Cutaneous Protothecosis Research Articles

Cutaneous Protothecosis in Patient with Diabetes Mellitus and Review of Published Case Reports

Protothecosis is an opportunistic infection caused by Prototheca, usually called as saprophytes, and is frequently found in natural and living surroundings with low virulence, but may cause chronic infection in immunocompromised individuals. We report a case of cutaneous protothecosis with zopfii var. portoricensis infection in a 66-year-old diabetic woman following hand surgery on middle right finger. Mycology study showed that smooth, creamy white, yeast-like colonies grown after necrotic tissue was cultured on Sabouraud dextrose agar at both 37 and 25°C. The organism was then identified as Prototheca zopfii var. portoricensis by molecular identification and also found from histopathology of the lesion. The lesion got improved with intravenous amphotericin B and itraconazole.

A case of cutaneous protothecosis in a polyarteritis nodosa patient and review of cases reported in Japan

A 76-year-old woman farmer with a 20-year history of oral steroid treatment for polyarteritis nodosa, noted a rash consisting of numerous small papules on the dorsum of her right hand in February 2007. The rash worsened over time, and in April 2008 red papules and pustules as big as grains of rice fused to form plaques extending up her arm from the dorsum of the right hand to the extensor surface of the forearm. The plaques were accompanied by erosions, ulcers, and crusts. Skin biopsy specimens from the dorsum of the right hand showed a dense cell infiltration in the upper to middle layer of the dermis, with numerous morula-like microorganisms within the cells. Cultures of the specimens on Sabouraud dextrose agar produced creamy, yeast-like colonies. The colonies produced sporangia, with cells of varying sizes arranged in the pattern of a spoked-wheel. The microorganisms were identified as Prototheca wickerhamii on the basis of their morphological characteristics, sugar assimilation patterns, and molecular biological techniques. Treatment with amphotericin B was planned, but the patient died from respiratory failure before initiating treatment. We review the characteristics of the cutaneous protothecosis cases reported to date in Japan.

Cutaneous Protothecosis

Abstract Prototheca species are an achlorophyllic algae that cause infections primarily in immunocompromised individuals. At least one-half of infectious cases are cutaneous. Because protothecosis is seldom suspected clinically, patients may be subjected to various treatment modalities for extended periods without satisfactory results. Cutaneous protothecosis shares similar clinical and pathologic findings with deep tissue fungal mycoses. The typical presentation occurs most commonly on the face and extremities as erythematous plaques, nodules, or superficial ulcers. Prototheca spp are spherical, unicellular, nonbudding organisms that are sometimes noted on routine hematoxylin-eosin staining but are best visualized with periodic acid–Schiff and Gomori methenamine-silver histochemical stains. Although protothecosis can be diagnosed on biopsy, culture of the organism on a medium such as Sabouraud dextrose agar is required for definitive diagnosis. Treatment may require a combination of surgical excision and antifungal agents. Therefore, cutaneous protothecosis should be considered in a lesion that appears suspicious for the more-common fungal infections.

A case of cutaneous protothecosis successfully treated with local thermal therapy as an adjunct to itraconazole therapy in an immunocompromised host

We report a case of human protothecosis in an immunocompromised host which was caused by Prototheca wickerhamii and was successfully treated with thermal adjunct therapy combined with systemic itraconazole therapy. A 78-year-old man taking 30 mg prednisolone daily had a 1-week history of erythematous plaques on the dorsal aspect of his right hand and forearm after sustaining a small traumatic injury. Histopathology of the lesions revealed granulomatous inflammatory changes with numerous microorganisms that had multiple septations in their cytoplasm. On the basis of mycological features and the results of the sugar assimilation test, the etiologic agent was identified as Prototheca wickerhamii. Although the lesion showed no response to the systemic itraconazole therapy and topical ketoconazole treatment, a complete resolution was achieved by the use of thermal therapy as an adjunct to systemic itraconazole.

Cutaneous Protothecosis following a Tape-Stripping Injury

Prototheca species are ubiquitous achlorophyllic algae that can, in rare instances, manifest as cutaneous infection in humans at sites of traumatic inoculation into the skin. We report a 77-year-old man who developed cutaneous protothecosis at the site of an iatrogenic tape-stripping type injury. The diagnosis was confirmed by histologic examination and tissue culture. The patient responded completely to a 17-week course of oral fluconazole. Cutaneous protothecosis can present clinically as nonspecific indolent inflammatory plaques that require skin biopsy for definitive diagnosis.

Prototecose cutânea: relato de caso

A case of cutaneous protothecosis was reported in a 78-year-old man that was in treatment for pemphigus foliaceus and phaeohyphomycosis. He presented erythematous lesions which were infiltrated into his right leg. The diagnosis was made histopathologically and confirmed by culture, and the patient was successfully treated with itraconazole.

Characteristics and importance of the genus Prototheca in human and veterinary medicine

Prototheca spp. are strange algae, assigned to the genus Prototheca, family Chlorelaceae. They are ubiquitous in nature, living predominantly in aqueous locales containing decomposing plant material. Prototheca spp. were isolated from skin scarificates, sputum and feces of humans in absence of infection as well as in a variety of domestic and some wild animals. Prototheca spp. are unicellular organisms, oval or spheric in shape. They differ from bacteria and fungi in size, shape and reproductive characteristics. Of the five known species of the genus, only P. wickerhamii and P. zopfii are considered pathogenic, and they are the only known plant causative agents of human and animal infections. Over the past 25 years medical references reported more than 100 cases of human protothecoses, mostly induced by P. wickerhamii and rarely by P. zopfii. A half of the reports on human protothecoses relates to localized cutaneous infections and oleocranon bursitis. The rarest and most severe form of the infection is disseminated or systemic protothecosis, described in patients with durable course of primary disease or immune disfunction. In veterinary medicine, Prototheca zopfii and rarely also P. wickerhamii are reported as causative agents of cutaneous protothecosis in dogs and cats, systemic protothecosis in dogs and mastitis in dairy cows. Protothecal infections are diagnosed by histopathology examination or, more exactly, by isolation of the agent, although the organism cannot be distinguished from the yeasts by its cultural characteristics. Final diagnosis is made by the carbon-hydrate assimilation test. Protothecal infections are easily missed in routine practice. Pharmacological protocol for therapy of this rare infection has not been developed yet either in human or in veterinary medicine. Several antifungal agents are applied for treatment; however, the effects are variable. Where possible, surgical excision is treatment of choice. Prognosis is promising in patients with localized infection, and healing is often achieved. Prognosis is less predictable, mostly bad, in patients with other diseases and in immunocompromized patients. Sensitivity of Prototheca spp. in vitro does not necessarily correlate with its efficacy in vivo.

A case of cutaneous protothecosis

A case of cutaneous protothecosis

Cutaneous protothecosis: report of a third Brazilian case

The present report describes a case of cutaneous protothecosis caused by Prototheca wickerhamii in a nonimmunocompromised Brazilian female. Dermatological examination revealed a 15-cm diffusely infiltrated eczema-like plaque recovered with many pustule-like lesions on the right forearm. We emphasize the mycological and pathological aspects of this infection that can lead to misdiagnosis. The patient was successfully treated with itraconazole.

Localized cutaneous protothecosis in a patient with Acquired Immune Deficiency Syndrome

Localized cutaneous protothecosis in a patient with Acquired Immune Deficiency Syndrome

Cutaneous Protothecosis in a Patient with AIDS and a Severe Functional Neutrophil Defect: Successful Therapy with Amphotericin B

Cutaneous Protothecosis in a Patient with AIDS and a Severe Functional Neutrophil Defect: Successful Therapy with Amphotericin B

Canine cutaneous protothecosis: An immunohistochemical analysis of the inflammatory cellular infiltrate

In this immunohistochemical study, the distribution of the cellular inflammatory infiltrate associated with cutaneous canine protothecosis (Prototheca wickerhamii) was evaluated by consecutive biopsies taken before, during and after treatment. Antibodies specific to canine immunoglobulins (IgG, IgM, IgA), human CD3 antigen (pan T-lymphocyte marker) and human myeloid/ histiocyte antigen (macrophage/neutrophil marker) were used. Before treatment, cellular infiltrate was very scanty in the inflamed areas, but it increased during the treatment, whereas the number of protothecal organisms decreased. Statistical analysis revealed an inverse relation between the number of protothecal organisms and the number of infiltrating macrophage/neutrophils (P < 0.004), T lymphocytes (P < 0.001), and cells containing immunoglobulin G (P < 0.001), M (P < 0.001) and A (P < 0.001) at different stages of the disease. These findings suggest either that protothecal organisms inhibit the migration or proliferation of cellular inflammatory infiltrate or that only dead protothecal organisms induce an effective local immune response.

Cutaneous protothecosis in a dog

A dog was infected systemically with Prototheca wickerhamii but showed only cutaneous protothecosis. The lesions appeared progressively and consisted of non-pruritic scrotal swelling and ulceration, cutaneous nodules, crusty ulcerative lesions...

Cutaneous Protothecosis: Unique Histopathological Finding with Crystal Violet Staining and the Therapeutic Effect of Itraconazole.

Cutaneous protothecosis sometimes poses diagnostic and therapeutic problems. Isolation of the causative organism may not be successful and spores may be mistaken for other diseases unless the characteristic sporangia are detected in tissue sections. Because there are few cases, the optimal therapy is still being debated. Our purposes were to detect any characteristic findings of Prototheca wickerhamii under light microscopy in order to aid diagnosis and to determine which drugs were effective. On crystal violet staining we found characteristic bluish dots in Prototheca spores; these correspond to the amyloplasts or dense bodies found under electron microscopy. In vitro the isolated organisms were inhibited by itraconazole, amphotericin B, ketoconazole, and amorolfine and we were able to successfully treat three patients with itraconazole. Crystal violet staining can be helpful in diagnosing protothecosis, especially when the causative organism has not been isolated. The therapeutic effect of itraconazole was confirmed in vivo and in vitro.

Two Cases of Cutaneous Protothecosis : Unique Histopathological Findings with Crystal Violet Staining and the Therapeutic Effect of Itraconazole

Two Cases of Cutaneous Protothecosis : Unique Histopathological Findings with Crystal Violet Staining and the Therapeutic Effect of Itraconazole

Successful treatment with fluconazole of protothecosis developing at the site of an intralesional corticosteroid injection

We report a case of cutaneous protothecosis treated successfully with oral fluconazole. Fluconazole appears to be an effective alternative to conventional drugs for the treatment of cutaneous protothecosis. Cutaneous protothecosis is an uncommon infection due to achlorophyllic, saprophytic, algae-like unicellular organisms of the genus Prototheca that occurs mainly in immunocompromised patients. To date there is no standard treatment regimen. Surgical excision, oral ketoconazole, intravenous amphotericin B alone or in combination with oral tetracycline have been reported to be effective in the management of protothecosis. We report a 55-year-old immunocompetent woman with cutaneous protothecosis which developed at the site of intralesional triamcinolone acetonide injection, who was successfully treated with oral fluconazole.

Cutaneous protothecosis: report of a case in Hong Kong

We report a patient who presented with recalcitrant ulcerated papules and plaques on both legs. Histopathology revealed protothecosis, and subsequent culture of the lesions grew Prototheca wickerhamii. Gradual resolution of the ulcers occurred on treatment with itraconazole.

Cutaneous protothecosis and AIDS

Cutaneous protothecosis is an uncommon algal infection with a varied clinical presentation that occurs mainly in immunocompromised patients. We describe a 33-year-old Hispanic woman with AIDS who had a verrucous plaque on the dorsum of her hand. A biopsy specimen revealed organisms suggestive of Prototheca. Culture confirmed the organism to be Prototheca wickerhamii. To our knowledge, this is the first case of cutaneous protothecosis reported in a patient with AIDS.

Experimental Cutaneous Protothecosis in Mice: Epithelioid Cell Granuloma Formation

Prototheca wickerhamii, isolated from skin biopsy specimens of a patient with cutaneous protothecosis, were cultured in Sabouraud's medium and inoculated in the skin of 8 ICR albino mice and 3 BALB/c mice. Only in 3 ICR albino mice and 3 BALB/c mice were organisms found in skin tissue, as confirmed by identification of organisms by staining with periodic acid-Schiff (PAS) stain and culture. Histologic findings from affected nodular skin lesions indicated epithelioid cell granuloma and histiocytic cell infiltrates in the dermis and subcutaneous tissue.

A case of cutaneous protothecosis.

A-62-year old female, under treatment with systemic corticosteroids, developed widespread ulcerative lesions on her left leg. Histological examination revealed granulomatous inflammatory changes containing few microorganisms, typical of Prototheca species. Culture of the specimen using several different media, however, yielded no microorganisms. This is the second case of protothecosis reported in Japan. Possible reasons for the failure to isolate pathogens were discussed.