Recent update in diagnosis and treatment of human pythiosis

Abstract

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.

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

“…The striking difference in seroprevalences of the Thai (0.7%) and Brazilian (11.1%) horses could imply that Thai people, by comparison, might have a lower chance of having environmental exposure to P. insidiosum. However, the reported cases of human pythiosis from Thailand are much higher than those from Brazil [10,13,13,16,16,[37][38][39]. A host or pathogen factors might contribute to such a different prevalence of human pythiosis: Thalassemia is a common underlying condition in Thai patients with pythiosis [2,40]; Genotypes of the Thai P. insidiosum strains are different from that of the Brazilian strains [41,42].…”

“…The pathogen has been identi ed in water and soil samples from around the world [3][4][5][6][7]. Direct contact with P. insidiosum can initiate the deadly condition called pythiosis [1,2,[8][9][10]. Laboratory tests are required to make a de nitive diagnosis of pythiosis [1,[10][11][12].…”

“…Direct contact with P. insidiosum can initiate the deadly condition called pythiosis [1,2,[8][9][10]. Laboratory tests are required to make a de nitive diagnosis of pythiosis [1,[10][11][12]. Early and proper treatment may substantially improve the clinical outcomes for pythiosis patients [1,2,10].…”

“…Laboratory tests are required to make a de nitive diagnosis of pythiosis [1,[10][11][12]. Early and proper treatment may substantially improve the clinical outcomes for pythiosis patients [1,2,10].…”

“…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].…”