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.
Acknowledgements
Barbara Reilly, Dixie Jones, Kerri Christopher, Ronald Silberman, Yoko Okuyama, J. Yu-Yun Lee, Katsutaro Nishimoto, Takeji Nishikawa, Dawn Parker, Barbara Schild, Robert Wood, and Atsushi Hosokawa helped locate publications about Prototheca. Jerry McLarty, Runhua Shi, and Gloria Caldito helped with statistics. Richard Lawrence Lee prepared photographs. The following people reviewed publications in foreign languages: for Japanese, Yoshinobu Odaka; for Chinese, Lijia Yin and Yue-Kong Au; for Portuguese, Sandra Guidry; for French, Leonard Prouty, Paul Jordan, and Lisa Hodges; for Korean, James Kim; for Hungarian, Peter Gergay; for Spanish and German, John R. Todd. We thank our patient with protothecosis for her continuing enthusiastic participation in this project.
Financial support. None.
Declaration of interest: The authors have no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
This paper was first published online on Early Online on 09 May 2012.
