Clinical and Epidemiological Analyses of Human Pythiosis in Thailand

Krajaejun, Theerapong; Sathapatayavongs, Boonmee; Pracharktam, Roongnapa; Nítiyanant, Prawat; Leelachaikul, Paisan; Wanachiwanawin, Wanchai; Chaiprasert, Angkana; Assanasen, Paraya; Saipetch, Marisa; Mootsikapun, Piroon; Chetchotisakd, Ploenchan; Lekhakula, Arnuparp; Mitarnun, Winyou; Kalnauwakul, Sineenart; Supparatpinyo, Khuanchai; Chaiwarith, Romanee; Chiewchanvit, Siri; Tananuvat, Napaporn; Srisiri, Sawet; Suankratay, Chusana; Kulwichit, Wanla; Wongsaisuwan, Mawin; Somkaew, Shawarash

doi:10.1086/506353

Cited by 205 publications

(378 citation statements)

References 36 publications

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“…Four forms of human pythiosis have been described: (i) cutaneous pythiosis, affecting the face or limbs as a granulomatous and ulcerating lesion; (ii) vascular pythiosis, affecting arteries and resulting in arterial occlusion or an aneurysm; (iii) ocular pythiosis, causing corneal ulcers; and (iv) disseminated pythiosis, featuring the infection of internal organ (9). Vascular and ocular infections are the most common forms of pythiosis.…”

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confidence: 99%

“…Vascular and ocular infections are the most common forms of pythiosis. The majority of vascular pythiosis patients have an affected leg amputated, while most ocular pythiosis patients have an infected eye removed (9). Many vascular pythiosis patients die from a ruptured aneurysm.…”

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confidence: 99%

“…Many vascular pythiosis patients die from a ruptured aneurysm. Thalassemias and agriculture-related careers are known as predisposing factors (9,21,27).…”

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confidence: 99%

“…Culture identification is a definite diagnostic method for pythiosis, but it is a time-consuming procedure and requires expertise and often hard-to-obtain internal tissue (1,9,11,17,23). Conventional antifungal drugs are not effective to control the infection (9).…”

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confidence: 99%

“…Conventional antifungal drugs are not effective to control the infection (9). The main treatment option for pythiosis is surgery, which should be urgently performed to limit disease progression and ensure better prognoses for patients (9). Some serodiagnostic tests have been developed to facilitate the early diagnosis of pythiosis (4, 6, 7, 13-15, 18, 25).…”

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confidence: 99%

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Development of an Immunochromatographic Test for Rapid Serodiagnosis of Human Pythiosis

Krajaejun

Imkhieo

Intaramat

et al. 2009

Clin Vaccine Immunol

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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 ϳ24 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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confidence: 99%

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confidence: 99%

“…Many vascular pythiosis patients die from a ruptured aneurysm. Thalassemias and agriculture-related careers are known as predisposing factors (9,21,27).…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Development of an Immunochromatographic Test for Rapid Serodiagnosis of Human Pythiosis

Krajaejun

Imkhieo

Intaramat

et al. 2009

Clin Vaccine Immunol

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Unusual Fungal and Pseudofungal Infections

Richardson

Warnock

2012

Fungal Infection

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Successful management of colonic pythiosis in two dogs in Thailand using antifungal therapy

Sukanan¹,

Suparp²,

Yongsiri³

et al. 2022

Veterinary Medicine & Sci

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Gastrointestinal pythiosis is a severe, progressive and often a fatal disease, which is caused by the aquatic pathogen Pythium insidiosum. Treatment is challenging due to the disease's resistance to antifungal drugs. Surgical resection is frequently attempted in cases of pythiosis; however, it can be technically challenging. This report presents two dogs with decreased appetite, abdominal pain, progressive haematochezia, tenesmus and significant weight loss. With the medical histories of both being young canines, living in areas with access to natural water resources and with the main chronic gastrointestinal symptoms having not responded to symptomatic treatment, pythiosis was taken into consideration. Abdominal ultrasound revealed severe, diffuse thickening and loss of normal layering of the colonic wall. These findings led to a differential diagnosis between intestinal neoplasia and fungal disease. Full‐thickness biopsies were later performed, and immunohistochemistry staining was suggested for colonic pythiosis. Medical treatment for pythiosis was successful with a combination of oral terbinafine and prednisolone. However, therapy with itraconazole in case 1 did not improve the clinical signs, and in case 2, itraconazole was used after all clinical signs have improved for clinical control. Since then, there has been no recurrence of clinical signs until the time of preparing this report (19 months for case 1, 11 months for case 2 since the cessation of treatment). The treatment was successful based on clinical signs and ultrasonographic data, and the disease remission was not confirmed by advance imaging, monitoring of pythiosis enzyme‐linked immunosorbent essay concentration or repeat sampling.

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Clinical and Epidemiological Analyses of Human Pythiosis in Thailand

Cited by 205 publications

References 36 publications

Development of an Immunochromatographic Test for Rapid Serodiagnosis of Human Pythiosis

Development of an Immunochromatographic Test for Rapid Serodiagnosis of Human Pythiosis

Unusual Fungal and Pseudofungal Infections

Successful management of colonic pythiosis in two dogs in Thailand using antifungal therapy

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