Lass-Flörl C, Mayr A, 2007. Human protothecosis. Clin Microbiol Rev 20: 230–242.
Huerre M, Ravisse P, Solomon H, Ave P, Briquelet N, Maurin S, Wuscher N, 1993. Human protothecosis and environment. Bull Soc Pathol Exot 86: 484–488.
De Montclos M, Chatte G, Perrin-Fayolle M, Flandrois JP, 1995. Olecranon bursitis due to Prototheca wickerhamii, an algal opportunistic pathogen. Eur J Clin Microbiol Infect Dis 14: 561–562.
Thiele D, Bergmann A, 2002. Protothecosis in human medicine. Int J Hyg Environ Health 204: 297–302.
Mayorga J, Barba-Gomez JF, Verduzco-Martinez AP, Munoz-Estrada VF, Welsh O, 2012. Protothecosis. Clin Dermatol 30: 432–436.
Todd JR, King JW, Oberle A, Matsumoto T, Odaka Y, Fowler M, Sanusi ID, 2012. Protothecosis: report of a case with 20-year follow-up, and review of previously published cases. Med Mycol 50: 673–689.
Żak I, Jagielski T, Kwiatkowski S, Bielecki J, 2012. Prototheca wickerhamii as a cause of neuroinfection in a child with congenital hydrocephalus. First case of human protothecosis in Poland. Diagn Microbiol Infect Dis 74: 186–189.
Torres HA, Bodey GP, Tarrand JJ, Kontoyiannis DP, 2003. Protothecosis in patients with cancer: case series and literature review. Clin Microbiol Infect 9: 786–792.
Carey WP, Kaykova Y, Bandres JC, Sidhu GS, Bräu N, 1997. Cutaneous protothecosis in a patient with AIDS and a severe functional neutrophil defect: successful therapy with amphotericin B. Clin Infect Dis 25: 1265–1266.
McMullan B, Pollett S, Biswas C, Packham D, 2016. Successful treatment of cutaneous protothecosis with liposomal amphotericin and oral itraconazole. Med Mycol Case Rep 12: 21–23.
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Human protothecosis is a rare algal infection caused by Prototheca; it is a ubiquitous achlorophyllic alga, which rarely causes human disease. Currently, the pathogenesis remains unclear and no treatment options have been elucidated. We present a case of olecranon bursitis caused by Prototheca wickerhamii in an immunocompromised patient. A 45-year-old man presented with left elbow pain after scraping his elbow on a tree. He reported significant pain and swelling of the elbow after injury, which resolved without intervention. He was diagnosed with HIV/AIDS infection and started on antiretroviral therapy. Afterward, he experienced recurrent elbow swelling and pain; an incision and drainage was performed and cultures demonstrated P. wickerhamii. Unsuccessful treatment with oral voriconazole led to an attempt at therapy with parental amphotericin and oral doxycycline; however the patient left against medical advice. He presented to our facility and both parental amphotericin and doxycycline were initiated with planned outpatient bursectomy. He clinically improved on that regimen but left against medical advice before completing his recommended course of IV amphotericin and oral doxycycline. Patients diagnosed with disseminated protothecosis can have a mortality rate upward of 67%. Given the rarity of this pathogen, no official treatment guidelines exist and there are few studies analyzing the antimicrobial susceptibility of Prototheca. Management is challenging because of slow-growing nature of the algae, paucity of research studies, and limited susceptibility of this pathogen. This case adds to the limited body of literature by demonstrating the clinical presentation of protothecosis and highlighting the pathology and current treatment options.
Authors’ addresses: Kruti Yagnik and Raphaël Bossé, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, E-mails: kruti.yagnik@medicine.ufl.edu and raphael.bosse@medicine.ufl.edu. Jennifer Reppucci, Department of Pathology, University of Florida College of Medicine, Gainesville, FL, E-mail: jreppucci@ufl.edu. Rachel Butts, University of Florida College of Medicine, Gainesville, FL, E-mail: rachelmbutts@ufl.edu. Shehla Islam, Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, E-mail: shehla.islam@medicine.ufl.edu. Anthony P. Cannella, Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, and Medicine-Infectious Diseases, University of Florida Emerging Pathogens Institute, Gainesville, FL, E-mail: anthony.cannella@medicine.ufl.edu.
Lass-Flörl C, Mayr A, 2007. Human protothecosis. Clin Microbiol Rev 20: 230–242.
Huerre M, Ravisse P, Solomon H, Ave P, Briquelet N, Maurin S, Wuscher N, 1993. Human protothecosis and environment. Bull Soc Pathol Exot 86: 484–488.
De Montclos M, Chatte G, Perrin-Fayolle M, Flandrois JP, 1995. Olecranon bursitis due to Prototheca wickerhamii, an algal opportunistic pathogen. Eur J Clin Microbiol Infect Dis 14: 561–562.
Thiele D, Bergmann A, 2002. Protothecosis in human medicine. Int J Hyg Environ Health 204: 297–302.
Mayorga J, Barba-Gomez JF, Verduzco-Martinez AP, Munoz-Estrada VF, Welsh O, 2012. Protothecosis. Clin Dermatol 30: 432–436.
Todd JR, King JW, Oberle A, Matsumoto T, Odaka Y, Fowler M, Sanusi ID, 2012. Protothecosis: report of a case with 20-year follow-up, and review of previously published cases. Med Mycol 50: 673–689.
Żak I, Jagielski T, Kwiatkowski S, Bielecki J, 2012. Prototheca wickerhamii as a cause of neuroinfection in a child with congenital hydrocephalus. First case of human protothecosis in Poland. Diagn Microbiol Infect Dis 74: 186–189.
Torres HA, Bodey GP, Tarrand JJ, Kontoyiannis DP, 2003. Protothecosis in patients with cancer: case series and literature review. Clin Microbiol Infect 9: 786–792.
Carey WP, Kaykova Y, Bandres JC, Sidhu GS, Bräu N, 1997. Cutaneous protothecosis in a patient with AIDS and a severe functional neutrophil defect: successful therapy with amphotericin B. Clin Infect Dis 25: 1265–1266.
McMullan B, Pollett S, Biswas C, Packham D, 2016. Successful treatment of cutaneous protothecosis with liposomal amphotericin and oral itraconazole. Med Mycol Case Rep 12: 21–23.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 840 | 649 | 129 |
| Full Text Views | 1299 | 13 | 0 |
| PDF Downloads | 649 | 7 | 0 |
