1440. What is the currently effective treatment for human pythiosis: combination therapy, surgery, antifungal agents or immunotherapy?
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Pythiosis.pdf (949.6 kB)
  • Background:

    Human pythiosis, caused by Pythium insidiosum (P.insidiosum), is an emerging, life-threatening disease. Since immunotherapy with P.insidiosum antigen (PIA) demonstrated efficacy in some vascular cases, combination treatment with surgery, medications and PIA has become standard practice. This study was conducted to evaluate the efficacy of this treatment protocol

    Methods:

    We conducted a retrospective analysis of proven vascular and ocular pythiosis infections in patients between April 2003 and March 2013. The diagnosis was confirmed by having 2 of the following criteria: presence of typical pathological features, isolation of P. insidiosum, positive Western blot test or positive polymerase chain reactions. 18 patients met the criteria: 9 cases had vascular pythiosis and 9 cases had ocular pythiosis. Fisher’s exact test and Wilcoxon rank sum test were used to analyze the data.

    Results:

    Clinical information of vascular and ocular pythiosis patients is summarized in table 1 and table 2, respectively. All vascular patients had major thalassemia with secondary hemochromatosis (mean serum ferritin 2539.63 ng/ml) while none of ocular patients had thalassemia.  All survived vascular cases had adequate surgery. Patients in the eye-lost group were significantly older than the eye-saved group. There were no associations between median time from onset to surgery, types of vaccine and treatment outcomes (death and blindness). Itraconazole and terbinafine were given in all patients.

    Table 1: Vascular pythiosis

    Deceased patients (n=4)

    Survived patients (n=5)

    P-value

    Mean age (years)

    38.0

    38.2

    0.99

    Median time from onset to surgery (months)

    4.5

    6

    0.99

    Obtained free margins from surgery (n)

    0

    5

    -

    PIA-1 (n)

    2

    4

    0.52

    PIA-2 (n)

    2

    1

    0.52


    Table 2: Ocular pythiosis

    Eye-lost patients (n=5)

    Eye-saved patients (n=4)

    P-value

    Mean age (years)

    57.2

    27.5

    < 0.05

    Median time from onset to surgery (days)

    36

    33

    0.47

    PIA-1 (n)

    2

    3

    0.99

    PIA-2 (n)

    2

    2

    0.99



    Conclusion:

    This study unveils the crucial role of adequate surgery in vascular cases and the inability of medications and immunotherapy  to clear the infection in patients with disease positive margins. Our series had a 44% eye-saved rate, higher than previous studies at 12.5% and 21%. The higher eye-saved rate may be due to the routine administration of PIA. 

    Nitipong Permpalung, M.D.1,2, Leilani Paitoonpong, MD, M.Sc.1, Rongpong Plongla, M.D., M.Sc.1, Navaporn Worasilchai, M.Sc1 and Ariya Chindamporn, Ph.D.1, (1)Chulalongkorn University, Bangkok, Thailand, (2)Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY

    Disclosures:

    N. Permpalung, None

    L. Paitoonpong, None

    R. Plongla, None

    N. Worasilchai, None

    A. Chindamporn, None

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