Treatment outcomes of surgery, antifungal therapy and immunotherapy in ocular and vascular human pythiosis: a retrospective study of 18 patients

Abstract

Surgery with adequate surgical margins is a crucial determinant of survival in patients with vascular pythiosis. Itraconazole and terbinafine do not have synergistic effects on Thai P. insidiosum strains. The role of immunotherapy remains inconclusive for both vascular and ocular pythiosis.

A Leishmania murine model to evaluate the immunomodulatory properties of Pythium insidiosum proteins

“…Previous data support claims that PiV proteins have the ability to modulate the Th2 response in cases of pythiosis to a Th1 response after successful immunotherapy [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 23]. Using the mouse Leishmania model, we demonstrated that the Th2 response in place during experimental L. major mice experimental infection of BALB/c mice, switched to a polarized Th1 response.…”

“…However, few immunotherapeutic proteins of microbial origin are presently being considered for immunotherapy; one of them is PiV, while the rest represent antigenic epitopes harvested from cancer patients [33, 37]. So far, PiV antigenic preparation has shown minimal or no side effects in experimental animals (1,2,10,13, this study), and in cured humans and animals with pythiosis [3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 23]. Based on these results, we anticipate further interest in PiV immunomodulatory capabilities applied to other infectious and non-infectious processes that otherwise involve a non-curative Th2 response.…”

“…These authors linked the curative properties of P. insidiosum ’ s extracts to a change from an eosinophilic granuloma to a lymphocytic mononuclear cell response, which they proposed was key in the killing of P. insidiosum ’ s hyphae in infected tissues [3, 4]. Since then, PiV immunogens have been successful in humans [5, 6, 7, 8], cattle [2], dogs [9, 10, 11] and horses [12, 13, 14] with pythiosis. It was later found in successfully treated mammals that in addition to the switching from an eosinophilic to a mononuclear cell response, a shift from a Th2 to a Th1 cytokine profile occurred [2].…”

In Vitro and In Vivo Antimicrobial Activities of Minocycline in Combination with Azithromycin, Clarithromycin, or Tigecycline against Pythium insidiosum

“…This morphological similarity has been targeted for the treatment of many pythiosis cases in humans and other mammals using antifungal drugs (1). Despite a few reports of successful therapy with antifungal drugs (2,3), many studies have demonstrated their ineffectiveness (1,(4)(5)(6). We previously described antibacterial compounds belonging to the glycylcycline, macrolide, and tetracycline classes (7)(8)(9)(10) as having potent in vitro activity against P. insidiosum.…”

Geographic variation in the elicitin-like glycoprotein, ELI025, of Pythium insidiosum isolated from human and animal subjects

“…Almost all cases of pythiosis in humans have been reported from Thailand, whereas cases of pythiosis in animals have been found worldwide (Gaastra et al, 2010;Krajaejun et al, 2006;Mendoza, 2008;Mendoza and Vilela, 2009). No effective antimicrobial drug is currently available for treatment of P. insidiosum infection (Krajaejun et al, 2006;Permpalung et al, 2015). Extensive surgical removal of the infected organ (eye or leg) is an only treatment option for controlling the disease.…”