Cutaneous Protothecosis with Meningitis Due to Prototheca wickerhamii in an Immunocompetent Teenager: Case Report and Literature Review

Figures & data

Figure 1 Direct microscopic morphology of skin tissue and CSF. (A) Direct wet film microscopy of skin tissue, 400×. (B) Gram stain of skin tissue, 1000×. (C) GMS of skin tissue, 1000×. (D) GMS of CSF after centrifugation, 1000×.

Figure 2 Colonies and microscopic morphology of cultured skin tissue and CSF specimens. (A) Colonies on CHROMagar Candida medium from skin tissue cultures. (B) Wet film microscopy of skin tissue cultures, 40×. (C) Gram stain of skin tissue cultures, 1000×. (D) Colonies on blood agar from CSF cultures.

Table 1 Reports of Meningitis Due to Prototheca spp. Up to April 2021

Reference	Age	Sex	Species	Immunity	Risk Factors	Symptoms	Treatment	Outcome	Year	Country
1^Citation16	12	M	P. wickerhamii	Immunocompetent	Ventriculoperitoneal shunt	Hydrocephalus, blurred vision, and optic neuritis and peripapillary retinitis	AMB	Improved	2017	Korea
2^Citation17	6-month	M	P. wickerhamii	Immunocompromised	Contamination during ventriculoperitoneal drain care procedures. The parents of the child farmed a fishery.	Increased intracranial pressure	KTZ, FCA, AMB	Improved	2012	Poland
3^Citation18	25	F	P. wickerhamii	Immunocompromised	Inoculation trauma caused by intravenous drug use	Headache, stiff neck	AMB, 5-FC	Died	1992	USA
4^Citation19	24	M	P. wickerhamii	Immunocompetent	Contacting something contaminated by Prototheca or skin trauma	From paroxysmal headache to persistent headache accompanied with ambiopia and difficulty in walking.	AMB, ITZ	Improved	2007	China
5^Citation20	20	M	P. wickerhamii	Immunocompetent	Prototheca sp. was histopathologically detected in the liver, abdominal lymph nodes, and submucosal tissue of the ileum by open biopsy.	Headache and double vision	MCZ, FCA, AMB, ITZ	Not cured in 6 years	1996	Japan
6^Citation21	13	F	P. zopfii	Immunocompetent	Swimming in freshwater ponds, working on a farm, including the milking of cows.	Shuffling gait and had trouble bending over, headache, pain in the lumbar spine and bilateral lower extremities, hydrocephalus	AMB	Improved	2020	USA
7. This report	17	M	P. wickerhamii	Immunocompetent	Full-body tattoo	Rash, headache and pain, nausea and vomiting	AMB, VOR	Improved	2021	China

Abbreviations: KTZ, ketoconazole; ITZ, itraconazole; MCZ, miconazole.

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