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Shakoei S, Mohamadi F, Ghiasvand F, Khosravi AR, Kamyab K, Salahshour F. Disseminated protothecosis: Case report and review of the literature. J Cutan Pathol 2024; 51:705-713. [PMID: 38863080 DOI: 10.1111/cup.14668] [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: 07/07/2023] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Human protothecosis is an uncommon infection caused by Prototheca spp that rarely infects humans. AIM Description of a rare disease and a review of its articles. MATERIALS AND METHODS We reported a 24-year-old man who presented with red-brown papules and plaques on the trunk's lateral side. We reviewed the literature about disseminated protothecosis and reported our experience with a patient with protothecosis between 2021 and 2023. RESULTS Overall, 54 cases of disseminated protothecosis were evaluated, 39 were due to P. wickerhamii, 12 were due to P. zopfii (22.2%), and three were due to Prototheca spp. We found that males were more affected (37 cases, 68.5%) than females (16 cases, 29.6%). The mean age of patients was 39.53 ± 22.48 years. However, disseminated protothecosis can affect people of any age (1-80 years). In contrast to P. wickerhamii, which causes blood, skin, brain, and gastrointestinal tract infections, P. zopfii was mainly found in the blood (7/22) and did not have a significant difference in the mortality rate (P = 0.11). DISCUSSION Disseminated protothecosis is a rare disease in immunocompromised patients but is generally rarer in immunocompetent hosts. Several underlying disorders include immunocompromised patients, prolonged application of steroids, diabetes mellitus, malignancies, organ transplantation, AIDS, and surgeries. Amphotericin B has been the most effective agent for protothecosis and is reserved for visceral and disseminated infections. Regarding localized cutaneous types, excision or surgical debridement is used. CONCLUSION Mulberry's appearance and appropriate cultural environments are helpful in diagnosing it.
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Affiliation(s)
- Safoura Shakoei
- Department of Dermatology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farid Mohamadi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Fereshteh Ghiasvand
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Reza Khosravi
- Department of Microbiology and Immunology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Kambiz Kamyab
- Department of Pathology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Faeze Salahshour
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Jinatham V, Cantoni DM, Brown IR, Vichaslip T, Suwannahitatorn P, Popluechai S, Tsaousis AD, Gentekaki E. Prototheca bovis, a unicellular achlorophyllous trebouxiophyte green alga in the healthy human intestine. J Med Microbiol 2021; 70. [PMID: 34486973 DOI: 10.1099/jmm.0.001415] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Prototheca species are non-photosynthetic trebouxiophyte algae ubiquitously distributed in nature and can be found in sewage and soil. This microbial eukaryote causes human protothecosis in immunocompromised individuals. Thus, Prototheca presence in the stool of individuals without gastrointestinal symptoms has been reported only rarely.Hypothesis/Gap statement. There is an absence of detailed characterization of human Prototheca isolates.Aim. The aim of this study was to perform morphological and molecular characterization of Prototheca isolates obtained from human stool.Methodology. Prototheca was isolated from faecal samples of four individuals living in a rural area in Thailand. A combination of bioimaging along with molecular and bioinformatics tools was used to characterize the four strains. The growth rate was tested using four media and three temperature conditions. Phylogenetic analysis using the small subunit ribosomal RNA (SSU rRNA) and cytochrome b (cytb) was also performed.Results. Static and live microscopy demonstrated the various life stages of Prototheca and its major defining cellular characteristics. An optimized DNA extraction methodology that improves DNA yield is provided. Partial fragments of the SSU rRNA and cytb genes were obtained. Phylogenetic analysis placed all four strains in the clade with Prototheca bovis. More broadly, Prototheca was not monophyletic but split into at least two distinct clades instead.Conclusion. The results represent the first molecular characterization of Prototheca in Thailand. The study provides insight into transmission dynamics of the organism and potential caveats in estimating the global prevalence of Prototheca. These will spearhead further investigations on Prototheca occurrence in rural areas of both industrialized and developing nations.
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Affiliation(s)
- Vasana Jinatham
- School of Science, Mae Fah Luang University, Chiang Rai 57100, Thailand
| | - Diego M Cantoni
- Laboratory of Molecular and Evolutionary Parasitology, RAPID group, School of Biosciences, University of Kent, Canterbury, UK
| | - Ian R Brown
- Bioimaging Facility, School of Biosciences, University of Kent, Canterbury, UK
| | | | | | - Siam Popluechai
- School of Science, Mae Fah Luang University, Chiang Rai 57100, Thailand.,Gut Microbiome Research Group, Mae Fah Luang University, Chiang Rai 57100, Thailand
| | - Anastasios D Tsaousis
- Laboratory of Molecular and Evolutionary Parasitology, RAPID group, School of Biosciences, University of Kent, Canterbury, UK
| | - Eleni Gentekaki
- School of Science, Mae Fah Luang University, Chiang Rai 57100, Thailand.,Gut Microbiome Research Group, Mae Fah Luang University, Chiang Rai 57100, Thailand
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Maboni G, Elbert JA, Stilwell JM, Sanchez S. Genomic and Pathologic Findings for Prototheca cutis Infection in Cat. Emerg Infect Dis 2021; 27:979-982. [PMID: 33622485 PMCID: PMC7920651 DOI: 10.3201/eid2703.202941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Severe nasal Prototheca cutis infection was diagnosed postmortem for an immunocompetent cat with respiratory signs. Pathologic examination and whole-genome sequencing identified this species of algae, and susceptibility testing determined antimicrobial resistance patterns. P. cutis infection should be a differential diagnosis for soft tissue infections of mammals.
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De Kyvon MA, Carvalho-Schneider C, Lemaignen A, Dussart D, Barbaz M, Barbe PG, Lanotte P, Bernard L, Bailly É, Chandenier J, Desoubeaux G. A "Kelp-Like" Microorganism Within the Belly. Clin Infect Dis 2018; 67:1463-1466. [PMID: 30321356 DOI: 10.1093/cid/ciy112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - David Dussart
- Chirurgie digestive, Transplantation hépatique, Tours, France
| | | | | | - Philippe Lanotte
- Service de Bactériologie-Virologie, CHU de Tours, France.,UMR ISP1282 INRA Université de Tours, France
| | - Louis Bernard
- Médecine interne & Maladies infectieuses, Tours, France
| | - Éric Bailly
- Parasitologie, Mycologie, Médecine tropicale, Tours, France
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cytb as a New Genetic Marker for Differentiation of Prototheca Species. J Clin Microbiol 2018; 56:JCM.00584-18. [PMID: 30068534 DOI: 10.1128/jcm.00584-18] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/21/2018] [Indexed: 11/20/2022] Open
Abstract
Achlorophyllous unicellular microalgae of the genus Prototheca (Trebouxiophyceae, Chlorophyta) are the only known plants that cause infections in both humans and animals, collectively referred to as protothecosis. Human protothecosis, most commonly manifested as cutaneous, articular, and disseminated disease, is primarily caused by Protothecawickerhamii, followed by Protothecazopfii and, sporadically, by Protothecacutis and Protothecamiyajii In veterinary medicine, however, P. zopfii is a major pathogen responsible for bovine mastitis, which is a predominant form of protothecal disease in animals. Historically, identification of Prototheca spp. has relied upon phenotypic criteria; these were later replaced by molecular typing schemes, including DNA sequencing. However, the molecular markers interrogated so far, mostly located in the ribosomal DNA (rDNA) cluster, do not provide sufficient discriminatory power to distinguish among all Prototheca spp. currently recognized. Our study is the first attempt to develop a fast, reliable, and specific molecular method allowing identification of all Prototheca spp. We propose the mitochondrial cytb gene as a new and robust marker for diagnostics and phylogenetic studies of the Prototheca algae. The cytb gene displayed important advantages over the rDNA markers. Not only did the cytb gene have the highest discriminatory capacity for resolving all Prototheca species, but it also performed best in terms of technical feasibility, understood as ease of amplification, sequencing, and multiple alignment analysis. Based on the species-specific polymorphisms in the partial cytb gene, we developed a fast and straightforward PCR-restriction fragment length polymorphism (RFLP) assay for identification and differentiation of all Prototheca species described so far. The newly proposed method is advocated to be a new gold standard in diagnostics of protothecal infections in human and animal populations.
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Ramanan P, Virk A, Boland JM, Pritt B, Rizzo M, Wengenack NL. Answer to August 2018 Photo Quiz. J Clin Microbiol 2018; 56:e02418-16. [PMID: 30049808 PMCID: PMC6062793 DOI: 10.1128/jcm.02418-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Poornima Ramanan
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer M Boland
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bobbi Pritt
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nancy L Wengenack
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
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Jagielski T, Niedźwiecka K, Roeske K, Dyląg M. 3-Bromopyruvate as an Alternative Option for the Treatment of Protothecosis. Front Pharmacol 2018; 9:375. [PMID: 29725298 PMCID: PMC5917324 DOI: 10.3389/fphar.2018.00375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/03/2018] [Indexed: 12/13/2022] Open
Abstract
Protothecosis is an unusual infection of both humans and animals caused by opportunistically pathogenic microalgae of the genus Prototheca. Until now, no standardized treatment protocols exist for the protothecal disease, boosted by a remarkable resistance of Prototheca spp. to a wide array of antimicrobial agents currently available in clinical use. Consequently, there is an urgent need for new effective drugs against Prototheca algae. In this study, the anti-Prototheca activity of 3-bromopyruvate (3BP), either alone or in combination with amphotericin B (AMB) was assessed in vitro, as well as the cytotoxicity of 3BP toward the bovine mammary epithelial cells and murine skin fibroblasts. The mean minimum inhibitory concentrations (MIC) and minimum algaecidal concentrations (MAC) were 0.85 ± 0.21 and 2.25 ± 0.54 mM for Prototheca wickerhamii, 1.25 ± 0.47 and 4.8 ± 1.03 mM for Prototheca blaschkeae, and 1.55 ± 0.69 and 5.6 ± 1.3 mM for Prototheca zopfii gen. 2, respectively. For all Prototheca strains tested, a synergistic interaction between 3BP and AMB was observed, resulting in about 4-fold reduction of their individual MICs, when used together. The elevated content of intracellular glutathione (GSH) was associated with a decreased susceptibility to 3BP. Both epithelial and fibroblast cells retained high viability upon treatment with 3BP at concentrations equivalent to the highest MIC recorded (3 mM) and 10-fold higher (30 mM), with the mean cell viability exceeding 80%, essentially the same as for the untreated cells. The results from these in vitro studies emphasize the high activity of 3BP against the Prototheca algae, its synergistic effect when used in combination with AMB, and the safety of the drug toward the tested mammalian cells. Along with the advantageous physico-chemical and pharmacokinetic properties, 3BP may be considered an effective and safe novel agent against the protothecal disease.
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Affiliation(s)
- Tomasz Jagielski
- Department of Applied Microbiology, Institute of Microbiology, University of Warsaw, Warsaw, Poland
| | - Katarzyna Niedźwiecka
- Department of Genetics, Institute of Genetics and Microbiology, University of Wroclaw, Wroclaw, Poland
| | - Katarzyna Roeske
- Department of Applied Microbiology, Institute of Microbiology, University of Warsaw, Warsaw, Poland
| | - Mariusz Dyląg
- Department of Genetics, Institute of Genetics and Microbiology, University of Wroclaw, Wroclaw, Poland
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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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Prototheca wickerhamii algaemia presenting as cholestatic hepatitis in a patient with systemic lupus erythematosus: A case report and literature review. Med Mycol Case Rep 2012; 2:19-22. [PMID: 24432207 DOI: 10.1016/j.mmcr.2012.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 11/27/2012] [Accepted: 12/05/2012] [Indexed: 11/24/2022] Open
Abstract
Human protothecal infection is uncommon and could be localized or systemic disease. Disseminated Prototheca algaemia tends to occur in immunocompromised patients (solid organ transplants, hematological malignancies) with high mortality. Diagnosis could be missed or delayed due to unusual clinical presentation and/or under-recognition of characteristic microscopic features of Prototheca species. Combined approach that includes removal of source of infection and intravenous amphotericin B provides the best chance of cure.
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Todd JR, King JW, Oberle A, Matsumoto T, Odaka Y, Fowler M, Pore RS, Shahan TA, Yin L, Sanusi ID. Protothecosis: report of a case with 20-year follow-up, and review of previously published cases. Med Mycol 2012; 50:673-89. [DOI: 10.3109/13693786.2012.677862] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Prototheca spp. are environmental algae that may cause serious infection in the immunocompromised patient. Clinical manifestations may mimic other diseases. We present a case of fatal infection in a 78-year-old cardiac transplant recipient and discuss pitfalls in the clinical and laboratory diagnoses.
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