Vascular pythiosis of carotid artery with meningitis and cerebral septic emboli: A case report and literature review

Abstract

Vascular Pythiosis caused by Pythium insiodiosum rarely involves carotid artery. A case of concealed ruptured pseudoaneurysm of the carotid artery with neck abscesses, and cerebral septic emboli is described. Patient presented with large pulsatile neck mass that failed to response to surgery, antifungals and immunotherapeutic vaccine. Residual unresectable disease leads to death in the patient. Pythiosis should be considered as a differential diagnosis of head and neck infection.

Recent update in diagnosis and treatment of human pythiosis

“…When stimulate with P. insidiosum zoospore, peripheral blood mononuclear cells collected from thalassemic patients showed lower level of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interferon gamma (IFN-γ) production, compared with the non-thalassemic controls (Ud-Naen et al, 2019). Other hematologic disorders that predispose individuals to vascular pythiosis include paroxysmal nocturnal hemoglobinuria, aplastic anemia, myelodysplasia, idiopathic thrombocytopenic purpura, and leukemia (Krajaejun et al, 2006b), and to a lesser extent, young age, alcoholism, malnourishment, immunosuppression, HIV infection, cancer, and neutropenia (Krajaejun et al, 2006b;Pan et al, 2014;Shenep et al, 1998;Chitasombat et al, 2018a;Hoffman, Cornish & Simonsen, 2011;Hilton et al, 2016;Kirzhner et al, 2015;Franco et al, 2010;Chitasombat et al, 2018b).…”

“…Presurgical assessment Urgent preoperative assessment determined by computerized tomography angiogram (CTA) of affected vessel (i.e., lower extremities) up to the proximal origin of vessels (i.e., CTA of whole aorta with femoral run off) is recommended. Abnormal radiography showing thickening of the vessel wall with enhancement, thrombosis, and aneurysmal dilation may indicate arteritis (Krajaejun et al, 2006b;Sermsathanasawadi et al, 2016;Chitasombat et al, 2018b). The CTA method has some advantages compared with angiogram for the determination of soft tissue and lymph node involvement.…”

“…The CTA method has some advantages compared with angiogram for the determination of soft tissue and lymph node involvement. Magnetic resonance imaging with angiogram (MRI/MRA) is the preferred modality to assess cranial involvement, i.e., septic emboli, small abscesses, and cavernous sinus extensions (Rathi et al, 2018;Chitasombat et al, 2018b;Narkwiboonwong et al, 2011).…”

“…If the warning signs are present, prompt re-grafting and adjunct therapies should be considered to avoid eye loss. Extensive infection involving the sclera and extraocular muscles could potentially lead to cavernous sinus thrombophlebitis (Rathi et al, 2018;Chitasombat et al, 2018b). Thus, imaging study of brain and orbit should be considered to determine disease extension and treatment planning.…”

An initial survey of 150 horses from Thailand for anti-Pythium insidiosum antibodies

“…Data on the epidemiology of pythiosis is limited. Since the rst case in 1985, human pythiosis has been increasingly reported from all over Thailand [2,10,[13][14][15][16][17][18][19], where P. insidiosum is ubiquitous in the environment [3,4]. A seroprevalence study estimated that ~32,000 Thai people have been exposed to the pathogen [20].…”