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September 1989, Vol 125, No. 9 >
Article | September 1989

Papular Protothecosis of the Chest: Title and subTitle BreakImmunologic Evaluation and Treatment With a Combination of Oral Tetracycline and Topical Amphotericin B

Stephen K. Tyring, MD, PhD; Patricia C. Lee, MD; Patrick Walsh, MD; Jo F. Garner, MD; Walter P. Little, MD
[+] Author Affiliations

Accepted for publication June 2, 1989.

Reprint requests to Department of Dermatology, Route G-83, University of Texas Medical Branch, Galveston, TX 77550 (Dr Tyring).


From the Departments of Dermatology (Drs Tyring, Lee, and Walsh) and Microbiology (Dr Tyring), University of Texas Medical Branch, Galveston; and Dermatopathology Services (Dr Little), Birmingham, Ala; Dr Garner is in private practice in Boone, NC.


Arch Dermatol. 1989;125(9):1249-1252. doi:10.1001/archderm.1989.01670210087014
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References
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† A 65-year-old woman presented with cutaneous, pruritic papules of the upper part of her chest. Histologic findings and culture of a biopsy specimen confirmed that these papules were caused by an infection with Prototheca wickerhamii, an achloric alga that rarely infects humans. Natural killer cell activity in this patient was significantly depressed before initiation of therapy. Reevaluation following successful treatment with oral tetracycline hydrochloride and topical amphotericin B cream revealed an improvement in natural killer cell activity. This patient is presented to demonstrate a rare clinical presentation of protothecosis; to document that cutaneous protothecosis can be successfully treated without the risk of toxic side effects associated with systemic antifungal agents; and to illustrate that although most patients with cutaneous protothecosis are immunosuppressed, infection with this alga appears to be at least partially responsible for the immunosuppression.

(Arch Dermatol. 1989;125:1249-1252)

REFERENCES

1 +
Nelson AM, Neafie RC, Connor DH.  Cutaneous protothecosis and chlorellosis, extraordinary `aquatic-borne' algal infections . Clin Dermatol. 1987;;5:76-87.
2 +
Padhye AA, Baker JG, D'Amato RF.  Rapid identification of Prototheca species by the API 20c system . J Clin Microbiol. 1979;; 10:579-582.
3 +
Boyum A.  Isolation of leukocytes from human blood: methyl cellulose, dextran and Ficoll as erythrocyte-aggregating agents . Scand J Clin Lab Invest ( (Suppl) ). 1968;;21:31-50.
4 +
Abo T, Balch CM.  A differentiation antigen of human NK and K cells identified by a monoclonal antibody (HNK-1) . J Immunol. 1981;;127:1024-1029.
5 +
Pross HF, Baines MG, Rubin P, Shragge P, Patterson MS.  Spontaneous human lymphocyte-mediated cytotoxicity against tumor target cells, IX: the quantitation of natural killer cell activity . J Clin Immunol. 1981;;1:51-66.
6 +
Davies RR, Spencer H, Wakelin PO.  A case of human protothecosis . Trans R Soc Trop Med Hyg. 1964;;58:448-451.
7 +
Kuo T-T, Hseuh S, Wu J-L, Wang A-M.  Cutaneous protothecosis . Arch Pathol Lab Med. 1987;;111:737-740.
8 +
Goldstein GD, Bhatia P, Kaliyas J.  Herpetiform protothecosis . Int J Dermatol. 1986;;25:54-55.
9 +
Heitzman HB, Brooks TJ, Phillips BJ.  Protothecosis . South Med J. 1987;;77:1477-1478.
10 +
Mezger E, Eisses JF, Smith MJ.  Protothecal cellulitis in a renal transplant patient . Lab Invest. 1981;;44:81A.
11 +
McAnally T, Parry EL.  Cutaneous protothecosis presenting as recurrent chromomycosis . Arch Dermatol. 1985;;121:1066-1069.
12 +
Holcomb HS, Behrens F, Winn WC, Hughes JM, McCue FC.  Prototheca wickerhamii—an alga infecting the hand . J Hand Surg. 1981;;6:595-599.
13 +
Pegram PS, Kerns FT, Wasilauskas BL, Hampton KD, Scharyj M, Burke JG.  Successful ketoconazole treatment of protothecosis with ketoconazole-associated hepatotoxicity . Arch Intern Med. 1983;;143:1802-1805.
14 +
Venezio FR, Lavoo E, Williams JE, et al.  Progressive cutaneous protothecosis . Am J Clin Pathol. 1982;;77:485-493.
15 +
Cox GE, Wilson JD, Brown P.  Protothecosis: a case of disseminated algal infection . Lancet. 1974;;2:379-382.
16 +
Casal M, Zerolo J, Linares UJ, Ibarra A.  First human case of protothecosis in Spain . Mycopathologia. 1983;;83:19-20.
17 +
O'Connor JP, Nimmo GR, Rigby RJ, Petrie JJB, Hardie IR, Strong RW.  Algal peritonitis complicating continuous ambulatory peritoneal dialysis . Am J Kidney Dis. 1986;;8:122-123.
18 +
Sudman MS, Kaplan W.  Identification of the Prototheca species by immunofluorescence . Appl Microbiol. 1973;;25:981-990.
19 +
Berkhoff NA, Connelly MR, Lockett LJ.  Differential microbiological diagnosis of protothecosis from non-human sources . Am J Med Technol. 1982;;48:609-612.
20 +
Herberman RB, Ortaldo JR.  Natural killer cells: their role in defenses against disease . Science. 1981;;214:24-30.
21 +
Trinchieri G, Perussia B.  Biology of disease: human natural killer cells: biologic and pathologic aspects . Lab Invest. 1984;;50:489-513.
22 +
Pore RS, Barnett EA, Barnes WC, Walker JD.  Prototheca ecology . Mycopathologia. 1983;;81:49-62.
23 +
Clark CS, Linnemann CC, Gartside PS, Phair JP, Blacklow N, Zeiss CR.  Serologic survey of rotavirus, Norwalk agent and Prototheca wickerhamii in wastewater workers . Am J Public Health. 1985;;75:83-85.
24 +
Font RL, Hook SR.  Metastatic protothecal retinitis in a dog: electron microscopic observations . Vet Pathol. 1984;;21:61.-66.

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1 +
Nelson AM, Neafie RC, Connor DH.  Cutaneous protothecosis and chlorellosis, extraordinary `aquatic-borne' algal infections . Clin Dermatol. 1987;;5:76-87.
2 +
Padhye AA, Baker JG, D'Amato RF.  Rapid identification of Prototheca species by the API 20c system . J Clin Microbiol. 1979;; 10:579-582.
3 +
Boyum A.  Isolation of leukocytes from human blood: methyl cellulose, dextran and Ficoll as erythrocyte-aggregating agents . Scand J Clin Lab Invest ( (Suppl) ). 1968;;21:31-50.
4 +
Abo T, Balch CM.  A differentiation antigen of human NK and K cells identified by a monoclonal antibody (HNK-1) . J Immunol. 1981;;127:1024-1029.
5 +
Pross HF, Baines MG, Rubin P, Shragge P, Patterson MS.  Spontaneous human lymphocyte-mediated cytotoxicity against tumor target cells, IX: the quantitation of natural killer cell activity . J Clin Immunol. 1981;;1:51-66.
6 +
Davies RR, Spencer H, Wakelin PO.  A case of human protothecosis . Trans R Soc Trop Med Hyg. 1964;;58:448-451.
7 +
Kuo T-T, Hseuh S, Wu J-L, Wang A-M.  Cutaneous protothecosis . Arch Pathol Lab Med. 1987;;111:737-740.
8 +
Goldstein GD, Bhatia P, Kaliyas J.  Herpetiform protothecosis . Int J Dermatol. 1986;;25:54-55.
9 +
Heitzman HB, Brooks TJ, Phillips BJ.  Protothecosis . South Med J. 1987;;77:1477-1478.
10 +
Mezger E, Eisses JF, Smith MJ.  Protothecal cellulitis in a renal transplant patient . Lab Invest. 1981;;44:81A.
11 +
McAnally T, Parry EL.  Cutaneous protothecosis presenting as recurrent chromomycosis . Arch Dermatol. 1985;;121:1066-1069.
12 +
Holcomb HS, Behrens F, Winn WC, Hughes JM, McCue FC.  Prototheca wickerhamii—an alga infecting the hand . J Hand Surg. 1981;;6:595-599.
13 +
Pegram PS, Kerns FT, Wasilauskas BL, Hampton KD, Scharyj M, Burke JG.  Successful ketoconazole treatment of protothecosis with ketoconazole-associated hepatotoxicity . Arch Intern Med. 1983;;143:1802-1805.
14 +
Venezio FR, Lavoo E, Williams JE, et al.  Progressive cutaneous protothecosis . Am J Clin Pathol. 1982;;77:485-493.
15 +
Cox GE, Wilson JD, Brown P.  Protothecosis: a case of disseminated algal infection . Lancet. 1974;;2:379-382.
16 +
Casal M, Zerolo J, Linares UJ, Ibarra A.  First human case of protothecosis in Spain . Mycopathologia. 1983;;83:19-20.
17 +
O'Connor JP, Nimmo GR, Rigby RJ, Petrie JJB, Hardie IR, Strong RW.  Algal peritonitis complicating continuous ambulatory peritoneal dialysis . Am J Kidney Dis. 1986;;8:122-123.
18 +
Sudman MS, Kaplan W.  Identification of the Prototheca species by immunofluorescence . Appl Microbiol. 1973;;25:981-990.
19 +
Berkhoff NA, Connelly MR, Lockett LJ.  Differential microbiological diagnosis of protothecosis from non-human sources . Am J Med Technol. 1982;;48:609-612.
20 +
Herberman RB, Ortaldo JR.  Natural killer cells: their role in defenses against disease . Science. 1981;;214:24-30.
21 +
Trinchieri G, Perussia B.  Biology of disease: human natural killer cells: biologic and pathologic aspects . Lab Invest. 1984;;50:489-513.
22 +
Pore RS, Barnett EA, Barnes WC, Walker JD.  Prototheca ecology . Mycopathologia. 1983;;81:49-62.
23 +
Clark CS, Linnemann CC, Gartside PS, Phair JP, Blacklow N, Zeiss CR.  Serologic survey of rotavirus, Norwalk agent and Prototheca wickerhamii in wastewater workers . Am J Public Health. 1985;;75:83-85.
24 +
Font RL, Hook SR.  Metastatic protothecal retinitis in a dog: electron microscopic observations . Vet Pathol. 1984;;21:61.-66.

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