An outbreak of Phialemonium infective endocarditis linked to intracavernous penile injections for the treatment of impotence.
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.
Strahilevitz
Jacob
J
Infectious Diseases Unit, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. jstrahilevitz@partners.org
Rahav
Galia
G
Schroers
Hans-Josef
HJ
Summerbell
Richard C
RC
Amitai
Ziva
Z
Goldschmied-Reouven
Anna
A
Rubinstein
Ethan
E
Schwammenthal
Yvonne
Y
Feinberg
Micha S
MS
Siegman-Igra
Yardena
Y
Bash
Edna
E
Polacheck
Itzhack
I
Zelazny
Adrian
A
Howard
Susan J
SJ
Cibotaro
Pnina
P
Shovman
Ora
O
Keller
Nathan
N
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*