Hickman Catheter-Related Protothecal Algaemia in an Immunocompromised Child

Heney, Claire; Greeff, Michael; Davis, Valerie

doi:10.1093/infdis/163.4.930

Cited by 44 publications

(23 citation statements)

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“…Hospital-acquired cases of protothecosis have been reported in association with surgery and orthopedic procedures (53,54,94,100,139,150). Infection may also occur by penetration of the agent when a skin injury comes in contact with contaminated water (45,59,161).…”

Section: Epidemiologymentioning

confidence: 99%

Human Protothecosis

2007

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SUMMARY Human protothecosis is a rare infection caused by members of the genus Prototheca. Prototheca species are generally considered to be achlorophyllic algae and are ubiquitous in nature. The occurrence of protothecosis can be local or disseminated and acute or chronic, with the latter being more common. Diseases have been classified as (i) cutaneous lesions, (ii) olecranon bursitis, or (iii) disseminated or systemic manifestations. Infections can occur in both immunocompetent and immunosuppressed patients, although more severe and disseminated infections tend to occur in immunocompromised individuals. Prototheca wickerhamii and Prototheca zopfii have been associated with human disease. Usually, treatment involves medical and surgical approaches; treatment failure is not uncommon. Antifungals such as ketoconazole, itraconazole, fluconazole, and amphotericin B are the most commonly used drugs to date. Among them, amphotericin B displays the best activity against Prototheca spp. Diagnosis is largely made upon detection of characteristic structures observed on histopathologic examination of tissue.

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Section: Epidemiologymentioning

confidence: 99%

Human Protothecosis

2007

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“…Signs and symptoms appear gradually several weeks following the trauma and include mild induration of the bursa accompanied by tenderness, erythema, and production of a variable amount of serosanguinous fluid. Disseminated protothecosis is rare and almost always occurs in individuals with severe immunocompromise from cancer treatment, a prior solid organ transplant, or AIDS (36,43,48,54,93,104). The organs most commonly affected in disseminated infection are skin, subcutaneous tissue, and spleen (93).…”

Section: Unusual Pseudofungal Infectionsmentioning

confidence: 99%

Unusual Fungal and Pseudofungal Infections of Humans

Pfaller

Diekema²

2005

J Clin Microbiol

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“…The first case of multiorgan systemic infection was described by Cox et al in 1974 (2). Since then, few cases of protothecosis have been described, mainly in patients with diabetes mellitus, continuous peritoneal dialysis, renal transplantation, steroid use, AIDS, or immunologic defects involving lymphocytes or neutrophils (6,8,9,11,15). Protothecosis is an uncommon infection in cancer patients, as only 13 cases have been reported in the literature (15).…”

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confidence: 99%

“…Protothecosis is an uncommon infection in cancer patients, as only 13 cases have been reported in the literature (15). Most infections involve the skin or soft-tissue structures and were due to P. wickerhamii (1,6,8,9,16). We here report the first case of disseminated and ultimately fatal infection due to P. zopfii in a severely immunosuppressed leukemic patient following mismatched unrelated stem cell transplantation.…”

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confidence: 99%

Disseminated Infection with Prototheca zopfii after Unrelated Stem Cell Transplantation for Leukemia

Lass‐Flörl¹,

Fille²,

Gunsilius

et al. 2004

J Clin Microbiol

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Disseminated infection with Prototheca zopfii is a rare disease in immunosuppressed patients. We here report the first case of lethal infection with P. zopfii following unrelated stem cell transplantation for leukemia. Breakthrough protothecosis occurred during long-term administration of voriconazole in the case of pulmonary aspergillosis. CASE REPORTA 58-year-old man was diagnosed with osteomyelofibrosis in 1998. Four years later, the patient developed chemotherapyrefractory secondary acute leukemia (FAB-M1), and a oneantigen mismatched bone marrow transplantation from an unrelated donor was performed after reduced-intensity conditioning despite proven aspergillosis. Pulmonary aspergillosis was controlled by administering voriconazole (Pfizer, Vienna, Austria) in combination with caspofungin (MSD, Vienna, Austria) during the neutropenic period. Antifungal maintenance therapy consisted of monotherapy with voriconazole (400 mg/day). Three months later, leukemic relapse occurred while the patient was still under immunosuppression with cyclosporine. After immunosuppression was discontinued, reinduction with fludarabine, high-dose cytarabine, and granulocyte colony-stimulating factor was started but without success. The patient's refractory leukemia was treated with gemtuzumab ozogamicin (Mylotarg; Wyeth, Vienna, Austria) in order to induce remission for subsequent donor lymphocyte infusion since no graft-versus-host disease had yet been diagnosed. During severe pancytopenia after gemtuzumab ozogamicin the patient developed fever of up to 41°C, which was unresponsive to ceftazidime, vancomycin, and netilmicin. Concurrently, spotted pulmonary infiltrates were visible in a computerized tomography scan, raising suspicion of aspergillosis reactivation. Antifungal therapy was extended to caspofungin. At that time, erythematous skin papules appeared on the upper extremities and spread rapidly over the whole body. Multiple blood cultures with aerobic, anaerobic, and fungal broths were taken and incubated in a BACTEC 9050 blood culture system (Becton Dickinson, Cockeysville, Md.).After 3 days of incubation at 37°C yeast-like fungi were grown on Sabouraud dextrose agar (Merck, Vienna, Austria) from several blood cultures. Prototheca zopfii was identified with Vitek 2 (bioMerieux, Marcy l'Etoile, France) and confirmed with the RapID Yeast Plus (code 730010) system (Remel, Santa Fe, N.Mex.) and microscopic examination. Cornmeal agar showed typical findings for P. zopfii: small spherules in aggregates with multiple internal cleavage. Susceptibility testing was performed by E-test as described by the manufacturer (AB Biodisk, Solna, Sweden). The medium consisted of RPMI 1640 agar with 2% glucose; the inoculum suspension was adjusted to the turbidity of a 0.5 McFarland standard and incubated at 37°C for 48 h. In vitro susceptibility gave the following MICs: amphotericin B, 0.125 g/ml; voriconazole, Ͼ64 g/ml. These results correlated with the MICs obtained with the National Committee for Clinical Laboratory Standards reference br...

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Hickman Catheter-Related Protothecal Algaemia in an Immunocompromised Child

Cited by 44 publications

References 0 publications

Human Protothecosis

Human Protothecosis

Unusual Fungal and Pseudofungal Infections of Humans

Disseminated Infection with Prototheca zopfii after Unrelated Stem Cell Transplantation for Leukemia

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