Pythiosis presenting with chronic swelling and painful subcutaneous lesion at right deltoid

Luangnara, Athitaya; Chuamanochan, Mati; Chiewchanvit, Siri; Pattamapaspong, Nuttaya; Salee, Parichat; Chaiwarith, Romanee

doi:10.1016/j.idcr.2023.e01873

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…In humans, there has been only one reported case of subcutaneous pythiosis, characterized by a right deltoid mass developing over six months, where a regimen incorporating antibacterials was used. In this case, administering itraconazole, azithromycin, and terbinafine led to a gradual lesion regression after three months of follow-up [96].…”

Section: Antibacterial Drugs and Pythiosis: Challenges From In Vitro ...mentioning

confidence: 65%

Treating Pythiosis with Antibacterial Drugs Targeting Protein Synthesis: An Overview

Loreto,

Tondolo,

Zanette

2024

JoF

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This review article explores the effectiveness of antibacterial drugs that inhibit protein synthesis in treating pythiosis, a difficult-to-treat infection caused by Pythium insidiosum. The article highlights the susceptibility of P. insidiosum to antibacterial drugs, such as macrolides, oxazolidinones, and tetracyclines. We examine various studies, including in vitro tests, experimental infection models, and clinical case reports. Based on our synthesis of these findings, we highlight the potential of these drugs in managing pythiosis, primarily when combined with surgical interventions. The review emphasizes the need for personalized treatment strategies and further research to establish standardized testing protocols and optimize therapeutic approaches.

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Section: Antibacterial Drugs and Pythiosis: Challenges From In Vitro ...mentioning

confidence: 65%

Treating Pythiosis with Antibacterial Drugs Targeting Protein Synthesis: An Overview

Loreto,

Tondolo,

Zanette

2024

JoF

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Human cutaneous pythiosis: A case report

Nutthapan,

Sutichaiworapong,

2024

J Cutan Pathol

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Human pythiosis is a rarely encountered yet potentially harmful infectious disease. It is mostly caused by Pythium insidiosum, an aquatic fungal‐like organism, and primarily manifests in tropical locales such as India and Thailand. Cutaneous/subcutaneous pythiosis accounts for a small proportion of all clinical forms. The relationship between cutaneous pythiosis and hemoglobinopathy remains uncertain, unlike the vascular form. The histopathology of the disease demonstrates eosinophilic granulomatous inflammation and dense eosinophilic material enveloping the organism, known as the Splendore–Hoeppli phenomenon. These histopathologic characteristics resemble those observed in entomophthoromycosis. Until now, the histopathology of human cutaneous pythiosis has been scarcely delineated in the literature. Herein, we report a case of cutaneous pythiosis in an adult thalassemic agricultural worker who presented with a 2‐month history of a progressive, painful, erythematous infiltrative plaque on the left leg. The definitive diagnosis was ascertained through histopathologic examination and the identification of anti‐P. insidiosum antibodies in the serum utilizing enzyme‐linked immunosorbent assay. This report demonstrates the exquisite histopathologic findings of a rare case of human cutaneous pythiosis.

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Treatment of Pythiosis

Yolanda

2024

Rama Med J

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Dear Editor: Due to its rising global incidence, I have dedicated years to studying pythiosis, a rare yet deadly infectious disease caused by Pythium insidiosum.1 Pythiosis typically presents with the infection of the artery, eye, gastrointestinal tract, and skin, and if left untreated, it can lead to organ loss or even death. In recent decades, a deeper understanding of P. insidiosum has been seen across molecular, serological, and histological studies, enhancing clinical awareness and diagnostic advancements.1, 2 Traditionally mistaken for a fungus because of its microscopic appearance, P. insidiosum was treated with antifungal medications like terbinafine and amphotericin B.3, 4 Molecular research clarifies that P. insidiosum is an oomycete, more closely related to algae, with significant biological differences from fungi, impacting drug efficacy.5 Since the 1980s, P. insidiosum antigen immunotherapy (PIAI) has emerged as a treatment alternative, with ongoing enhancements to increase efficacy.6 Surgery often serves as a last resort to limit the disease progression or to save lives.7 Current treatment strategies for pythiosis include antimicrobial drugs, PIAI, and surgery. Antimicrobial susceptibility testing reveals a higher sensitivity of P. insidiosum to antibacterials like macrolides, oxazolidinones, and tetracyclines, reducing the reliance on surgery.8 Though less effective, antifungals, sometimes in combination with antibacterials, can treat pythiosis.9, 10 PIAI, prepared by crude antigen extract of P. insidiosum, is beneficial for humans and animals with pythiosis, potentially reducing surgery needs and increasing survival rates. However, its efficacy varies across different disease manifestations.6 Surgical intervention, typically reserved for unresponsive cases, ranges from organ-preserving procedures to more radical approaches like amputation, depending on disease progression.2, 3, 7 Additional treatments, including dimethyl sulfoxide, potassium iodide, steroids, ethanol, and mefenoxam, applied singly or combined, have shown promise in treating specific pythiosis forms.11, 12 Treatment is the most challenging aspect of pythiosis, but there is hope. The morbidity and mortality of affected patients remain high. However, with continued attention and basic/clinical research by the medical community, we can gain insight into the disease and find a better way of pythiosis control, potentially improving their clinical outcomes.

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Pythiosis presenting with chronic swelling and painful subcutaneous lesion at right deltoid

Cited by 3 publications

References 18 publications

Treating Pythiosis with Antibacterial Drugs Targeting Protein Synthesis: An Overview

Treating Pythiosis with Antibacterial Drugs Targeting Protein Synthesis: An Overview

Human cutaneous pythiosis: A case report

Treatment of Pythiosis

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