Protothecosis after liver transplantation

Abstract

Prototheca species are unicellular algae of low virulence that are rarely associated with human infections. We report a liver transplant recipient with disseminated protothecosis and review the literature on this unusual opportunistic infection in transplant recipients. Of 9 cases, including ours, 5 had a localized infection, and 4 had disseminated protothecosis. Seven cases were due to Prototheca wickerhamii, and 2 were due to Prototheca zopfii. Overall mortality in transplant recipients with Prototheca infections was 88% (7/8). All 4 cases of disseminated protothecosis died despite therapy with amphotericin B. Posttransplant protothecosis is a rare but significant infection that is associated with a grave prognosis.

<i>Prototheca</i> Algaemia: a Rare but Fatal Opportunistic Infection among Immunocompromised Individuals

“…CVC tip cultures were performed in 3 cases (12,16,22) and 1 of our cases (Case 15), and all were negative for Prototheca spp. Thus, the possibility of catheter-related algaemia was low.…”

“…were isolated wounds or (12,18,19) were commonly observed. In addition, 3 cases experienced cytomegalovirus viremia (16,19,21). To identify the possible sources of infection, we observed various skin lesions in 9 cases.…”

Fatal Algaemia in Patient with Chronic Lymphocytic Leukemia

“…Although such infections are infrequent, they can manifest themselves clinically as cutaneous lesions, olecranon bursitis, and, even more rarely, as disseminated or systemic infections ( 1 ). These infections occur in severely immunocompromised patients, such as persons with AIDS, or patients undergoing extensive treatment, such as cancer treatment or organ transplantation ( 1 – 4 ). We describe a fatal case of P. wickerhamii algaemia in a patient with chronic lymphocytic leukemia.…”

“…Some authors have described a successful treatment on localized protothecosis with voriconazole ( 6 ). Amphotericin B currently seems to be most effective agent, although the best treatment remains a matter of debate ( 1 , 4 , 7 ). Although in vitro susceptibility test results are not necessarily well correlated with results obtained in vivo, the low MIC of posaconazole reported here may be of interest in clinical practice ( 8 ).…”

“…This association is probably the result of disseminated protothecosis in severely immunocompromised patients, and the alga may cross digestive or cutaneous barriers. Reasons for septic shock or death are unclear for most associations of pathogens ( 2 , 4 ). Prototheca spp.…”