Publication: Clinical and epidemiological analyses of human pythiosis in Thailand
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2006-09-01
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10584838
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2-s2.0-33747613581
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item.page.oaire.edition
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Mahidol University
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Clinical Infectious Diseases. Vol.43, No.5 (2006), 569-576
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Theerapong Krajaejun, Boonmee Sathapatayavongs, Roongnapa Pracharktam, Prawat Nitiyanant, Paisan Leelachaikul, Wanchai Wanachiwanawin, Angkana Chaiprasert, Paraya Assanasen, Marisa Saipetch, Piroon Mootsikapun, Ploenchan Chetchotisakd, Arnuparp Lekhakula, Winyou Mitarnun, Sineenart Kalnauwakul, Khuanchai Supparatpinyo, Romanee Chaiwarith, Siri Chiewchanvit, Napaporn Tananuvat, Sawet Srisiri, Chusana Suankratay, Wanla Kulwichit, Mawin Wongsaisuwan, Shawarash Somkaew (2006). Clinical and epidemiological analyses of human pythiosis in Thailand. Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/23640.
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Clinical and epidemiological analyses of human pythiosis in Thailand
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Theerapong Krajaejun
Boonmee Sathapatayavongs
Roongnapa Pracharktam
Prawat Nitiyanant
Paisan Leelachaikul
Wanchai Wanachiwanawin
Angkana Chaiprasert
Paraya Assanasen
Marisa Saipetch
Piroon Mootsikapun
Ploenchan Chetchotisakd
Arnuparp Lekhakula
Winyou Mitarnun
Sineenart Kalnauwakul
Khuanchai Supparatpinyo
Romanee Chaiwarith
Siri Chiewchanvit
Napaporn Tananuvat
Sawet Srisiri
Chusana Suankratay
Wanla Kulwichit
Mawin Wongsaisuwan
Shawarash Somkaew
Boonmee Sathapatayavongs
Roongnapa Pracharktam
Prawat Nitiyanant
Paisan Leelachaikul
Wanchai Wanachiwanawin
Angkana Chaiprasert
Paraya Assanasen
Marisa Saipetch
Piroon Mootsikapun
Ploenchan Chetchotisakd
Arnuparp Lekhakula
Winyou Mitarnun
Sineenart Kalnauwakul
Khuanchai Supparatpinyo
Romanee Chaiwarith
Siri Chiewchanvit
Napaporn Tananuvat
Sawet Srisiri
Chusana Suankratay
Wanla Kulwichit
Mawin Wongsaisuwan
Shawarash Somkaew
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Abstract
Background. Pythiosis is an emerging and life-threatening infectious disease in humans and animals that is caused by the pathogenic oomycete Pythium insidiosum. Human pythiosis is found mostly in Thailand, although disease in animals has been increasingly reported worldwide. Clinical information on human pythiosis is limited, and health care professionals are unfamiliar with the disease, leading to underdiagnosis, delayed treatment, and poor prognosis. Methods. To retrospectively study the clinical and epidemiological features of human pythiosis, we analyzed clinical data from patients with pythiosis diagnosed during the period of January 1985 through June 2003 at 9 tertiary care hospitals throughout Thailand. Results. A total of 102 cases of human pythiosis were documented nationwide. A substantial proportion (40%) of cases occurred in the last 4 years of the 18-year study interval. Clinical presentations fell into 4 groups: cutaneous/subcutaneous cases (5% of cases), vascular cases (59%), ocular cases (33%), and disseminated cases (3%). Almost all patients with cutaneous/subcutaneous, vascular, and disseminated pythiosis (85%) had underlying thalassemia-hemoglobinopathy syndrome. Most ocular cases (84%) were associated with no underlying disease. A majority of the patients were male (71%), were aged 20-60 years (86%), and reported an agricultural occupation (75%). Regarding treatment outcomes, all patients with disseminated infection died; 78% of patients with vascular disease required limb amputation, and 40% of these patients died; and 79% of patients with ocular pythiosis required enucleation/evisceration. Conclusions. Here, we report, to our knowledge, the largest case study of human pythiosis. The disease has high rates of morbidity and mortality. Early diagnosis and effective treatment are urgently needed to improve clinical outcomes. Because P. insidiosum is distributed worldwide and can infect healthy individuals, an awareness of human pythiosis should be promoted in Thailand and in other countries. © 2006 by the Infectious Diseases Society of America. All rights reserved.