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Chen Y, Gao A, Ke Y, Zhou X, Lin L, Lu S, Liu Y. Successful Treatment of Cutaneous Protothecosis Due to Prototheca wickerhamii with Terbinafine. Clin Cosmet Investig Dermatol 2024; 17:913-919. [PMID: 38689756 PMCID: PMC11059624 DOI: 10.2147/ccid.s453620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/31/2024] [Indexed: 05/02/2024]
Abstract
Protothecosis, an infrequent human infection, is caused by achlorophyllic algae belonging to the genus Prototheca, particularly Prototheca wickerhamii. The skin stands as the most commonly affected organ. This report documents a case involving an 82-year-old male with Protothecosis. Histopathological analysis revealed granulomatous inflammation in the dermis, exhibiting necrotic features and hosting numerous non-budding spherical organisms. These organisms were positively stained using methenamine silver and periodic acid-Schiff stains, confirming identification as P. wickerhamii after validation through tissue culture and sequencing procedures. Initially, the patient received oral itraconazole at a dosage of 200 mg daily, accompanied by topical 1% naftifine-0.25% ketoconazole cream for a duration of 4 weeks, resulting in significant improvement. Subsequently, due to gastrointestinal discomfort presumably linked to itraconazole, terbinafine was administered. Over a span of 3 months, the patient received oral terbinafine at a dosage of 250 mg/day alongside the application of topical 1% naftifine-0.25% ketoconazole cream, leading to complete healing of the skin lesion, leaving behind a fibrotic scar.
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Affiliation(s)
- Yue Chen
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, 510095, People’s Republic of China
| | - Aili Gao
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, 510095, People’s Republic of China
| | - Yanan Ke
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, 510095, People’s Republic of China
| | - Xin Zhou
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, 510095, People’s Republic of China
| | - Li Lin
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, People’s Republic of China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, People’s Republic of China
| | - Yumei Liu
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, 510095, People’s Republic of China
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Di Prinzio A, Ruf M, Torre AC, Duran Daza SV, Volonteri VI, Flores V, Mazzuoccuolo LD. Cutaneous protothecosis in a solid organ transplanted patient. An Bras Dermatol 2023; 98:723-725. [PMID: 37120408 PMCID: PMC10404499 DOI: 10.1016/j.abd.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 05/01/2023] Open
Affiliation(s)
| | - Marina Ruf
- Italian Hospital of Buenos Aires, CABA, Argentina
| | - Ana C Torre
- Italian Hospital of Buenos Aires, CABA, Argentina
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Chen F, Saab-Chalhoub M, Tao J, Harrington AT, Albarillo FS, Crone AS, Clark NM, Speiser JJ. Disseminated Protothecosis Due to Prototheca zopfii and Literature Review. Am J Dermatopathol 2023; 45:237-241. [PMID: 36805355 DOI: 10.1097/dad.0000000000002395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
ABSTRACT Prototheca species are achlorophyllic algae that are a rare cause of infection in humans. It most commonly causes localized cutaneous disease and rarely disseminated infection. Immunocompromised patients have the highest risk of disseminated protothecosis, with a higher mortality rate than localized cutaneous infections. At the species level, infections caused by Prototheca zopfii are reported less frequently than those caused by Prototheca wickerhamii. The diagnosis can be made using histopathology, culture, and molecular testing. There is no definitive evidence for an effective treatment, which currently consists of antifungals (primarily amphotericin B). With only a handful of cases of disseminated protothecosis reported worldwide that are caused by P. zopfii , we herein present an additional case of a postbone marrow transplant patient in the Midwest of the United States.
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Affiliation(s)
- Feifan Chen
- Pathology Department, Allegheny General Hospital, Pittsburgh, PA
| | | | - Joy Tao
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL
| | - Amanda T Harrington
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL; and
| | - Fritzie S Albarillo
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL; and
- Division of Infectious Diseases, Department of Medicine, Loyola University Medical Center, Maywood, IL
| | - Andrew S Crone
- Division of Infectious Diseases, Department of Medicine, Loyola University Medical Center, Maywood, IL
| | - Nina M Clark
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL; and
- Division of Infectious Diseases, Department of Medicine, Loyola University Medical Center, Maywood, IL
| | - Jodi J Speiser
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL; and
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Góes LDM, Monteiro VDS, Souza ATOD. Case for diagnosis. Ulcer and papular lesions in a patient with diabete mellitus. Protothecosis. An Bras Dermatol 2021; 96:613-616. [PMID: 34266685 PMCID: PMC8441448 DOI: 10.1016/j.abd.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/11/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022] Open
Abstract
Protothecosis is a rare disease caused by achlorophilic algae of the genus Prototheca spp. In general, three clinical forms are observed: cutaneous, articular and systemic. The cutaneous form is the most common one. This study describes a patient with isolated erythematous papules and erythematous papular plaques in the scapular regions, with a previous histopathological diagnosis of cryptococcosis. New tests were conclusive for the diagnosis of protothecosis, caused by Prototheca wickerhamii.
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Palaniappan PA, Abot CA, Mohd Tap R, Amran F. Protothecosis algaemia in a patient presenting with septic arthritis: A rare case of Prototheca zopfii isolated from Malaysia. IDCases 2021; 24:e01121. [PMID: 33912392 PMCID: PMC8065273 DOI: 10.1016/j.idcr.2021.e01121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022] Open
Abstract
Prototheca species have been reported to cause infections in human. Typically, clinical symptoms of protothecosis include cutaneous infection, olecranon bursitis, tenosynovitis and disseminated systemic disease. We report a case of septic arthritis in which Prototheca zopfii was isolated from blood. Joint aspirate was also sent for cultures but did not yield any growth. No other organisms were isolated from this patient during his admission. The blood isolate was identified to species level via Polymerase Chain Reaction (PCR) method. The patient improved with administration of intravenous itraconazole.
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Affiliation(s)
- Prem Ananth Palaniappan
- Mycology Section, Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia
| | | | - Ratna Mohd Tap
- Mycology Section, Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia
| | - Fairuz Amran
- Mycology Section, Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia
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Godofredo VR, Enokihara MMSES, Tomimori J, Ogawa MM. Cutaneous protothecosis in kidney transplant recipient. An Bras Dermatol 2020; 95:210-213. [PMID: 32059817 PMCID: PMC7175028 DOI: 10.1016/j.abd.2019.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/04/2019] [Indexed: 11/26/2022] Open
Abstract
Protothecosis is a rare condition caused by the aclorophylated algae of the genus Prototheca. In humans, protothecosis, caused mainly by P. wickerhamii, manifests itself in three forms: cutaneous, articular and systemic. It can occur in both immunocompetent and immunosuppressed individuals, being much more common in the latter. We present a new case of protothecosis in Brazil in a kidney transplant recipient.
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Affiliation(s)
| | - Milvia Maria Simões E Silva Enokihara
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Department of Pathology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Jane Tomimori
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Khan ID, Sahni AK, Sen S, Gupta RM, Basu A. Outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care chemotherapy oncology unit. Med J Armed Forces India 2017; 74:358-364. [PMID: 30449922 DOI: 10.1016/j.mjafi.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/31/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prototheca is an emerging, opportunistic, pathogenic, zoonotic achlorophyllous green alga, expanding in pathogenicity and host range, causing localized and disseminated infections. This outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care 30-bedded chemotherapy oncology unit is the first human outbreak to the best of our knowledge. METHODS P. wickerhamii algaemia was confirmed on consecutive isolation. Person to person transmission was hypothesized considering all patients in the unit at risk. Clinico-demographic, diagnostic and treatment profile were correlated. Both manual and automated systems were used for blood culture, isolation, identification and susceptibility of Prototheca. Liposomal amphotericin B was given. Outbreak surveillance of faeces, fingertips and environmental reservoirs, retrospective surveillance during past 15 years and prospective surveillance was continued for two years. RESULTS The outbreak affected 12 neutropenic patients over 50 days. No specific clinical features were noted. The hypothesis could not be substantiated. P. wickerhamii was isolated as yeast-like colonies revealing Gram positive yeast-like cells without budding and pseudohyphae which were confirmed by automated system. Post amphotericin B blood cultures were negative for Prototheca. Surveillance studies were not contributory. CONCLUSION P. wickerhamii has no documented reservoirs or transmission. Endogenous colonization in the gut followed by translocation during chemotherapy induced immunosuppression is likely to cause algaemia and sepsis. Outbreaks are difficult to detect and control as incubation period is variable and clinical presentation is muted, emphasizing the need to strengthen hospital and laboratory based surveillance systems to ensure adequate preparedness, rapid detection and response to outbreaks.
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Affiliation(s)
- I D Khan
- Assistant Professor (Microbiology), Army College of Medical Sciences and Base Hospital, New Delhi 110010, India
| | - A K Sahni
- Brig Med, HQ 15 Corps, c/o 56 APO, India
| | - Sourav Sen
- Professor and Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - R M Gupta
- Consultant and Professor (Microbiology), Affiliated Faculty, Dept of Lab Sciences and Molecular Medicine, Army Hospital (R & R), New Delhi 110001, India
| | - Atoshi Basu
- Consultant, Department of Pathology, Apollo Gleneagles Hospital, Kolkata, India
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Velez-Mejia C, Velez-Londoño J. Prototheca: A Danger Underwater. IDCases 2017; 9:106-108. [PMID: 28752062 PMCID: PMC5520952 DOI: 10.1016/j.idcr.2017.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/29/2017] [Indexed: 11/18/2022] Open
Abstract
Prototheca wickerhamii rarely causes systemic infection in humans but when it occurs, there are coexisting comorbidities. This case illustrated shows the manifestation of this opportunistic microorganism in an immunosuppressed patient. The patient was successfully treated with Liposomal amphotericin B with complete resolution of the lesions.
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Fernández MS, Rojas FD, Cattana ME, Mussin JE, de Los Ángeles Sosa M, Benzoni CD, Giusiano GE. Protothecosis in a patient with T cell lymphocytic leukemia. Rev Argent Microbiol 2017; 49:224-226. [PMID: 28554708 DOI: 10.1016/j.ram.2017.02.007] [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: 11/16/2016] [Revised: 02/03/2017] [Accepted: 02/24/2017] [Indexed: 11/18/2022] Open
Abstract
Human protothecosis is a rare infection caused by algae of the genus Prototheca. Prototheca wickerhamii has been recognized as the main species that causes infection in immunocompromised hosts with deficits in innate or cellular immunity. We report a case of persisting subcutaneous protothecosis in a patient with T-cell large granular lymphocyte leukemia, who also presented a history of disseminated histoplasmosis.
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Affiliation(s)
- Mariana S Fernández
- Universidad Nacional del Nordeste, CONICET, Instituto de Medicina Regional, Departamento de Micología, Resistencia, Chaco, Argentina.
| | - Florencia D Rojas
- Universidad Nacional del Nordeste, Instituto de Medicina Regional, Departamento de Micología, Resistencia, Chaco, Argentina
| | - María E Cattana
- Universidad Nacional del Nordeste, CONICET, Instituto de Medicina Regional, Departamento de Micología, Resistencia, Chaco, Argentina
| | - Javier E Mussin
- Universidad Nacional del Nordeste, CONICET, Instituto de Medicina Regional, Departamento de Micología, Resistencia, Chaco, Argentina
| | - María de Los Ángeles Sosa
- Universidad Nacional del Nordeste, Instituto de Medicina Regional, Departamento de Micología, Resistencia, Chaco, Argentina
| | - Carlos D Benzoni
- Sanatorio Frangioli 2000, Servicio de Infectología, Resistencia, Chaco, Argentina
| | - Gustavo E Giusiano
- Universidad Nacional del Nordeste, CONICET, Instituto de Medicina Regional, Departamento de Micología, Resistencia, Chaco, Argentina
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Ramírez I, Nieto-Ríos JF, Ocampo-Kohn C, Aristizábal-Alzate A, Zuluaga-Valencia G, Muñoz Maya O, Pérez JC. Protothecal bursitis after simultaneous kidney/liver transplantation: a case report and review. Transpl Infect Dis 2016; 18:266-74. [PMID: 26779785 DOI: 10.1111/tid.12496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 09/16/2015] [Accepted: 11/01/2015] [Indexed: 01/18/2023]
Abstract
Solid organ transplantation is an accepted therapy for end-stage diseases of the kidneys, liver, heart, and lungs. Unfortunately, transplantation is associated with infectious complications. Here, we present a case report of Prototheca wickerhamii olecranon bursitis and review all of the cases in solid organ transplant (SOT) recipients published in the literature to date. In our patient, the infection resolved with surgical therapy and limited antifungal therapy, and no symptoms have recurred over 24 months of follow-up. A review of the literature suggests that 50% of SOT recipients with Prototheca infection present with disseminated infection, and the overall mortality is 75%. More studies are required to determine the optimal management of protothecosis in this population.
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Affiliation(s)
- I Ramírez
- Infectious Diseases, Department of Internal Medicine, Hospital Pablo Tobón Uribe, Universidad de Antioquia, Medellín, Colombia
| | - J F Nieto-Ríos
- Nephrology, Department of Internal Medicine, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - C Ocampo-Kohn
- Nephrology, Department of Internal Medicine, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - A Aristizábal-Alzate
- Nephrology, Department of Internal Medicine, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - G Zuluaga-Valencia
- Nephrology, Department of Internal Medicine, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - O Muñoz Maya
- Hepatology, Department of Internal Medicine, Hospital Pablo Tobón Uribe, Universidad de Antioquia, Medellín, Colombia
| | - J C Pérez
- Department of Pathology, Hospital Pablo Tobón Uribe, Dinámica IPS, Medellín, Colombia
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Cutaneous Protothecosis in a Patient with Chronic Lymphocytic Leukemia: A Case Report and Literature Review. J Fungi (Basel) 2015; 1:4-12. [PMID: 29376895 PMCID: PMC5770008 DOI: 10.3390/jof1010004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/31/2014] [Indexed: 11/17/2022] Open
Abstract
Protothecosis is a rare infection, which has the potential to cause severe disease in patients with underlying immunosuppression. We describe a case of an elderly female with chronic lymphocytic leukemia (CLL), as well as other risk factors, who presented with pustular and erythematous plaques, initially presumed to be leukemia cutis. A biopsy with special stains revealed the lesions to be cutaneous protothecosis, thus presenting a most unusual concurrence of disease entities. The literature to date on this rare infection will be reviewed.
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