a difficult-to-treat infection caused by Pythium insidiosum. The article highlights the susceptibility of P. insidiosum to antibacterial drugs, such as macrolides, oxazolidinones, and tetracyclines. We examine various studies, including in vitro tests, experimental infection models, and clinical case reports. Based on our synthesis of these findings, we highlight the potential of these drugs in managing pythiosis, primarily when combined with surgical interventions. The review emphasizes the need for personalized treatment strategies and further research to establish standardized testing protocols and optimize therapeutic approaches.
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Affiliation(s)
- Erico S. Loreto
- Sobresp Faculty of Health Sciences, 520 Appel Street, Santa Maria 97015-030, RS, Brazil;
| | - Juliana S. M. Tondolo
- Sobresp Faculty of Health Sciences, 520 Appel Street, Santa Maria 97015-030, RS, Brazil;
| | - Régis A. Zanette
- Department of Pharmacology, Basic Health Sciences Institute, Federal University of Rio Grande do Sul, 2600 Ramiro Barcelos Street, Porto Alegre 90035-003, RS, Brazil;
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Ianiski LB, Maciel AF, Colla ACN, Braga CQ, Sangioni LA, Pal M, Pereira DIB, Santurio JM, Botton SDA. Pythium insidiosum: In vitro oomicidal evaluation of telithromycin and interactions with azithromycin and amorolfine hydrochloride. J Mycol Med 2024; 34:101460. [PMID: 38266397 DOI: 10.1016/j.mycmed.2024.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
This study evaluated the repositioning of the ketolide antibacterial telithromycin (TLT) against the oomycete Pythium insidiosum and verified the combination of TLT and the antimicrobials azithromycin (AZM) and amorolfine hydrochloride (AMR), which have known anti-P. insidiosum activity. Susceptibility tests of P. insidiosum isolates (n = 20) against the drugs were carried out according to CLSI protocol M38-A2, and their combinations were evaluated using the checkerboard microdilution method. The minimum inhibitory concentrations were 0.5-4 µg/mL for TLT, 2-32 µg/mL for AZM, and 16-64 µg/mL for AMR. For the TLT+AZM combination, 52.75 % of interactions were indifferent, 43.44 % were antagonistic, and 9.70 % were synergistic. As for interactions of the TLT+AMR combination, 60.43 % were indifferent, 39.12 % were antagonistic, and 10.44 % synergistic interactions. This study is the first to evaluate the repositioning of the antibacterial TLT against mammalian pathogenic oomycetes, and our results show that its isolated action is superior to its combinations with either AZM or AMR. Therefore, we recommend including TLT in future research to evaluate therapeutic approaches in different clinical forms of human and animal pythiosis.
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Affiliation(s)
- Lara Baccarin Ianiski
- Departamento de Medicina Veterinária Preventiva, Laboratório de Saúde Única, Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF) e de Medicina Veterinária (PPGMV), Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Av. Roraima N° 1000, Prédio 44, sala 5132, CEP, Santa Maria, RS 97105-900, Brazil
| | - Aline Fontanella Maciel
- Departamento de Medicina Veterinária Preventiva, Laboratório de Saúde Única, Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF) e de Medicina Veterinária (PPGMV), Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Av. Roraima N° 1000, Prédio 44, sala 5132, CEP, Santa Maria, RS 97105-900, Brazil
| | - Ana Carolina Nolasco Colla
- Departamento de Medicina Veterinária Preventiva, Laboratório de Saúde Única, Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF) e de Medicina Veterinária (PPGMV), Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Av. Roraima N° 1000, Prédio 44, sala 5132, CEP, Santa Maria, RS 97105-900, Brazil
| | | | - Luis Antônio Sangioni
- Departamento de Medicina Veterinária Preventiva, Laboratório de Saúde Única, Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF) e de Medicina Veterinária (PPGMV), Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Av. Roraima N° 1000, Prédio 44, sala 5132, CEP, Santa Maria, RS 97105-900, Brazil
| | - Mahendra Pal
- Narayan Consultancy on Veterinary Public Health and Microbiology, Bharuch, India
| | | | - Janio Morais Santurio
- Departamento de Medicina Veterinária Preventiva, Laboratório de Saúde Única, Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF) e de Medicina Veterinária (PPGMV), Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Av. Roraima N° 1000, Prédio 44, sala 5132, CEP, Santa Maria, RS 97105-900, Brazil
| | - Sônia de Avila Botton
- Departamento de Medicina Veterinária Preventiva, Laboratório de Saúde Única, Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF) e de Medicina Veterinária (PPGMV), Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Av. Roraima N° 1000, Prédio 44, sala 5132, CEP, Santa Maria, RS 97105-900, Brazil.
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History and Perspective of Immunotherapy for Pythiosis. Vaccines (Basel) 2021; 9:vaccines9101080. [PMID: 34696188 PMCID: PMC8539095 DOI: 10.3390/vaccines9101080] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022] Open
Abstract
The fungus-like microorganism Pythium insidiosum causes pythiosis, a life-threatening infectious disease increasingly reported worldwide. Antimicrobial drugs are ineffective. Radical surgery is an essential treatment. Pythiosis can resume post-surgically. Immunotherapy using P. insidiosum antigens (PIA) has emerged as an alternative treatment. This review aims at providing up-to-date information of the immunotherapeutic PIA, with the focus on its history, preparation, clinical application, outcome, mechanism, and recent advances, in order to promote the proper use and future development of this treatment modality. P. insidiosum crude extract is the primary source of immunotherapeutic antigens. Based on 967 documented human and animal (mainly horses) pythiosis cases, PIA immunotherapy reduced disease morbidity and mortality. Concerning clinical outcomes, 19.4% of PIA-immunized human patients succumbed to vascular pythiosis instead of 41.0% in unimmunized cases. PIA immunotherapy may not provide an advantage in a local P. insidiosum infection of the eye. Both PIA-immunized and unimmunized horses with pythiosis showed a similar survival rate of ~70%; however, demands for surgical intervention were much lesser in the immunized cases (22.8% vs. 75.2%). The proposed PIA action involves switching the non-protective T-helper-2 to protective T-helper-1 mediated immunity. By exploring the available P. insidiosum genome data, synthetic peptides, recombinant proteins, and nucleic acids are potential sources of the immunotherapeutic antigens worth investigating. The PIA therapeutic property needs improvement for a better prognosis of pythiosis patients.
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Ianiski LB, Stibbe PC, Denardi LB, Weiblen C, Soares MP, Valente JDSS, Sangioni LA, Pereira DIB, Santurio JM, Botton SDA. In vitro anti-Pythium insidiosum activity of amorolfine hydrochloride and azithromycin, alone and in combination. Med Mycol 2021; 59:67-73. [PMID: 32400872 DOI: 10.1093/mmy/myaa032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/18/2020] [Accepted: 04/13/2020] [Indexed: 11/14/2022] Open
Abstract
Pythium insidiosum infections have been widely studied in an attempt to develop an effective therapeutic protocol for the treatment of human and animal pythiosis. Several antifungal agents are still prescribed against this oomycete, although they present contradictory results. To evaluate the susceptibility profile and to verify the morphological alterations in P. insidiosum isolates treated with amorolfine hydrochloride and azithromycin, alone or in combination. Susceptibility tests for P. insidiosum isolates (n = 20) against amorolfine hydrochloride (AMR) and azithromycin (AZM) were performed according to Clinical and Laboratory Standards Institutes (CLSI) protocol M38-A2. Combinations of both drugs were evaluated using the checkerboard microdilution method. Additionally, transmission and scanning electron microscopy were performed in order to verify the morphological alterations in P. insidiosum isolates in response to these drugs. All P. insidiosum isolates had a minimum inhibitory concentration (MIC) ranging from 16 to 64 mg/l and 8 to 64 mg/l for amorolfine hydrochloride and azithromycin, respectively. Synergistic interactions between the drugs were not observed, with antagonism in 59.8% of isolates, and indifferent interactions in 36.2%. Electron microscopy showed changes in the surface of P. insidiosum hyphae, disorganization of intracellular organelles, and changes in the plasma membrane and cell wall of oomycetes treated with the drugs. This is the first study to demonstrate in vitro anti-P. insidiosum effect of amorolfine hydrochloride. These results indicate the therapeutic potential of this drug against cutaneous and subcutaneous forms of pythiosis, but further studies are necessary to confirm this potential.
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Affiliation(s)
- Lara Baccarin Ianiski
- Universidade Federal de Santa Maria (UFSM), Centro de Ciências da Saúde (CCS), Programa de Pós-Graduação em Ciências Farmacêuticas, Santa Maria, RS, Brazil.,UFSM, CCS, Departamento de Microbiologia e Parasitologia, Laboratório de Pesquisas Micológicas, Santa Maria, RS, Brazil
| | - Paula Cristina Stibbe
- Universidade Federal de Santa Maria (UFSM), Centro de Ciências da Saúde (CCS), Programa de Pós-Graduação em Ciências Farmacêuticas, Santa Maria, RS, Brazil.,UFSM, CCS, Departamento de Microbiologia e Parasitologia, Laboratório de Pesquisas Micológicas, Santa Maria, RS, Brazil
| | - Laura Bedin Denardi
- UFSM, CCS, Departamento de Microbiologia e Parasitologia, Laboratório de Pesquisas Micológicas, Santa Maria, RS, Brazil
| | - Carla Weiblen
- UFSM, CCS, Departamento de Microbiologia e Parasitologia, Laboratório de Pesquisas Micológicas, Santa Maria, RS, Brazil.,UFSM, Centro de Ciências Rurais, Departamento de Medicina Veterinária Preventiva. Programa de Pós-Graduação em Medicina Veterinária, Santa Maria, RS, Brazil
| | - Mauro Pereira Soares
- Universidade Federal de Pelotas (UFPel), Faculdade de Veterinária, Laboratório Regional de Diagnóstico. Pelotas, RS, Brazil
| | - Julia de Souza Silveira Valente
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Microbiologia e Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia. Pelotas, RS, Brazil
| | - Luís Antônio Sangioni
- UFSM, Centro de Ciências Rurais, Departamento de Medicina Veterinária Preventiva. Programa de Pós-Graduação em Medicina Veterinária, Santa Maria, RS, Brazil
| | - Daniela Isabel Brayer Pereira
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Microbiologia e Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia. Pelotas, RS, Brazil
| | | | - Sônia de Avila Botton
- Universidade Federal de Santa Maria (UFSM), Centro de Ciências da Saúde (CCS), Programa de Pós-Graduação em Ciências Farmacêuticas, Santa Maria, RS, Brazil.,UFSM, Centro de Ciências Rurais, Departamento de Medicina Veterinária Preventiva. Programa de Pós-Graduação em Medicina Veterinária, Santa Maria, RS, Brazil
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Ferreira JC, Pires RH, Costa GBD, Carrijo BN, Guiotto FG, Rodrigues VS. The In Vitro Effect of Ozone Therapy Against Equine Pythium insidiosum. J Equine Vet Sci 2020; 98:103305. [PMID: 33663716 DOI: 10.1016/j.jevs.2020.103305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022]
Abstract
The goal of the present study was to characterize the antimicrobial action of different ozone (O3) presentations against Pythium insidiosum isolated from horses. In experiment 1, P. insidiosum was treated with ozonated distilled water, ozonated sunflower oils with distinct peroxide indexes or O3 gas (72 μg O3 mL-1). In experiment 2, samples were exposed one or three times to oxygen (O2) or O3 gas (72 μg O3 mL-1; 30 min/day). In experiment 3, P. insidiosum was treated with different concentrations of O3 gas (Ø, 32, 52, or 72 μg O3 mL-1) for three days (30 min/day). In experiment 4, samples were exposed to O2 or O3 gas (72 μg O3 mL-1) for 05, 15, or 30 minutes during three days. Posteriorly, all samples were cultured for two weeks, and the pathogen growth area was measured until D14. Samples with absence of growth on D14 were recultured to assess the germicidal or germistatic action of the treatment. In experiment 1, only ozonized sunflower oil with a high peroxide index had germicidal action against the pathogen. In experiment 2, samples exposed three times to O3 gas were inactivated. In experiment 3, the O3 therapy had germicidal action against P. insidiosum independently of the gas concentration (P > .1). In experiment 4, O3 treatments ≥15 minutes suppressed the pathogen development, whereas samples exposed to O3 gas for 5 minutes had progressive growth (P < .01). In conclusion, ozonated sunflower oil with a high peroxide index and multiple exposures to O3 gas mixtures were able to inactivate P. insidiosum isolated from horses.
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Yolanda H, Krajaejun T. Review of methods and antimicrobial agents for susceptibility testing against Pythium insidiosum. Heliyon 2020; 6:e03737. [PMID: 32322727 PMCID: PMC7160450 DOI: 10.1016/j.heliyon.2020.e03737] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/30/2020] [Accepted: 03/31/2020] [Indexed: 12/19/2022] Open
Abstract
Pythiosis is a life-threatening infectious disease of humans and animals caused by the oomycete microorganism Pythium insidiosum. The disease has been increasingly diagnosed worldwide. P. insidiosum inhabits freshwater and presents in two forms: mycelium and zoospore. Clinical manifestations of pythiosis include an infection of the artery, eye, skin, or gastrointestinal tract. The management of pythiosis is problematic due to the lack of effective treatment. Many patients die from an uncontrolled infection. The drug susceptibility testing provides clinically-useful information that could lead to proper drug selection against P. insidiosum. Currently, no standard CLSI protocol for the drug susceptibility of P. insidiosum is available. This review aims at describing methods and antimicrobial agents for susceptibility testing against P. insidiosum. Several in-house in vitro susceptibility methods (i.e., broth microdilution method, radial growth method, and agar diffusion method) have been established for P. insidiosum. Either mycelium or zoospore can be an inoculum. Rabbit is the commonly-used model of pythiosis for in vivo drug susceptibility testing. Based on the susceptibility results (i.e., minimal inhibitory concentration and inhibition zone), several antibacterial and antifungal drugs, alone or combination, exhibited an in vitro or in vivo effect against P. insidiosum. Some distinct compounds, antiseptic agents, essential oils, and plant extracts, also show anti-P. insidiosum activities. Successfully medical treatment, guided by the drug susceptibility data, has been reported in some pythiosis patients. Future studies should emphasize finding a novel and effective anti-P. insidiosum drug, standardizing in vitro susceptibility method and correlating drug susceptibility data and clinical outcome of pythiosis patients for a better interpretation of the susceptibility results.
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Affiliation(s)
- Hanna Yolanda
- Section for Translational Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Parasitology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Theerapong Krajaejun
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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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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Susaengrat N, Torvorapanit P, Plongla R, Chuleerarux N, Manothummetha K, Tuangsirisup J, Worasilchai N, Chindamporn A, Permpalung N. Adjunctive antibacterial agents as a salvage therapy in relapsed vascular pythiosis patients. Int J Infect Dis 2019; 88:27-30. [DOI: 10.1016/j.ijid.2019.08.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022] Open
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