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Subcutaneous pythiosis in human treated successfully with antimicrobial treatment, debridement and immunotherapy
Moni Roy1, Joel Borden2, Douglas J Kasper3
1Department of Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA moniroy27@gmail.com.
Abstract:
Pythiosis is caused due to a filamentous eukaryotic micro-organism called Pythium insidiosum and the disease occurs commonly in horses and cattle. Subcutaneous pythiosis infection in humans is rare with no clear clinical guidelines for treatment. We present a case of a man in his 20s with non-resolving ulcers noted over lower extremity after exposure to swamp water draining animal remains. The patient received several courses of oral antibiotics with no improvement in symptoms before getting admitted to our institution. A diagnosis of subcutaneous pythiosis was made after deep wound culture following debridement detected P. insidiosum by use of PCR. Due to the rare incidence of such infection in humans and no clear guidelines available for treatment, the case was discussed with infectious disease specialists outside our institution and with veterinary physicians. An emergent approval for use of immunotherapy in conjunction with surgical debridement and antimicrobials was obtained from Food and Drug administration. The patient underwent successful treatment of infection and skin graft following treatment.
Insights
Subcutaneous pythiosis, a rare human infection caused by Pythium insidiosum, requires novel treatment approaches. This case highlights successful immunotherapy combined with surgery and antimicrobials for a lower extremity infection.
Area of Science:
- Medical Mycology
- Infectious Diseases
Background:
- Pythiosis is a rare infection caused by the oomycete Pythium insidiosum, primarily affecting animals.
- Human cases of subcutaneous pythiosis are exceptionally uncommon, lacking established treatment protocols.
Observation:
- A young man presented with non-healing lower extremity ulcers after swamp water exposure.
- Initial antibiotic treatments were ineffective, necessitating further investigation.
Findings:
- Deep wound culture and Polymerase Chain Reaction (PCR) confirmed Pythium insidiosum infection.
- A multidisciplinary approach involving infectious disease and veterinary specialists was crucial.
Implications:
- This case demonstrates the successful use of immunotherapy alongside surgical debridement and antimicrobials for human pythiosis.
- It underscores the importance of considering rare pathogens and exploring novel therapeutic strategies in complex infections.
