Disseminated protothecosis

Mathew, Leni Grace; Pulimood, Susanne; Thomas, Meera; Acharya, Mary A.; Raj, Promila Mohan; Mathews, Mary S.

doi:10.1007/s12098-009-0251-6

Cited by 11 publications

(8 citation statements)

References 4 publications

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“…It is not a part of human microflora although can rarely colonize skin, nails, respiratory tract and digestive system. 2,14,15 Despite widespread distribution and exposure, human infection is rare and is restricted to hosts with compromised immunity. Prototheca may be transmitted by direct traumatic inoculation resulting in onychoprotothecosis and cutaneous protothecosis manifesting as papules, pustules, plaques, erosions, ulcers, crusts and nodules which need to be differentiated from other indolent conditions.…”

Section: Discussionmentioning

confidence: 99%

Outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care chemotherapy oncology unit

Khan

Sahni²,

Sen

et al. 2018

Medical Journal Armed Forces India

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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 30bedded 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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Section: Discussionmentioning

confidence: 99%

Outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care chemotherapy oncology unit

Khan

Sahni²,

Sen

et al. 2018

Medical Journal Armed Forces India

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“…Systemic infections occur almost always in immune compromised conditions. [4] These include those on cancer treatment, and with solid organ tumors and immune deficiency diseases. The diagnosis can be made on histopathology and/or culture.…”

Section: Discussionmentioning

confidence: 99%

Onychoprotothecosis: An uncommon presentation of protothecosis

Vyawahare

Chaudhaury

et al. 2015

Indian Journal of Medical Microbiology

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Onychomycosis is a fairly common condition seen in a dermatology clinic. Dermatophytes Trichophyton and Epidermophyton are the known filamentous fungi implicated. The yeast-like fungi such as Candida less commonly cause Onychomycosis. The genus Prototheca may on preliminary observation resemble yeast-like fungi but a detailed microscopy will reveal the absence of budding and presence of endospores. Onychoprotothecosis is an uncommon presentation of human protothecosis. Of the two Prototheca species (Prototheca zopfii and Prototheca wickerhamii) known to cause the disease, P. wickerhamii has been reported more commonly. We report a culture proven case of this condition caused by P. zopfii. The patient, a 55-year-old housewife presented with discolouration and breaking off of the right thumb and forefinger nails since a period of six months. Samples of nail scrapping sent to the Microbiology Laboratory were culture-positive for Prototheca. Speciation by the automated Vitek-2 system (bioMerieux) identified the isolate as P. zopfii, which was further confirmed at PGI, Chandigarh.

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“… References from Table : Leimann et al ., 2004 ; Heney et al ., 1991 ; Iacoviello et al ., 1992 ; Ravisse et al ., 1993 ; Buendra et al ., 1998 ; Mathew et al ., 2010 ; Zak et al ., 2012 ; Kalsy et al ., 2012 ; Tan et al ., 2013 ; Tello‐Zavala et al ., 2013 . Am B, amphotericin B; ALL Ph+, positive high‐risk acute lymphoblastic leukaemia; IVIG, intravenous immunoglobulin; MUD BMT, unrelated matched donor bone marrow transplantation. …”

Section: Discussionmentioning

confidence: 99%

Protothecal peritonitis in child after bone marrow transplantation: case report and literature review of paediatric cases

Sýkora¹,

Hořáková²,

Buzzasyova

et al. 2014

New Microbes and New Infections

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The case presented here illustrates a protothecal infection caused by Prototheca wickerhamii in a paediatric haematopoietic stem cell recipient followed by a review of the literature of all 13 paediatric cases published since 1980. Protothecosis is a rare disease caused by algae, not described in this setting before. Infection was proven additionally post-mortem from peritoneal dialysis fluid. Even though no death of a paediatric patient due to this infection has been reported and the mortality rate associated with protothecosis is low, our patient died from multiorgan failure as a result of numerous post-transplant complications and a strain of cultivated alga that was highly resistant to antifungal agents. Prototheca spp. show various susceptibility profiles, and there is no direct correlation between in vitro activity and clinical response. There are different treatment regimens described but there are no clear published guidelines of specific therapy of protothecosis. Paediatric cases were successfully treated mostly with amphotericin B and azoles. As the number of immunocompromised patients increases, it is necessary to think more about unusual pathogens such as Prototheca.

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Disseminated protothecosis

Cited by 11 publications

References 4 publications

Outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care chemotherapy oncology unit

Outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care chemotherapy oncology unit

Onychoprotothecosis: An uncommon presentation of protothecosis

Protothecal peritonitis in child after bone marrow transplantation: case report and literature review of paediatric cases

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