title: Protothecosis: report of a case with 20-year follow-up, and review of previously published cases.
abstract: We present a Prototheca wickerhamii wound infection case that failed treatment with ketoconazole but was cured with amphotericin-B plus tetracycline. The patient was immunocompetent but had had local steroid injections. We reviewed another 159 cases from the literature. Prototheca has infected many areas of the human body, but most often skin, olecranon bursa, or wounds. Prior treatment with steroids and immune deficiencies are contributing factors. Itraconazole and fluconazole are reasonable initial treatments for patients with mild infections. For serious infections, or for infections that have failed azole treatment, amphotericin-B is the treatment of choice.
authors.affiliation: Section of Infectious Diseases, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130 - 3932, USA. jtodd@lsuhsc.edu
authors.forename: John R
authors.initials: JR
authors.lastname: Todd
authors.forename: John W
authors.initials: JW
authors.lastname: King
authors.forename: Arnold
authors.initials: A
authors.lastname: Oberle
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Odaka
authors.forename: Marjorie
authors.initials: M
authors.lastname: Fowler
authors.forename: R Scott
authors.initials: RS
authors.lastname: Pore
authors.forename: Tracy Allan
authors.initials: TA
authors.lastname: Shahan
authors.forename: Lijia
authors.initials: L
authors.lastname: Yin
authors.forename: Irwan D
authors.initials: ID
authors.lastname: Sanusi
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D011525:Prototheca / Q000302:isolation & purification* / Q000472:pathogenicity*; D013752:Tetracycline / Q000008:administration & dosage; D016896:Treatment Outcome; D014946:Wound Infection / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000890:Anti-Infective Agents; D000666:Amphotericin B; D013752:Tetracycline