title: An outbreak of Phialemonium infective endocarditis linked to intracavernous penile injections for the treatment of impotence.
abstract: BACKGROUND
  In March 2002, a patient in Tel Aviv, Israel, died of endocarditis caused by Phialemonium curvatum. As part of his therapy for erectile dysfunction, the patient had been trained to self-inject a compound of vasoactive drugs provided by an impotence clinic into his penile corpus cavernosous.
  
  
  METHODS
  We identified the used prefilled syringes as the source of his infection. Similar cases were investigated as a putative outbreak of P. curvatum invasive disease among customers of this impotence clinic. P. curvatum isolates, cultured from samples obtained from the patients and from prefilled syringes, were compared by DNA sequencing of the nuclear ribosomal internal transcribed spacer.
  
  
  RESULTS
  We identified 2 additional customers at the impotence clinic who had P. curvatum endocarditis. In addition, cultures of unused, prefilled syringes and bottles provided by the same clinic to 5 asymptomatic customers tested positive for pathogenic molds (P. curvatum in 4 cases and Paecilomyces lilacinus in 1). All P. curvatum isolates were of a single genetic type that is known only from this outbreak but is closely related to 3 other P. curvatum genotypes associated with pathogenicity in humans.
  
  
  CONCLUSIONS
  P. curvatum is an emerging pathogen that can be readily isolated from blood. We identified an outbreak of P. curvatum endocarditis among men who had erectile dysfunction treated by intracavernous penile injections from contaminated prefilled syringes.
authors.affiliation: Infectious Diseases Unit, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. jstrahilevitz@partners.org
authors.forename: Jacob
authors.initials: J
authors.lastname: Strahilevitz
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
authors.forename: Hans-Josef
authors.initials: HJ
authors.lastname: Schroers
authors.forename: Richard C
authors.initials: RC
authors.lastname: Summerbell
authors.forename: Ziva
authors.initials: Z
authors.lastname: Amitai
authors.forename: Anna
authors.initials: A
authors.lastname: Goldschmied-Reouven
authors.forename: Ethan
authors.initials: E
authors.lastname: Rubinstein
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schwammenthal
authors.forename: Micha S
authors.initials: MS
authors.lastname: Feinberg
authors.forename: Yardena
authors.initials: Y
authors.lastname: Siegman-Igra
authors.forename: Edna
authors.initials: E
authors.lastname: Bash
authors.forename: Itzhack
authors.initials: I
authors.lastname: Polacheck
authors.forename: Adrian
authors.initials: A
authors.lastname: Zelazny
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Howard
authors.forename: Pnina
authors.initials: P
authors.lastname: Cibotaro
authors.forename: Ora
authors.initials: O
authors.lastname: Shovman
authors.forename: Nathan
authors.initials: N
authors.lastname: Keller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001203:Ascomycota / Q000235:genetics / Q000302:isolation & purification*; D004196:Disease Outbreaks; D004696:Endocarditis / Q000150:complications / Q000209:etiology* / Q000382:microbiology*; D017743:Equipment Reuse; D007172:Erectile Dysfunction / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D009181:Mycoses / Q000382:microbiology*