Successful treatment of a child with vascular pythiosis

Area of Science:

• Infectious Diseases
• Vascular Surgery
• Pediatrics

Background:

• Human pythiosis, caused by Pythium insidiosum, is an emerging and severe infection prevalent in tropical and subtropical regions.
• This case report focuses on the first documented pediatric instance of vascular pythiosis, a condition rarely seen in children.
• The patient, a 10-year-old boy with beta-thalassemia, presented with symptoms indicative of severe vascular compromise in the leg.

Observation:

• The patient exhibited non-responsive gangrenous ulcers and claudication, alongside evidence of chronic arterial occlusion in the right distal external iliac artery.
• Diagnostic tests confirmed Pythium insidiosum infection in resected arterial tissue and detected specific antibodies in the patient's serum.
• Initial treatment involved high-above-knee amputation to manage the extensive infection and prevent further spread.

Findings:

• Pythium insidiosum was definitively identified as the causative agent through fungal culture and nucleic acid sequencing of the affected iliac artery.
• The patient received a combination of immunotherapeutic vaccine and antifungal agents post-surgery.
• Successful management led to the patient's discharge after two months, with no recurrence of symptoms for two years.

Implications:

• This case highlights the critical need for increased awareness of vascular pythiosis among pediatricians to ensure timely diagnosis and intervention.
• Prompt surgical intervention combined with appropriate medical and immunotherapeutic treatments is crucial for favorable prognoses in pediatric vascular pythiosis.
• The findings underscore the importance of considering rare infections like pythiosis in pediatric patients presenting with severe vascular complications, even in the absence of typical risk factors.