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Protothecosis complicating prolonged endotracheal intubation: case report and literature review
V R Iacoviello1, P C DeGirolami, J Lucarini
1Division of Infectious Diseases, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts 02215.
Abstract:
Prototheca species are ubiquitous, aerobic, unicellular algae closely related to the green algae Chlorella. Their involvement in human disease--in both immunocompetent and immunocompromised patients--has been reported with increasing frequency. The wide array of presentations has included cutaneous, subcutaneous, mucosal, bursal, catheter-related, and (in rare instances) systemic disease. We report a case of protothecosis complicating prolonged endotracheal intubation presenting as a nasopharyngeal ulceration with a soft-tissue mass, and we review the presentation, treatment, and outcome of the 59 previously reported cases of protothecosis. Optimal therapy for protothecosis includes excision (where possible) followed by systemic administration of amphotericin B; the sole exception is in the case of olecranon bursitis, where excision alone appears curative. The role of the newer imidazoles is yet to be determined.
Insights
Prototheca algae can cause various human infections, even in healthy individuals. Treatment involves surgical removal and amphotericin B, but further research is needed for imidazoles.
Area of Science:
- Microbiology
- Mycology
- Infectious Diseases
Background:
- Prototheca species are ubiquitous, unicellular algae related to Chlorella.
- These algae are increasingly recognized as agents of human disease in both immunocompetent and immunocompromised individuals.
Observation:
- A case of protothecosis is presented, complicating prolonged endotracheal intubation and manifesting as a nasopharyngeal ulceration with a soft-tissue mass.
- A review of 59 previously reported cases of protothecosis is included, detailing presentation, treatment, and outcomes.
Findings:
- Protothecosis presents with a wide array of clinical manifestations, including cutaneous, subcutaneous, mucosal, bursal, catheter-related, and systemic infections.
- Optimal treatment for most protothecal infections involves surgical excision combined with systemic amphotericin B administration.
Implications:
- Surgical excision alone may be curative for olecranon bursitis caused by Prototheca.
- The efficacy of newer imidazole antifungal agents for treating protothecosis requires further investigation.