Successful Medical Therapy for Deeply Invasive Facial Infection Due to Pythium insidiosum in a Child

Pythiosis occurs in animals and humans who encounter aquatic habitats that harbor Pythium insidiosum. Drug therapy for deeply invasive infections with this organism has been ineffective in humans and animals; patients have been cured only by radical surgical debridement. A 2-year-old boy developed p...

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Bibliographic Details
Published in:Clinical infectious diseases 1998-12, Vol.27 (6), p.1388-1393
Main Authors: Shenep, Jerry L., English, B. Keith, Kaufman, Leo, Pearson, Ted A., Thompson, Jerome W., Kaufman, Robert A., Frisch, Glenn, Rinaldi, Michael G.
Format: Article
Language:English
Subjects:
Animals
Anti-Infective Agents - therapeutic use
Biological and medical sciences
Biopsies
Cellulitis
Cellulitis - diagnostic imaging
Cellulitis - drug therapy
Cellulitis - microbiology
Cellulitis - surgery
Child, Preschool
Clinical Articles
Debridement
Facial Dermatoses - diagnostic imaging
Facial Dermatoses - drug therapy
Facial Dermatoses - microbiology
Facial Dermatoses - surgery
Fungal diseases
Fungal infections
Fungi
Head
Human mycoses
Humans
Infection - diagnostic imaging
Infection - drug therapy
Infection - microbiology
Infection - surgery
Infections
Infectious diseases
Itraconazole - therapeutic use
Male
Medical sciences
Mycoses
Mycoses of the eye and the orbit
Naphthalenes - therapeutic use
Neck
Pythium - isolation & purification
Pythium - pathogenicity
Pythium insidiosum
Radiography
Swelling
Terbinafine
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Summary:Pythiosis occurs in animals and humans who encounter aquatic habitats that harbor Pythium insidiosum. Drug therapy for deeply invasive infections with this organism has been ineffective in humans and animals; patients have been cured only by radical surgical debridement. A 2-year-old boy developed periorbital cellulitis unresponsive to antibiotic and antifungal therapy. The cellulitis extended to the nasopharynx, compromising the airway and necessitating a gastrostomy for feeding. P. insidiosum was isolated from surgical biopsy specimens of the affected tissue. On the basis of in vitro susceptibility studies of the isolate, the patient was treated with a combination of terbinafine and itraconazole. The infection resolved over a period of a few months. The patient remained well 1.5 years after completing a 1-year course of therapy. Cure of deep P. insidiosum infection is feasible with drug therapy.
ISSN:1058-4838
1537-6591
DOI:10.1086/515042