Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand.
Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand.
Int J Infect Dis. 2018 Jun;71:33-41. doi: 10.1016/j.ijid.2018.03.021. Epub 2018 Apr 10.
Vascular pythiosis is a life-threatening infection caused by the oomycete Pythium insidiosum. This article reports the clinical presentation, serodiagnosis, pathology, and outcomes seen at the authors' institution.
The cases of patients with proven vascular pythiosis at Ramathibodi Hospital, Mahidol University, Bangkok, Thailand from January 2006 to December 2016 were analyzed retrospectively.
Thirteen patients were analyzed, eight of whom had underlying thalassemias. Of the remaining five patients, one had aplastic anemia, one had myelodysplasia, one had acute leukemia, one had cirrhosis, and one had alcoholism. Neutropenic patients showed a rapid clinical deterioration. Atypical presentations including carotid arteritis, aneurysm, brain abscess, and stroke occurred in the non-thalassemic patients. Serology yielded positive results in all cases, with a rapid turnaround time. Serology has the advantage of providing a presurgical diagnosis, which allows prompt surgery and clinical cure to be achieved. Pathology revealed a neutrophilic response in the acute phase and a later shift to granuloma. Immunotherapy in combination with itraconazole and terbinafine was given. The amputation rate was 77%, and disease-free surgical margins were achieved in five cases (38%). The mortality rate was 31%.
This study highlights new aspects of pythiosis, such as the unusual host, clinical presentation, serology as a marker for rapid diagnosis, histopathology, and outcomes. Early recognition of the disease with prompt multimodality treatment may improve survival.
血管内类鼻疽是一种由卵菌纲丝体菌属引起的危及生命的感染。本文报道了作者所在机构所见的血管内类鼻疽的临床表现、血清学诊断、病理学和结局。
回顾性分析了 2006 年 1 月至 2016 年 12 月在泰国玛希隆大学 Ramathibodi 医院确诊为血管内类鼻疽的患者的病例。
分析了 13 例患者，其中 8 例患有地中海贫血。其余 5 例患者中，1 例患有再生障碍性贫血，1 例患有骨髓增生异常综合征，1 例患有急性白血病，1 例患有肝硬化，1 例患有酒精中毒。中性粒细胞减少症患者的临床病情迅速恶化。非地中海贫血患者出现了颈动脉炎、动脉瘤、脑脓肿和中风等不典型表现。所有病例的血清学检查均呈阳性，且具有快速的周转时间。血清学检查具有术前诊断的优势，可及时进行手术，从而获得临床治愈。病理学检查显示在急性期呈中性粒细胞反应，后期转为肉芽肿。采用免疫疗法联合伊曲康唑和特比萘芬进行治疗。截肢率为 77%，5 例（38%）获得无疾病手术切缘。死亡率为 31%。
本研究强调了类鼻疽的一些新方面，如不常见的宿主、临床表现、血清学作为快速诊断的标志物、组织病理学和结局。早期认识疾病并及时进行多模式治疗可能会提高生存率。
