Cutaneous protothecosis: A case report

Introduction@#Cutaneous protothecosis usually presents as pyoderma-like lesions or infiltrating papules and plaques on the extensor side of the extremities. It can be misdiagnosed as eczema, pyoderma, or a fungal infection. Although it has been isolated from a swimming pool, sewers and rivers in the Philippines, there has been no reported case of cutaneous protothecosis in the country.@*Case summary@#A 78-year-old Taiwanese male farmer visited the dermatology clinic due to a six-month history of a large, pruritic erythematous plaque studded with papulopustules on his left forearm. A potassium hydroxide (KOH) examination showed negative for hyphae or spores. And a skin biopsy showed morula-like bodies, which were highlighted by the Periodic acid-Schiff stain.@*Conclusion@#We report a case of cutaneous protothecosis from Taiwan so Filipino dermatologists will be aware of the clinical and histopathologic manifestations and management of cutaneous protothecosis.

Successful Treatment of Protothecal Tenosynovitis in an Immunocompetent Patient using Amphotericin B Deoxycholate / 감염과화학요법

Protothecosis is an uncommon human infection caused by achlorophyllic algae of the genus Prototheca, especially P. wickerhamii. The skin is the most frequently involved organ and cases of protothecal tenosynovitis are very rare. A 71-year-old woman without prior medical history except hypertension presented with painful swelling of her right hand that did not improve despite receiving antibiotic treatment. She underwent tenosynovectomy and drainage. Histopathologic examination revealed necrotizing granulomatous inflammation and numerous spherical or morula-like organisms with a spoked wheel appearance. P. wickerhamii was identified from tissue culture. The lesion did not improve with empirical fluconazole therapy. Conventional amphotericin B was administered according to antifungal susceptibility tests and the lesion completely resolved. Protothecosis should be considered in the differential diagnosis for chronic tenosynovitis that does not respond to conventional antibacterial treatment; tissue biopsy with culture is required for diagnosis.

A Case of Protothecosis on Scalp and Face in the Immunocompetent Patient / 대한의진균학회지

Protothecosis is an unusual human infection, caused by the genus prototheca, especially Prototheca wickerhamii. A 80-year-old immunocompetent man presented with a 1-month history of multiple reddish brown lobulated plaques on the scalp and face. He denied any history of trauma and had no evidence of underlying diseases such as diabetes mellitus or malignancy. On histopathological examination, characteristic morula-like sporangia in the dermis was revealed. After treatment with oral itraconazole for 8 weeks, the patient's skin lesions are almost healed.

Onychoprotothecosis: An uncommon presentation of protothecosis.

Onychomycosis is a fairly common condition seen in a dermatology clinic. Dermatophytes Trichophyton and Epidermophyton are the known filamentous fungi implicated. The yeast‑like fungi such as Candida less commonly cause Onychomycosis. The genus Prototheca may on preliminary observation resemble yeast‑like fungi but a detailed microscopy will reveal the absence of budding and presence of endospores. Onychoprotothecosis is an uncommon presentation of human protothecosis. Of the two Prototheca species (Prototheca zopfii and Prototheca wickerhamii) known to cause the disease, P. wickerhamii has been reported more commonly. We report a culture proven case of this condition caused by P. zopfii. The patient, a 55‑year‑old housewife presented with discolouration and breaking off of the right thumb and forefinger nails since a period of six months. Samples of nail scrapping sent to the Microbiology Laboratory were culture‑positive for Prototheca. Speciation by the automated Vitek‑2 system (bioMerieux) identified the isolate as P. zopfii, which was further confirmed at PGI, Chandigarh.

A Case of Cutaneous Protothecosis / 대한의진균학회지

Protothecosis is a rare skin infection caused by pathogenic algae of the genus Prototheca, especially Prototheca wickerhamii. It is widely distributed throughout the natural world in tree, river, lake, sewage, soil, marsh, household waste, etc. A 79-year-old woman presented with ill-defined edematous and erythematous patches with various sized and shaped deep ulcers on both dorsal hands and left distal forearm for 1 month. The left forearm was initially injured by scratching due to pruritus and insidiously aggravated. Biopsy specimen revealed the characteristic morula-like sporangias containing multiple endospores in the dermis. The GMS and D-PAS stains highlighted the characteristic spores showing multiple internal septations and some unicellular endospore. P. wickerhamii was isolated in culture and identified by biochemical studies. Oral itraconazole 200 mg/day administration for 7 weeks resulted in marked improvement of the skin lesion.

Human Cutaneous Protothecosis: Report of a Case and Literature Review

The Prototheca species is achlorophyllic algae and rarely causes human infection. Human protothecosis presents clinically as a cutaneous infection, olecranon bursitis, and disseminated systemic disease. We report a case of human cutaneous protothecosis involving the left wrist. A 68-year-old man presented with an ill-defined erythematous lesion with crust at the dorsal aspect of his left wrist. A punch biopsy was performed to reveal the histologic features of granulomatous inflammation with necrosis at the upper dermis, containing Prototheca organisms, of which, the characteristic features were highlighted by special staining. Through a molecular study, the Prototheca zopfii species was identified.

Disseminated protothecosis.

Here is presented, a rare case of disseminated protothecosis in a 10-year-old boy with combined immunodeficiency, hitherto unreported from India. Even though it is difficult to diagnose clinically,observation of the sporangiospores within the sporangium in culture gives the accurate laboratory identification of Prototheca spp. In this patient, failure to eradicate the infection with amphotericin B and recurrence with olecranon bursitis along with skin lesions and splenomegaly was observed. Disseminated protothecosis in a child with combined immunodeficiency and failure to eradicate the infection with amphotericin B is reported.

Prototecose: uma doença emergente / Protothecosis: an emergent disease

Prototecose, causada por Prototheca zopfii ou P. wickerhamii, é uma doença emergente em animais e humanos. Em bovinos, P. zopfii é uma importante causa de mastite ambiental. Em cães e gatos, a prototecose é causada principalmente por P. zopfii. Em cães, causa infecção cutânea ou uma forma sistêmica envolvendo diversos órgãos. Em gatos, predominam as lesões tegumentares na região da face e plano nasal. No homem, a prototecose, causada principalmente por P. wickerhamii, manifesta-se sob três formas: cutânea, articular com bursite do olécrano e sistêmica. Pode ocorrer em indivíduos imunocompetentes, os quais podem apresentar bursite e/ou infecções cutâneas localizadas, ou em indivíduos imunossuprimidos, nos quais a enfermidade pode ser disseminada e/ou com envolvimento visceral. A prototecose causada por P. wickerhamii foi descrita recentemente em caprinos como causa de rinite afetando o vestíbulo nasal, união mucocutânea, pele da face e orelha. Nesta revisão são abordadas as características microbiologias e susceptibilidade a antimicrobianos do agente, e a epidemiologia, sinais clínicos, patologia, diagnóstico, tratamento e controle da prototecose em animais domésticos e no homem.

Protothecosis, caused by Prototheca zopfii or P. wickerhamii, is an emergent disease of human and animals. In cattle, P. zopfii is an important cause of environmental mastitis. In dogs and cats protothecosis is caused mainly by P. zopfii, causing cutaneous infections or a systemic form affecting many organs in dogs, and cutaneous infection affecting mainly the skin of the face and nose in cats. In humans, protothecosis, caused mainly by P. wickerhamii, occurs in three forms: cutaneous; olecran bursitis; and disseminated. The lesion is usually localized in the site of inoculation in immunocompetent individuals; however, in immunocompromised patients, it can become widespread. Protothecosis caused by P. wickerhamii was recently reported in goats causing rhinitis and dermatitis of the face and pinna. This paper reviews microbiologic characteristics and susceptibility to antimicrobials of Prototheca spp., and the epidemiology, clinical signs, pathology, diagnosis, treatment and control of protothecosis.

Prototecose em animais de companhia e aspectos da doença no homem / Protothecosis in companion animals and aspects of the disease in human

Foram revisados dados de etiologia, epidemiologia, patogenia, sinais clínicos, procedimentos diagnósticos, conduta terapêutica e ações de controle e profilaxia da prototecose em cães e gatos, além de aspectos da doença no homem e em bovinos.

Etiology, epidemiology, pathogeny, clinical signs, diagnosis, therapeutic, control and preventive measures in protothecosis in dogs and cats were reviewed, besides aspects of disease in human and bovines.

Prototecose cutânea: relato de caso / Cutaneous protothecosis: case report

Descreve-se um caso de prototecose cutânea em paciente de 78 anos, submetido a tratamento para pênfigo foliáceo e feohifomicose. Ele apresentava lesões eritematosas infiltradas na perna direita e o diagnóstico foi feito através de estudo histológico e através de cultura da pele lesada. A cura foi obtida com o uso oral de itraconazol.

A case of cutaneous protothecosis was reported in a 78-year-old man that was in treatment for pemphigus foliaceus and phaeohyphomycosis. He presented erythematous lesions which were infiltrated into his right leg. The diagnosis was made histopathologically and confirmed by culture, and the patient was successfully treated with itraconazole.

A Case of Cutaneous Protothecosis / 대한의진균학회지

Cutaneous protothecosis is a rare skin infection, caused by the genus prototheca, especially Prototheca wickerhamii. A 73-year-old woman had a painful, ulcerative patch and oozing plaque on left wrist and dorsum of hand for 2 months. Biopsy specimen revealed thick walled morula-like sporangia in the dermis. P. wickerhamii was isolated in the culture. Oral itraconazole therapy for 8 weeks is not satisfactory. New skin lesion is formed. After oral fluconazole therapy, patient's skin lesion is improved.

A Case of Cutaneous Protothecosis / 대한피부과학회지

Protothecosis is an unusual human infection caused by the achlorophyllic algae Prototheca, and most commonly by Prototheca wickerhamii. A 65-year-old man presented with a 2-month history of a painful, erythematous, non-healing, ulcerative plaque on the extensor surface of his left forearm. He was previously diagnosed with diabetes and iatrogenic Cushing syndrome. A skin biopsy specimen revealed characteristic morula-like sporangia in the dermis by PAS positive staining. Prototheca wickerhamii was identified by culture and biochemical studies. Initially, itraconazole was administered for 8 weeks, followed by fluconazole, and the patient's condition was greatly improved.

A Case of Cutaneous Prototheocsis / 대한의진균학회지

Protothecosis is an infection caused by achloric algae of the genus Prototheca. It is found ubiquitously in nature, particularly in the slime flux of trees and sewage. Only two species including Prototheca wickerhamii and Prototheca zopfii have been known to be pathogenic in humans. A 64-year-old man presented intermittent pruritic erythematous confluent grouped papules and nodules on the left upper arm. Histopathologic study revealed some sporangia of morula-like appearance and chronic granulomatous inflammation. The PAS stain demonstrated the characteristic spores showing multiple internal septations and some unicellular endospore. P. wickerhamii was isolated from culture and identified by the biochemical studies. Oral itraconazole 200 mg/day administration resulted in marked regression of the skin lesion after 8 weeks.

A Case of Cutaneous Protothecosis / 대한피부과학회지

Protothecosis is an unusual cutaneous soft tissue infection caused by the Prototheca, which is a genus of the unicelluar, achloric algae. We report a case of cutaneous protothecosis in a 66-year-old female, who showed erythematous, purulent patches and plaques with ulcerations on the right forearm for 2 months. Biopsy specimen revealed the characteristic thick-walled morulalike sporangia in the dermis. Prototheca wickerhamii was isolated in the culture and the biochemical study. Electron microscopic examination showed the thick-walled spores containing dark dense bodies and amyloplasts. After two months of oral itraconazole 200mg/day, skin lesions were improved.

Two Cases of Cutaneous Protothecosis : Unique Histopathological Findings with Crystal Violet Staining and the Therapeutic Effect of Itraconazole

Cutaneous protothecosis sometimes poses diagnostic and therapeutic problems. Isolation of the causative organism may not be successful and spores may be mistaken for other skin diseases unless the characteristic sporangia are detected in tissue sections. Because there are few cases, the optimal therapy is still being debated. On Liebs crystal violet staining we found charateristic purplish dots in Prototheca spores; these correspond to the amyloplasts or dense bodies found under electron microscopy. The isolated organisms were inhibited in vitro by itraconazole, amphotericin B, ketoconazole, and amorolfine and we were able to successfully treat two patients with itraconazole.

A Case of Cutaneous Protothecosis

Protothecosis is a rare cutaneous soft tissue infection caused by the genus prototheca, most commonly Prototheca wickerhatmii. An 80-year-old woman has had a painful or tender, non-healing, eczematous plaque on the extensor surface of the left forearm for 4 years. A biopsy specimen revealed the characteristic thick-walled morulalike sporangia in the dermis. P. wickerha mili was isolated in the culture and the biochemical studies. Electron microscopic examination showed the thick-walled spores containing dark dense bodies and amyloplasts. Oral itraconazole therapy for 4 weeks resulted-in a marked improvement of the skin lesion.