Cutaneous pythiosis in a donkey (Equus asinus) in Brazil

Equidae pythiosis in Brazil and the world: a systematic review of the last 63 years (1960-2023)

This systematic review compiles reports of clinical pythiosis in horses, mules and donkeys from 1960 to 2023 worldwide, focusing on Brazil. We searched databases and included 71 articles detailing clinical characteristics, geographic distribution, epidemiology, diagnostic methods, therapies, and outcomes. The results showed that publications on equine pythiosis have significantly increased since 2010. Brazil reported the highest incidence, comprising 55% of cases, predominantly in the southern, northeastern, and central-western regions during summer and autumn. Cutaneous pythiosis was the most prevalent form, generally presenting as single lesions in the appendicular region, and affected females more than males. Diagnosis typically involved histopathology, used alone or with other methods. Various treatments have been employed, with surgery, often combined with chemotherapy and immunotherapy, being the most common. Notably, 80.84% of treated animals recovered, highlighting the effectiveness of these therapies in enhancing survival rates. The limitations of the study included the lack of data in published case reports, which made it difficult to collect and calculate epidemiological data. Additionally, we recognize that pythiosis in Brazil is underreported, since this disease does not have mandatory notification and several cases are not registered and/or reported in the literature. Lastly, it is hypothesized that equid pythiosis may be more widespread than currently known, and its real occurrence in Brazil remains uncertain.

Pythiosis in Equidae in Northeastern Brazil: 1985-2020

The epidemiologic, clinical, pathologic, microbiological and immunohistochemical findings of pythiosis in equidae in northeastern Brazil are described. From January 1985 to December 2020 the Laboratory of Animal Pathology of the Federal University of Campina Grande received 1,331 tissue samples of equidae, 202 (15.17%) of which were diagnosed as pythiosis. Equidae of both sexes with ages varying from 4 months to 25 years were affected. Most animals were mixed breed (79.7%) and reared in an extensive system (73.26%). The disease occurred throughout the year but the highest incidence (70.29%) was noted after the rainy season. The clinical course was always chronic. The lesions were preferentially located on the limbs and ventral thoracoabdominal wall and characterized by nodules or tumor-like masses with ulcerations and serosanguineous discharge. The cut surface showed fistulous tracts containing kunkers. The direct examination of the kunkers and microbiological culture revealed sparsely septate and branched hyaline hyphae. Histopathology revealed a marked inflammatory infiltrate of eosinophils with multifocal well-defined areas of eosinophil necrosis and collagenolysis and intralesional negatively-stained hyphal profiles; in the donkey, a pyogranulomatous inflammatory infiltrate was noted surrounding these areas. Immunohistochemistry for Pythium insidiosum revealed strong immunolabelling of the hyphae. Pythiosis occurs endemically in equidae in northeastern Brazil, with seasonal variation in the incidence. The intralesional kunkers establishes an accurate presumptive diagnosis, but confirmation should preferably be performed through histopathology associated with immunohistochemistry, culture-based or molecular methods.

History and Perspective of Immunotherapy for Pythiosis

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.

Skin Diseases in Donkeys and Mules-An Update

Simple Summary

Equids are part of the history of many countries, including Brazil, where they were used in trade routes and expansion of the current states. Several skin diseases affect these animals; however, visibility is higher on horses than on donkeys and mules, which is linked to regional cultural and socioeconomic factors, even resulting in a decline of the world population of these animals. In this context, the objective of this study was to review which skin diseases have been reported in the scientific literature with emphasis on skin pathologies.

Abstract

The skin of donkeys and mules represents a promising source of income; however, cultural, productive, and infectious factors can directly interfere with the quality of the integumentary tissue and well-being of these species. The objective of this study is to present a literature review on equine dermatopathies. This literature review included scientific articles related to equine medicine and breeding according to pre-established search terms and expressions published in recently articles. The evaluation of the clinical and pathological behavior of dermatopathies implies the use of control strategies and the recognition of pathological patterns that may be particular to the species.

Pythiosis in cats in northeastern Brazil

The epidemiological, clinical and anatomopathological aspects of pythiosis in cats in northeastern Brazil are described. From January 2000 to December 2018 the Laboratory of Animal Pathology of the Federal University of Campina Grande received 1928 tissue samples of cats, three of which were diagnosed as pythiosis. Grossly, the cats showed a multinodular mass in the oral cavity associated with facial deformity (case 1), a large multinodular mass thickening the jejunum wall (case 2), and an ulcerated nodule in the skin at the base of the tail (case 3). Histologically, pyogranulomatous inflammation and necrosis, with intralesional predominantly negatively stained hyphae, were observed in all cases. Immunohistochemistry for Pythium insidiosum revealed strong immunolabelling of the hyphae. The diagnosis of pythiosis was based on the epidemiological, clinical and anatomopathological findings, and was confirmed by immunohistochemistry. Although uncommon in cats, pythiosis should be readily considered as a differential diagnosis of chronic pyogranulomatous infections of the gastrointestinal tract and skin, especially in endemic areas, where the disease is often diagnosed in other animal species.

Pythiosis in cattle in Northeastern Brazil

ABSTRACT: The epidemiological, clinical and pathological aspects of cutaneous pythiosis occurring in cattle from three farms in the Northeastern of Brazil are described. A biopsy of the lesions of one bovine from each farm was performed. In two cases, the affected cattle had contact with water accumulated in dams during the dry season in the semiarid region. Another case occurred in the coastal tropical region in cattle grazing around irrigation channels. Clinically, lesions were observed mainly on the skin of the thoracic and/or pelvic limbs, characterized by flat and irregular ulcerated areas or nodules of varying sizes, some with fistulous tracts penetrating deep into the subcutaneous tissue. In one case the regional lymph nodes were affected. Histologically, in all cases, pyogranulomatous dermatitis associated with negative hyphae images, in hematoxylin-eosin stained sections, were observed. In sections stained by Grocott methenamine silver, the hyphae measured 2-8μm and had irregular ramifications and rare septations. Immunohistochemistry technique demonstrated strong immunolabeling for Pythium insidiosum. Pythiosis should be included in the differential diagnosis of dermatopathies in cattle in the Northeastern of Brazil.

Equine pythiosis in Egypt: clinicopathological findings, detection, identification and genotyping of Pythium insidiosum

BACKGROUND

Equine pythiosis is an emerging, devastating disease that is hard to treat. The tumour-like nodular skin masses grow rapidly and the outcome is generally fatal, and thus early diagnosis and intervention are important.

OBJECTIVES

(i) To highlight the clinical, histological and haematological findings in pythiosis, and (ii) to evaluate the efficacy of direct sample multiplex-PCR targeting the single nucleotide polymorphisms within the ribosomal DNA region for detection and genotyping of Pythium insidiosum.

ANIMALS

Two hundred and twenty horses including 204 Arabian and 16 draft horses were surveyed.

METHODS

Case series study diagnosis was based on clinical, pathological and haematological findings typical of P. insidiosum infection, culture identification, immunohistochemical investigation and direct sample PCR.

RESULTS

The affected horses (24 of 220, 10.91%) presented with unifocal or multiple lesions on the abdomen, limbs, chest, face and mammary gland. Cases commonly had a history of access to stagnant water, ponds and intentionally flooded rice fields. Most were pregnant mares (58.33%). Histopathology revealed granulomatous reaction, blood vessel endotheliosis, heavy infiltration of eosinophils in the dermal layer, multifocal necrosis and Splendore-Hoeppli phenomenon. Unlike direct microscopy (50%) and culture (91.6%), multiplex-PCR assay identified P. insidiosum (Clade II) in all tested samples. To the best of the authors knowledge, this is the first study determining a clade of P. insidiosum causing equine pythiosis in Egypt.

CONCLUSIONS AND CLINICAL IMPORTANCE

Direct sample multiplex-PCR assay is a potential tool for the early and rapid diagnosis of equine pythiosis. It overcomes limitations associated with morphological identification and provides a definitive diagnosis.

Review of methods and antimicrobial agents for susceptibility testing against Pythium insidiosum

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.

A case of canine cutaneous pythiosis in Thailand

Introduction

Pythium insidiosum causes pythiosis in humans and animals in tropical and subtropical climates. The clinical manifestations in humans are mostly systemic, vascular or ocular forms, in contrast to animals, which are cutaneous, subcutaneous and gastrointestinal forms. The highest incidence of human cases is reported in Thailand, however, no canine pythiosis has been documented yet.

Case presentation

A female, mixed-breed, stray dog showed severe extensive ulcerative haemorrhagic dermatitis at the perineum involving the anus and tail. On cytology, there were sparse branching septate fungal hyphae. The tissue samples were subjected to polymerase chain reaction and gene sequencing for fungal identification.

Conclusion

The results of the internal transcribed spacer 1 and 2 (ITS1 and ITS2) gene had 99 % homology to Pythium insidiosum (accession no. FJ17396) and the COX2 gene (accession no. GQ451572). The phylogenetic tree of both genes was classified in clade A_TH. This is the first fully documented diagnosis of canine cutaneous pythiosis in Thailand.