Cutaneous Protothecosis Treatment & Management

  • Author: Sarah K Taylor, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 15, 2010
 

Medical Care

Protothecosis is difficult to eradicate once infection takes hold. Given that the infection is rare, no defined pharmacologic protocol is available. All reported patients with disseminated disease have been treated with intravenous amphotericin B. Isolated reports describe successful treatment of localized disease with ketoconazole, itraconazole, and fluconazole. Sensitivity in vitro has not been shown to be correlated with in vivo efficacy. Surgical removal of isolated lesions in combination with antifungal therapy (eg, with azoles) is effective in immunocompetent individuals. Also reported is dual use of local thermal application as an adjunct to azole therapy.[9]

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Surgical Care

Surgical excision is the treatment of choice in all cases amenable to excision.

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Contributor Information and Disclosures
Author

Sarah K Taylor, MD  Staff Physician, Kimbrough Dermatology, Ft George G Meade

Disclosure: Nothing to disclose.

Coauthor(s)

Jon H Meyerle, MD  Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Chief, Immunodermatology, Dermatology Laboratory Director, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center

Jon H Meyerle, MD is a member of the following medical societies: American Academy of Dermatology and Sigma Xi

Disclosure: Nothing to disclose.

Earl J Glusac, MD  Professor, Departments of Pathology and Dermatology, Yale University School of Medicine

Earl J Glusac, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Barbara R Reed, MD  Clinical Professor, Department of Dermatology, Dermatology Service, Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center; Consulting Staff, Denver Skin Clinic

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Christen M Mowad, MD  Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Humphrey S, Martinka M, Lui H. Cutaneous protothecosis following a tape-stripping injury. J Cutan Med Surg. Sept-Oct 2009;13(5):273-5. [Medline]. [Full Text].

  2. Walsh SV, Johnson RA, Tahan SR. Protothecosis: an unusual cause of chronic subcutaneous and soft tissue infection. Am J Dermatopathol. Aug 1998;20(4):379-82. [Medline].

  3. Lass-Florl C, Mayr A. Human protothecosis. Clin Microbiol Rev. Apr 2007;20(2):230-42. [Medline].

  4. Lee JS, Moon GH, Lee NY, Peck KR. Case report: Protothecal tenosynovitis. Clin Orthop Relat Res. Dec 2008;466(12):3143-6. [Medline].

  5. Khoury JA, Dubberke ER, Devine SM. Fatal case of protothecosis in a hematopoietic stem cell transplant recipient after infliximab treatment for graft-versus-host disease. Blood. Nov 15 2004;104(10):3414-5. [Medline].

  6. Torres HA, Bodey GP, Tarrand JJ, Kontoyiannis DP. Protothecosis in patients with cancer: case series and literature review. Clin Microbiol Infect. Aug 2003;9(8):786-92. [Medline].

  7. Carey WP, Kaykova Y, Bandres JC, Sidhu GS, Brau N. Cutaneous protothecosis in a patient with AIDS and a severe functional neutrophil defect: successful therapy with amphotericin B. Clin Infect Dis. Nov 1997;25(5):1265-6. [Medline].

  8. Polk P, Sanders DY. Cutaneous protothecosis in association with the acquired immunodeficiency syndrome. South Med J. Aug 1997;90(8):831-2. [Medline].

  9. Yamada N, Yoshida Y, Ohsawa T, Takahara M, Morino S, Yamamoto O. A case of cutaneous protothecosis successfully treated with local thermal therapy as an adjunct to itraconazole therapy in an immunocompromised host. Med. Mycol. Jan 22 2010;[Medline]. [Full Text].

 
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This subtle lesion of cutaneous protothecosis on the shoulder shows an ill-defined, slightly erythematous, thin plaque.
Periodic acid-Schiff–stained sections of protothecosis reveal rounded endospores that form characteristic moruloid structures in the dermis.
Electron photomicrograph of Prototheca wickerhamii shows a central rounded endospore surrounded by a corona of molded endospores.
 
 
 
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