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Cutaneous protothecosis: report of five cases
S-C Chao1, M M-L Hsu, J Y-Y Lee
1Department of Dermatology, National Cheng-Kung University Hospital, 138 Sheng-Li Road, Tainan 704, Taiwan.
The British Journal of Dermatology
|April 23, 2002
Summary
Prototheca wickerhamii, a rare cause of opportunistic infection, often presents as skin lesions in immunocompromised individuals. Antifungal treatments like amphotericin B are effective for cutaneous protothecosis.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Dermatology
Background:
- Prototheca, an achlorophyllic alga, is an uncommon opportunistic pathogen.
- Human infections, predominantly cutaneous, are rare, with Prototheca wickerhamii being the most frequent cause.
- Approximately 80 cases have been reported globally.
Observation:
- This study details five cases of cutaneous protothecosis diagnosed between 1991 and 1997.
- Patients were typically elderly farmers, immunocompromised, often due to steroid use.
- Clinical presentation included pyoderma-like lesions or infiltrating papules/plaques on extremities and face.
Findings:
- Diagnosis was confirmed via skin biopsy, revealing characteristic endospores with morula-like structures.
- Prototheca wickerhamii was isolated in four cases with pretreatment cultures.
- Successful treatment was achieved with various antifungal agents, including amphotericin B, ketoconazole, itraconazole, and fluconazole, within 2-7 weeks.
Implications:
- Cutaneous protothecosis should be considered in the differential diagnosis of deep fungal or mycobacterial infections, especially in immunocompromised patients presenting with non-tender skin lesions.
- The higher incidence in the study region may be linked to steroid abuse and the elderly farmer population.
- This highlights the importance of considering environmental and host factors in rare opportunistic infections.