Leap forward in the treatment of <i>Pythium insidiosum</i> keratitis

Bagga, Bhupesh; Sharma, Savitri; Guda, Sai Jeevan Madhuri; Nagpal, Ritu; Joseph, Joveeta; Manjulatha, Kodiganti; Mohamed, Ashik; Garg, Prashant

doi:10.1136/bjophthalmol-2017-311360

Cited by 66 publications

(122 citation statements)

References 13 publications

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“…Patients with Pythium keratitis usually present with typical clinical manifestations, including multiple, linear, tentacle-like infiltrates and dot-like or pinhead-shaped infiltrates, involving the subepithelial, anterior stromal, and midstromal layers in surrounding cornea and radiating in a reticular pattern from the central area of the lesion towards the limbus (Fig. 3) (Lekhanont et al, 2009;Lelievre et al, 2015;Bagga et al, 2018;Chatterjee & Agrawal, 2018;Agarwal et al, 2019;He et al, 2016;Thanathanee et al, 2013;Sharma et al, 2015;Agarwal et al, 2018). Radial keratoneuritis has been observed in some cases (Lekhanont et al, 2009;He et al, 2016).…”

Section: Ocular Pythiosismentioning

confidence: 99%

“…Potential risk factors for pythiosis include farming exposure, direct contact with a water resource (i.e., lake, river, lagoon, swamp, or even swimming pool), and a history of travel to endemic countries, such as Thailand (Krajaejun et al, 2006b;Lelievre et al, 2015;Hasika et al, 2019;Appavu, Prajna & Rajapandian, 2019). Inappropriate hygiene of contact lens can pose a risk (Lekhanont et al, 2009;Lelievre et al, 2015;Badenoch et al, 2001;Maeno et al, 2019;Bernheim et al, 2019;Tanhehco et al, 2011;Barequet, Lavinsky & Rosner, 2013;Neufeld et al, 2018;Raghavan et al, 2018), and exposure to dust or some foreign body in their eyes (Bagga et al, 2018;Hasika et al, 2019) predisposes individuals with no agricultural activity to this infection. The incidence of pythiosis follows a seasonal trend (Hasika et al, 2019;Thanathanee et al, 2013) with outbreaks of Pythium keratitis occurring during the rainy season in Thailand (Thanathanee et al, 2013) and around June to September during monsoon season in South India (Hasika et al, 2019).…”

Section: Environmental (Extrinsic) Factorsmentioning

confidence: 99%

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Recent update in diagnosis and treatment of human pythiosis

Chitasombat

Jongkhajornpong

Lekhanont

et al. 2020

PeerJ

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Human pythiosis is an infectious condition with high morbidity and mortality. The causative agent is the oomycete microorganism Pythium insidiosum. The pathogen inhabits ubiquitously in a wet environment, and direct exposure to the pathogen initiates the infection. Most patients with pythiosis require surgical removal of the affected organ, and many patients die from the disease. Awareness of pythiosis among healthcare personnel is increasing. In this review, we summarized and updated information on the diagnosis and treatment of human pythiosis. Vascular and ocular pythiosis are common clinical manifestations. Recognition of the typical clinical features of pythiosis is essential for early diagnosis. The definitive diagnosis of the disease requires laboratory testing, such as microbiological, serological, molecular, and proteomic assays. In vascular pythiosis, surgical intervention to achieve the organism-free margin of the affected tissue, in combination with the use of antifungal drugs and P. insidiosum immunotherapy, remains the recommended treatment. Ocular pythiosis is a serious condition and earliest therapeutic penetrating keratoplasty with wide surgical margin is the mainstay treatment. Thorough clinical assessment is essential in all patients to evaluate the treatment response and detect an early sign of the disease recurrence. In conclusion, early diagnosis and proper management are the keys to an optimal outcome of the patients with pythiosis.

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Section: Ocular Pythiosismentioning

confidence: 99%

Section: Environmental (Extrinsic) Factorsmentioning

confidence: 99%

Recent update in diagnosis and treatment of human pythiosis

Chitasombat

Jongkhajornpong

Lekhanont

et al. 2020

PeerJ

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Htun

Laikul

Pathomsakulwong

et al. 2020

Preprint

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Objectives: Pythium insidiosum causes a deadly condition, called pythiosis, in humans and other animals. The organism has been identified in tropical and subtropical environments worldwide. Since 1985, human pythiosis has been increasingly reported from Thailand. Seroprevalence studies estimated that ~32,000 Thai people have been exposed to the pathogen. In 2018, the first animal pythiosis case in Thailand was diagnosed in a horse. In this study, we surveyed anti-P. insidiosum antibodies in a sample of the Thai equine population. Results: Serum samples were available from 150 out of 6,353 registered horses distributed across Thailand. ELISA detected the anti-P. insidiosum antibodies in three horses. Immunochromatography and Western blot confirmed the presence of the antibodies in one of the ELISA-positive horses. Based on one positive out of 150 tested, the Pythium seroprevalence in the Thai equine population was 0.7%, which is 10 times higher than that of the Thai human population. The seroprevalence of the anti-P. insidiosum antibodies in a small sample of horses suggests a higher incidence of pythiosis in horses than in humans. Larger studies will be necessary to obtain the full picture of the epidemiology of animal pythiosis in Thailand.

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“…According to previous studies, patients without complete surgical resection or patients with persistently elevated post-surgical (1,3)-β-D-glucan (BG) have not survived longer than 3 months, despite treatment with antifungal agents and immunotherapy (Worasilchai et al, 2018). The potential activity of antibacterial agents such as azithromycin, clarithromycin, and doxycycline against Pythium insidiosum has been demonstrated in in vitro studies (Loreto et al, 2011;Jesus et al, 2014) and animal models (Loreto et al, 2019;Jesus et al, 2015a), and more recently, successful therapy in ocular pythiosis has been reported (Bagga et al, 2018). Therefore, oral bacterial agents, in conjunction with antifungal agents, were administered in two patients with relapsed vascular pythiosis.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive antibacterial agents as a salvage therapy in relapsed vascular pythiosis patients

Susaengrat

Torvorapanit

Plongla

et al. 2019

International Journal of Infectious Diseases

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Human vascular pythiosis is a life-threatening condition caused by Pythium insidiosum. Patients with unresectable intra-abdominal artery involvement have not previously survived, despite being treated with antifungal agents and immunotherapy. We report two novel cases of intra-abdominal pythiosis in patients for whom surgery could not be performed, who were successfully treated with adjunctive antibacterial agents.

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Leap forward in the treatment of Pythium insidiosum keratitis

Abstract: We report favourable but not statistically significant response of keratitis to antibacterial agents in a pilot series of patients. Further evaluation of this strategy in larger number of patients is recommended.

Cited by 66 publications

References 13 publications

Recent update in diagnosis and treatment of human pythiosis

Recent update in diagnosis and treatment of human pythiosis

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

Adjunctive antibacterial agents as a salvage therapy in relapsed vascular pythiosis patients

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