Treatment Options
| Medical treatment | Surgical procedures |
| Azoles: ketoconazole, itraconazole, fluc ... | Surgical procedures of localizated lesio ... |
| Amphotericin B | |
| Amphotericin B + tetracycline |
Which medications are used in the treatment of protothecosis?
No prospective clinical studies have been published comparing specific treatments for protothecosis. Antifungals such as ketoconazole, itraconazole, fluconazole, conventional amphotericin B, and liposomal amphotericin B are the most commonly used drugs to date.
What is the course of protothecosis?
The course of protothecosis is one of a chronic, low-grade inflammation that may be indolent. There is one case described of an immunocompromised host who developed disseminated cutaneous protothecosis with pulmonary involvement. Treatment options are summarized in Table I.
What are the treatment options for cutaneous protothecosis in AIDS?
Cutaneous protothecosis in a patient with AIDS and a severe functional neutrophil defect: successful therapy with amphotericin B. Clin. Infect. Dis.25:1265-1266.
What is the prognosis of protothecosis?
Protothecosis carries a grave prognosis in the canine patient. Stenner et al (10) identified only 2 cases of canine protothecosis that survived the infection out of 31 cases reviewed. In contrast, the same review found only 2 human cases in which death was attributable to protothecosis.
How do you get Protothecosis?
EPIDEMIOLOGY. Hospital-acquired cases of protothecosis have been reported in association with surgery and orthopedic procedures (53, 54, 94, 100, 139, 150). Infection may also occur by penetration of the agent when a skin injury comes in contact with contaminated water (45, 59, 161).
How do you treat Prototheca in dogs?
However, treatment is more difficult in dogs because P. zopfii is the most common species. Amphotericin B has been successful in slowing progression of the disease, but it is not curative. One dog with cutaneous and systemic infection survived nearly 1 year after treatment with amphotericin B alone.
Can algae infect humans?
Infection by unicellular green algae has not been described in humans. A case is reported in a 30-year-old woman who developed persistent infection of a healing operative wound on the dorsum of the right foot, after possible contamination by river water while canoeing.
What causes Pythiosis in dogs?
Pythiosis is the result of being infected by a water mold-like organism called Pythium insidiosum that is most commonly found in water, although it can also be present in soil. This organism can affect the gastrointestinal tract or the skin.
What are the symptoms of algae?
Exposure to high levels of blue-green algae and their toxins can cause diarrhea, nausea or vomiting; skin, eye or throat irritation; and allergic reactions or breathing difficulties.
Can algae grow in your body?
Fast Facts: Scientists have discovered that some healthy people carry in their throats a green algae virus previously thought to be non-infectious to humans.
What diseases are caused by algae?
Types of illness that can be caused by eating seafood contaminated with toxins from harmful algae:Ciguatera Fish Poisoning (CFP)Neurotoxic Shellfish Poisoning (NSP)Paralytic Shellfish Poisoning (PSP)Domoic Acid Poisoning and Amnesiac Shellfish Poisoning (ASP)Diarrheic Shellfish Poisoning (DSP)More items...
What is the photomicrograph of Prototheca Wickerhamii?
Electron photomicrograph of Prototheca wickerhamii shows a central rounded endospore surrounded by a corona of molded endospores.
Can protothecosis be eradicated?
Protothecosis can be difficult to eradicate. Reports describe successful treatment of localized disease with ketoconazole, itraconazole, and fluconazole. [ 20] Voriconazole is also effective. [ 21] Surgical removal of isolated lesions in combination with antifungal therapy (eg, with azoles) is effective in immunocompetent individuals. Also reported is dual use of local thermal application as an adjunct to azole therapy. [ 22] An increasing number of reports indicate that itraconazole 200 mg/day for 2 months can be helpful in some adults. [ 23]
How to diagnose protothecosis in dogs?
Dogs with acute blindness and diarrhea that develop exudative retinal detachment should be assessed for protothecosis. Diagnosis is through culture or finding the organism in a biopsy, cerebrospinal fluid, vitreous humour, or urine. Treatment of the disseminated form in dogs is very difficult, although use of antifungal medication has been successful in a few cases. Prognosis for cutaneous protothecosis is guarded and depends on the surgical options. Prognosis for the disseminated form is grave. This may be due to delayed recognition and treatment.
Where is prototheca found?
Prototheca is found worldwide in sewage and soil. Infection is rare despite high exposure, and can be related to a defective immune system. In dogs, females and Collies are most commonly affected. The first human case was identified in 1964 in Sierra Leone.
What stain is used for Prototheca Wickerhamii?
Photomicrograph of Prototheca wickerhamii infection in a human. Note the floret-like arrangements. Periodic acid-Schiff (PAS) stain.
Can protothecosis cause diarrhea in dogs?
Disseminated protothecosis is most commonly seen in dogs. The algae enters the body through the mouth or nose and causes infection in the intestines. From there it can spread to the eye, brain, and kidneys. Symptoms can include diarrhea, weight loss, weakness, inflammation of the eye ( uveitis ), retinal detachment, ataxia, and seizures.
Is Helicosporidium a parasite?
It and its close relative Helicosporidium are unusual in that they are actually green algae that have become parasites. The two most common species are Prototheca wickerhamii and Prototheca zopfii. Both are known to cause disease in dogs, while most human cases are caused by P. wickerhami.
What is protothecosis in humans?
Human protothecosis is a rare infection caused by members of the genus Prototheca. Prototheca species are considered to be achlorophyllic algae and are ubiquitous in nature. 1016 The disease has been reported worldwide. Trauma and inoculation with contaminated water is the most common mechanism of infection in humans. 1017 The clinical manifestations have been classified into three types: cutaneous lesions, olecranon bursitis, and disseminated or systemic disease. 1018 Infections can occur in both immunocompetent and immunosuppressed patients, although more severe and disseminated infections tend to occur in the immunocompromised. 1016 The great majority of patients with protothecosis are older than 30 years of age or elderly, although cases have also been reported in children and neonates. 1019-1021
How old is protothecosis?
The great majority of patients who develop protothecosis are immunocompromised and older than 30 years of age, although cases have also been reported in children650 and neonates. 651 The clinical manifestations have been classified into three types: (1) cutaneous lesions, (2) olecranon bursitis, and (3) disseminated or systemic disease. 647,648
What is fibrovascular proliferation?
However, fibrovascular proliferation is part of the inflammatory and healing responses, and many of the forms of uveitis commonly diagnosed by clinicians reflect vascular-mediated processes rather than leukocytic infiltration. Fibrovascular membranes may be present with leukocytic uveitis but also with neoplasms, trauma, and tissue damage associated with hypoxia such as retinal detachment and glaucoma. In fact, fibrovascular membranes are present in approximately 75% of all enucleated canine globes and in 20% to 30% of the enucleated globes in other species. Fibrovascular membranes develop when the balance of angiogenic and antiangiogenic factors favors neovascularization. Of the many cytokines that contribute to fibrovascular proliferation, vascular endothelial growth factor (VEGF) is the most significant. Fibrovascular membranes include newly formed vessels, spindle cells compatible with fibroblasts and myofibroblasts, and collagenous extracellular matrix. The contribution of each component to fibrovascular membranes depends in part on cause and chronicity. Fibrovascular membranes are often described by their distribution: retrocorneal, preiridal, posterior iridal, cyclitic, and intravitreal. Retrocorneal membranes line the posterior aspect of the cornea, often effacing the corneal endothelium. Preiridal membranes are the most common form of fibrovascular proliferation in the eye ( Fig. 21-15; E-Figs. 21-14 and 21-15 ). These fibrovascular membranes line the anterior aspect of the iris. The membranes arise from budding and migration of capillaries from the iris stroma ( Fig. 21-16) and recruitment of fibroblasts and myofibroblasts, similar to a healing response in other organs. Contraction of preiridal fibrovascular membranes can cause distortion of the iris, most often retraction of the pupillary margin of the iris, either anteriorly (ectropion uveae) or posteriorly (entropion uveae). Preiridal fibrovascular membranes may be continuous with retrocorneal membranes or extend posteriorly. Posterior iridal membranes cover the posterior iris epithelium and may extend to cover the ciliary body. Cyclitic membranes extend from the ciliary epithelium along the anterior vitreous face and may extend to carpet the posterior lens capsule. Intravitreal membranes typically originate from the pars plana ciliary body. Such membranes may be the cause of vitreal hemorrhage but may also be part of the response to chronic intravitreal hemorrhage. Retinal and epiretinal membranes seen in some human conditions are rare in domestic animals.
What is prototheca algae?
Prototheca are unicellular algae that lack chlorophyll and reproduce by endosporulation. Although not fungi, these organisms are described in this chapter because they are often preliminarily misidentified in tissue and culture as yeasts. Prototheca are found in a wide range of environmental sites, including tree slime, sewage, fresh and marine water, soil, and foodstuffs. They may colonize human skin, the respiratory tract, and the gastrointestinal tract. 194 A little more than 100 cases of human infection have been reported, 194,195 almost all in adults and from widely scattered geographic areas. Prototheca wickerhamii is the most common cause of infection in humans; infection secondary to Prototheca zopfii has also been reported.
How much less nephrotoxic is ABLC?
The improved therapeutic index of ABLC has been demonstrated in numerous animal studies. In dogs receiving multiple doses, ABLC was determined to be 8–10 times less nephrotoxic than conventional amphotericin B. This decreased nephrotoxicity can be attributed to several factors.
What is the best treatment for protothecosis of the olecranon bursa?
Simple bursectomy cures protothecosis of the olecranon bursa. The cutaneous lesions in immunosuppressed patients resist treatment and may persist for several years, eventually spreading to other sites [2]. Topical treatments, including Castellani's paint, saturated copper sulfate, potassium permanganate and amphotericin B, as well as systemic griseofulvin, penicillin, emetine hydrochloride, 5-fluorouricil, and pentamidine isothionate, have not been effective. In vitro studies have demonstrated sensitivity to amphotericin B, tetracycline, gentamicin, and ketoconazole [2]. Combined therapy with tetracycline and amphotericin B may be effective. Isolated cutaneous, bursal and soft tissue lesions are best treated with local excision and ketoconazole. Infections that are multifocal, visceral or occur in immunocompromised hosts require amphotericin-B or combined therapy.
What is the use of amphotericin B?
The use of novel delivery systems has been effective in reducing toxicity and improving organ-specific delivery of many drugs , including amphotericin B. The development of liposomal-encapsulated and lipid-complexed preparations of amphotericin B has reduced its nephrotoxicity and increased its uptake by specific tissue sites. There are currently three novel formulations of amphotericin B marketed for clinical use in human patients: amphotericin B lipid complex (Abelcet®), amphotericin B colloidal dispersion (Amphotec®) and liposome-encapsulated amphotericin B (AmBisome®). These formulations offer an improved therapeutic index, in part because they increase the drug's uptake by tissues such as the liver and lungs, preventing its accumulation in the kidneys. Of the three formulations, amphotericin B lipid complex (Abelcet®) has been the most extensively evaluated in small animals.
Protothecosis in dogs Causes
This pathology is caused by Prototheca, colorless algae, since it does not contain chlorophyll that can be found in the environment: in the soil, in decomposing vegetation, and in water contaminated by the feces of an already infected animal.
Protothecosis in dogs Symptoms
Symptoms vary according to the form of protothecosis that affects the dog, even if the systemic form is more common in our furry friend compared to the cutaneous form, which is more present in cats.
Protothecosis in dogs Treatment
Once diagnosed with protothecosis in dogs, the veterinarian will recommend the appropriate treatment. Although there is no real cure for this pathology.
