RESUMEN
We report necropsy findings in a captive 60-year-old female greater flamingo (Phoenicopterus roseus) that died suddenly following rupture of a pulmonary artery aneurysm. Histologically, there was focally extensive, intramural granulomatous inflammation with intralesional fungal hyphae, and adjacent severe mixed-cell inflammation and acute haemorrhage at the rupture site. Aspergillus fumigatus was identified as the aetiological agent following DNA PCR amplification and sequencing from paraffin-embedded pulmonary artery tissue sections. The most likely explanation is that this lesion was a consequence of haematogenous spread, secondary to mycotic pneumonia or aerosacculitis, following aspiration of A. fumigatus conidiospores. However, no further fungal-related lesions were observed on gross or histopathological examination.
Asunto(s)
Aneurisma , Aspergilosis , Aneurisma/microbiología , Aneurisma/veterinaria , Animales , Animales de Zoológico , Aspergilosis/veterinaria , Aspergillus fumigatus , Resultado Fatal , Femenino , Pulmón , Arteria Pulmonar/patologíaRESUMEN
BACKGROUND: Listeria monocytogenes-associated endovascular infections are not well characterized. METHODS: Retrospective study of 71 culture-proven cases reported to the French National Reference Center for Listeria from 1993 to 2018. RESULTS: Seventy-one cases were identified: 42 with vascular aneurysms/prosthetic infections, 27 with endocarditis, 2 with both. Fifty-eight were men (82%); median age was 75 years [46-92]; 93% reported co-morbidities (66/71), including 50% with immunosuppressive conditions. Vascular infections consisted of infected aneurysms (68%) or prosthetic graft infections (32%); vascular rupture was reported in 25/42 (60%). Tissue samples grew L. monocytogenes in 98% (43/44) and blood cultures in 64% (27/42). Endocarditis cases involved prosthetic or native valves or intracardiac devices in respectively 62% (18/29), 28% (8/29) and 10% (3/29). Infected valves were aortic (62%, 16/26), mitral (31%, 8/26) or both (8%, 2/26); 38% patients required surgery; 45% displayed heart failure; 17% had concomitant neurolisteriosis. In-hospital mortality in vascular infections was 12% (5/42) and 41% (12/29) for Lm-associated endocarditis. CONCLUSIONS: Endovascular listeriosis is a rare but severe infection. It manifests as vascular infections and endocarditis, mostly in older patients with vascular or cardiac valve prosthetic devices and co-morbidities. Mortality in Lm-associated endocarditis is twice higher than with other pathogens, requiring prompt recognition and treatment.
Asunto(s)
Endocarditis Bacteriana/microbiología , Listeriosis/microbiología , Anciano , Anciano de 80 o más Años , Aneurisma/microbiología , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/mortalidad , Monitoreo Epidemiológico , Femenino , Francia/epidemiología , Prótesis Valvulares Cardíacas/microbiología , Mortalidad Hospitalaria , Humanos , Listeria monocytogenes/patogenicidad , Listeriosis/epidemiología , Listeriosis/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Aneurisma/diagnóstico por imagen , Aneurisma/cirugía , Arteria Axilar/diagnóstico por imagen , Arteria Axilar/cirugía , Aorta Torácica/diagnóstico por imagen , Derivación Arteriovenosa Quirúrgica/métodos , Aneurisma/microbiología , Riesgos Laborales , Diagnóstico DiferencialRESUMEN
A 39-year-old Philipino man presented with acute onset fever and headache. Neurological examination was normal except for neck stiffness. There was no history of chest pain, cough or breathlessness. Cerebrospinal fluid (CSF) showed a mild increase in protein with normal sugar and lymphocytic pleocytosis. CSF PCR for herpes simplex and varicella zoster virus was negative. He developed acute right haemiplegia a week after hospitalisation. MRI showed acute infarct in the left centrum semiovale. His angiogram showed aneurysm in the left subclavian artery and aortic arch. The mycoplasma antibody test came positive with very high titres, while rest of the workup was negative. He was treated with azithromycin and his symptoms improved completely.He was asymptomatic on follow-up after a month. His repeat immunoglobulin G mycoplasma antibody titre showed elevation. Mycoplasma infection is a treatable cause of meningoencephalitis and stroke secondary to vasculitis. Arterial aneurysms are known to occur with mycoplasma infection although rare.
Asunto(s)
Aneurisma/microbiología , Meningoencefalitis/microbiología , Mycoplasma pneumoniae , Neumonía por Mycoplasma/complicaciones , Accidente Cerebrovascular/microbiología , Adulto , Antibacterianos/uso terapéutico , Aneurisma de la Aorta/microbiología , Azitromicina/uso terapéutico , Humanos , Masculino , Meningoencefalitis/tratamiento farmacológico , Neumonía por Mycoplasma/tratamiento farmacológico , Neumonía por Mycoplasma/microbiología , Accidente Cerebrovascular/tratamiento farmacológico , Arteria Subclavia/microbiologíaRESUMEN
Endocarditis is a consideration in the differential diagnosis when masses are seen on echocardiography in a patient with congenital heart disease. We present a case of insidious development of endocarditis caused by Streptobacillus moniliformis in a seven-month-old baby after a rat bite, when the baby was three months of age.
Asunto(s)
Aneurisma/microbiología , Endocarditis Bacteriana/diagnóstico , Arteria Pulmonar , Insuficiencia de la Válvula Pulmonar/microbiología , Fiebre por Mordedura de Rata/diagnóstico , Aneurisma/diagnóstico , Diagnóstico Diferencial , Endocarditis Bacteriana/complicaciones , Humanos , Lactante , Masculino , Insuficiencia de la Válvula Pulmonar/diagnóstico , Fiebre por Mordedura de Rata/complicacionesRESUMEN
Background. Disseminated invasive aspergillosis is an exceptional finding in immunocompetent hosts. As in immunocompromised patients, it has high mortality rates. Early diagnostic methods are required in order to properly manage the patient. Bis(methylthio)gliotoxin (bmGT) is a novel biomarker, useful in onco-hematological patients. Case report. A 70-year-old male, with non-insulin dependent type II diabetes mellitus and a past surgery history of aortic valve replacement with coronary by-pass five years ago, was seen in the emergency department with blurred vision. Three days later, endogen endophthalmitis was diagnosed in the ophthalmology clinic. During admission for the vitrectomy, he suffered an ischemia of the right lower limb. A thoracic computed tomography revealed a mycotic aneurysm of the ascending thoracic aorta and parietal thrombus. The ascending aorta was replaced and abundant brittle material of infectious appearance, found between the aortic valve graft and the aneurysm, was removed. Aspergillus fumigatus sensu stricto grew in both vitreous and aorta cultures. BmGT was detected in two serum samples obtained prior to intravenous antifungal treatment, which was then reduced after voriconazole treatment was started. Conclusions. Disseminated invasive aspergillosis is a severe disease regardless of the immune status of the patient. This case report suggests that bmGT could be a suitable early diagnostic biomarker, not only in neutropenic patients, but also in immunocompetent hosts (AU)
Antecedentes. La aspergilosis diseminada invasiva es un hallazgo excepcional en pacientes inmunocompetentes, y al igual que en los pacientes inmunodeficientes, alcanza valores de mortalidad elevados. Para el correcto manejo del paciente son necesarios métodos diagnósticos precoces. La bis(metiltio)gliotoxina es un nuevo biomarcador de gran utilidad en pacientes oncohematológicos. Caso clínico. Varón de 70 años de edad con diabetes mellitus tipo II no dependiente de insulina y antecedente de recambio valvular aórtico con by-pass coronario cinco años antes, que acude al Servicio de Urgencias por visión borrosa. Tres días después se le diagnosticó endoftalmitis endógena en la consulta de Oftalmología. Durante su ingreso para la vitrectomía presentó una isquemia del miembro inferior derecho. La tomografía computarizada de tórax reveló un aneurisma micótico en la aorta torácica ascendente y un trombo parietal. Se reemplazó la aorta ascendente y se eliminó abundante material friable de aspecto infeccioso entre la prótesis valvular aórtica y el aneurisma. En los cultivos de humor vítreo y aorta creció Aspergillus fumigatus sensu stricto. Se detectó bis(metiltio)gliotoxina en dos muestras de suero obtenidas antes del tratamiento antifúngico intravenoso, marcador que disminuyó tras comenzar el tratamiento con voriconazol. Conclusiones. La aspergilosis diseminada invasiva es una enfermedad grave independientemente del estado inmune del paciente. Este caso clínico evidencia que la bis(metiltio)gliotoxina podría ser un marcador diagnóstico precoz no solo en pacientes neutropénicos, sino también en huéspedes inmunocompetentes (AU)
Asunto(s)
Humanos , Masculino , Anciano , Inmunocompetencia , Aspergilosis/complicaciones , Aspergilosis/diagnóstico , Aspergilosis/microbiología , Gliotoxina/administración & dosificación , Gliotoxina/uso terapéutico , Aneurisma/complicaciones , Aneurisma/diagnóstico , Aneurisma/microbiología , Biomarcadores/análisis , Endoftalmitis/complicaciones , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Vitrectomía/métodos , Vitrectomía/normas , Vitrectomía , Voriconazol/uso terapéuticoRESUMEN
Salmonella enterica subsp. enterica serovar Abortusequi is a pathogen restricted to horses. Our investigation targeted 4 draft horses (9-10 months old) kept on a Japanese farm that had suffered an outbreak of S. Abortusequi abortion. The 4 horses were suspected to be carriers of the bacterium owing to their high agglutination titers (≥1:2,560) in tube agglutination testing. The owners' on-farm observations confirmed that the horses had no apparent abnormalities, and S. Abortusequi was not isolated from their blood, rectal swabs, or sternal bone marrow fluid at antemortem investigation. However, at autopsy, all horses displayed the following: suppurative aneurysm of the cranial mesenteric artery with heavy infection with Strongylus vulgaris larvae; heavy intestinal parasitic infection with Gasterophilus intestinalis, Parascaris equorum, Anoplocephala perfoliata, and S. vulgaris; and enlargement of the systemic lymph nodes. In each case, large numbers of S. Abortusequi were isolated from the anterior mesenteric artery thrombus. The thrombus isolates harbored a single virulence plasmid, and the pulsed-field gel electrophoresis profiles of the isolates were identical not only to each other but also to those of Japanese enzootic strains of S. Abortusequi. These results reveal that parasitic aneurysms of the cranial mesenteric artery should be considered an important possible site of carriage of S. Abortusequi in horses. The results also suggest high clonality of the isolated serovar in the horse population in Japan.
Asunto(s)
Aneurisma/veterinaria , Enfermedades de los Caballos/diagnóstico , Arterias Mesentéricas/patología , Salmonelosis Animal/diagnóstico , Salmonella enterica/aislamiento & purificación , Aneurisma/diagnóstico , Aneurisma/microbiología , Aneurisma/patología , Animales , Femenino , Enfermedades de los Caballos/microbiología , Enfermedades de los Caballos/patología , Caballos , Japón , Masculino , Arterias Mesentéricas/microbiología , Arterias Mesentéricas/parasitología , Salmonelosis Animal/complicaciones , Salmonelosis Animal/patología , Salmonella enterica/genética , SerogrupoAsunto(s)
Aneurisma/microbiología , Conductos Biliares , Hemobilia/microbiología , Mycobacterium tuberculosis , Tuberculosis/complicaciones , Anciano , Aneurisma/diagnóstico por imagen , Aneurisma/terapia , Embolización Terapéutica , Hemobilia/diagnóstico por imagen , Hemobilia/terapia , Humanos , Masculino , Tomografía Computarizada por Rayos XAsunto(s)
Aneurisma/terapia , Quimioembolización Terapéutica/métodos , Enbucrilato/uso terapéutico , Endocarditis/complicaciones , Endofuga/terapia , Arteria Hepática , Anciano de 80 o más Años , Aneurisma/microbiología , Implantación de Prótesis Vascular/efectos adversos , Medios de Contraste , Diagnóstico Diferencial , Endofuga/etiología , Aceite Etiodizado/uso terapéutico , Femenino , Humanos , Stents/efectos adversos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Candidatus Neoehrlichia mikurensis is a newly discovered noncultivatable bacterium spread among ticks and rodents in Europe and Asia that can infect humans, particularly immunocompromised patients. METHODS: We compiled clinical and laboratory data from 11 patients with hematological malignances or autoimmune diseases who were diagnosed with Candidatus N. mikurensis infection in Europe 2010-2013. Both published (6) and unpublished cases (5) were included. RESULTS: The patients had a median age of 67, were mostly male (8/11), and resided in Sweden, Switzerland, Germany, and the Czech Republic. All but one had ongoing or recent immune suppressive treatment and a majority were splenectomized (8/11). Less than half of them recalled tick exposure. The most frequent symptoms were fever (11/11), localized pain afflicting muscles and/or joints (8/11), vascular and thromboembolic events (6/11), that is, deep vein thrombosis (4), transitory ischemic attacks (2), pulmonary embolism (1), and arterial aneurysm (1). Typical laboratory findings were elevated C-reactive protein, leukocytosis with neutrophilia, and anemia. Median time from onset of symptoms to correct diagnosis was 2 months. In at least 4 cases, the condition was interpreted to be due to the underlying disease, and immunosuppressive therapy was scheduled. All patients recovered completely when doxycycline was administered. CONCLUSIONS: Candidatus N. mikurensis is an emerging tick-borne pathogen that may give rise to a systemic inflammatory syndrome in persons with hematologic or autoimmune diseases that could be mistaken for recurrence of the underlying disease and/or unrelated arteriosclerotic vascular events. Awareness of this new pathogen is warranted among rheumatologists, hematologists, oncologists, and infectious disease specialists.
Asunto(s)
Infecciones por Anaplasmataceae/diagnóstico , Enfermedades Autoinmunes/microbiología , Neoplasias Hematológicas/microbiología , Enfermedades por Picaduras de Garrapatas/diagnóstico , Anciano , Infecciones por Anaplasmataceae/complicaciones , Infecciones por Anaplasmataceae/tratamiento farmacológico , Aneurisma/microbiología , Antibacterianos/uso terapéutico , Proteína C-Reactiva/metabolismo , Enfermedades Transmisibles Emergentes/diagnóstico , Enfermedades Transmisibles Emergentes/tratamiento farmacológico , Enfermedades Transmisibles Emergentes/microbiología , ADN Bacteriano/sangre , Diagnóstico Tardío , Femenino , Fiebre/microbiología , Humanos , Ataque Isquémico Transitorio/microbiología , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/microbiología , Embolia Pulmonar/microbiología , Esplenectomía , Enfermedades por Picaduras de Garrapatas/complicaciones , Enfermedades por Picaduras de Garrapatas/tratamiento farmacológico , Enfermedades por Picaduras de Garrapatas/microbiología , Trombosis de la Vena/microbiologíaAsunto(s)
Aneurisma/etiología , Tronco Braquiocefálico/lesiones , Traumatismos de las Arterias Carótidas/etiología , Cateterismo/efectos adversos , Oxigenación por Membrana Extracorpórea/efectos adversos , Aneurisma/diagnóstico por imagen , Aneurisma/microbiología , Aneurisma/cirugía , Traumatismos de las Arterias Carótidas/cirugía , Niño , Endocarditis/microbiología , Femenino , Humanos , Infecciones Estafilocócicas/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
Mycobacterium malmoense is recognised as an environmental pathogen predominantly affecting populations in Northern Europe. In immuno-competent individuals, isolated pulmonary disease remains the commonest presentation. The authors report a rare case describing a mycotic popliteal aneurysm caused by M malmoense in a 74-year-old man from Hastings, UK with co-existing pulmonary M malmoense disease. Primary pulmonary disease was confirmed by a combination of history, examination and positive radiological and microbiological findings. Tissue analysis of the aneurysm wall during popliteal aneurysm repair confirmed the presence of disseminated M malmoense. Histological analysis of the aneurysm wall showed non-caseating granulomata. The patient completed a 2 year course of rifampicin, ethambutol and clarithromycin which eradicated the organism from his sputum. Further progress has been complicated by the development of an aspergilloma at the site of his eradicated pulmonary M malmoense disease and the need for angioplasty to his bypass grafts 1 year postsurgery.
Asunto(s)
Aneurisma/diagnóstico , Aneurisma/microbiología , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/microbiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Micobacterias no Tuberculosas/aislamiento & purificación , Arteria Poplítea/microbiología , Anciano , Diagnóstico Diferencial , Diagnóstico por Imagen , Humanos , Enfermedades Pulmonares/tratamiento farmacológico , Masculino , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológicoRESUMEN
Takayasu's arteritis (TA) is an inflammatory vasculitis of aorta and its branches, its low incidence limited our recognition to this entity. We sometimes can confuse this disease with polyarteritis nodosa and other vasculitis when no conventional "big artery" involved in TA cases. Here we report a 26-year-old man with Takayasu's arteritis who presented with a provisional intracranial granulomatosis first and then saccular aneurysms between celiac trunk and arteria hepatica communis and many other proteus manifestations, which is seldom described before.
Asunto(s)
Trastornos Cerebrovasculares/diagnóstico , Granuloma/diagnóstico , Infecciones por Proteus/diagnóstico , Arteritis de Takayasu/diagnóstico , Adulto , Aneurisma/diagnóstico , Aneurisma/diagnóstico por imagen , Aneurisma/microbiología , Anticoagulantes/uso terapéutico , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/efectos de los fármacos , Arteria Celíaca/microbiología , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/tratamiento farmacológico , Trastornos Cerebrovasculares/microbiología , Dexametasona/uso terapéutico , Fiebre/diagnóstico , Fiebre/tratamiento farmacológico , Fiebre/microbiología , Glucocorticoides/uso terapéutico , Granuloma/diagnóstico por imagen , Granuloma/tratamiento farmacológico , Granuloma/microbiología , Cefalea/diagnóstico , Cefalea/diagnóstico por imagen , Cefalea/microbiología , Humanos , Masculino , Infecciones por Proteus/diagnóstico por imagen , Infecciones por Proteus/tratamiento farmacológico , Radiografía , Arteritis de Takayasu/diagnóstico por imagen , Arteritis de Takayasu/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Aneurisma/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Anciano , Aneurisma/microbiología , Aneurisma/cirugía , Ecocardiografía Doppler en Color , Endocarditis Bacteriana/complicaciones , Enterococcus faecium/aislamiento & purificación , Femenino , Infecciones por Bacterias Grampositivas/complicaciones , Humanos , Válvula Mitral/microbiología , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Resultado del TratamientoRESUMEN
A 46-year-old man with a medical history notable only for schizophrenia was admitted to hospital with complaints of general fatigue and high fever. Transthoracic echocardiography on day 6 after admission demonstrated a large vegetation (17 mm) on the anterior leaflet of the mitral valve with mild regurgitation and mild aortic regurgitation. The patient also complained of abdominal pain. Abdominal computed tomography showed a remarkable enlargement of the superior mesenteric artery aneurysm (SMAA). An excision of the SMAA and double valve replacement was performed, and the patient was administered a six-week course of intravenous antibiotic therapy.
Asunto(s)
Aneurisma Infectado/microbiología , Aneurisma/microbiología , Endocarditis Bacteriana/microbiología , Arteria Mesentérica Superior/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Dolor Abdominal/microbiología , Aneurisma/diagnóstico por imagen , Aneurisma/cirugía , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/cirugía , Antibacterianos/administración & dosificación , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Quirúrgicos VascularesRESUMEN
The most common clinical presentation of chronic Q fever is endocarditis with infections of aneurysms or vascular prostheses being the second most common presentation. Here, the authors report a case of vascular chronic Q fever. In this patient, a renal artery aneurysm was discovered by abdominal and pelvic CT during a systematic investigation to identify predisposing factors to chronic Q fever because of high antibody titres in a patient with valve disease.
Asunto(s)
Aneurisma/diagnóstico , Aneurisma/microbiología , Fiebre Q/complicaciones , Fiebre Q/diagnóstico , Arteria Renal , Anciano , Antibacterianos/uso terapéutico , Antirreumáticos/uso terapéutico , Diagnóstico Diferencial , Diagnóstico por Imagen , Doxiciclina/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Masculino , Reacción en Cadena de la Polimerasa , Prednisona/uso terapéutico , Fiebre Q/tratamiento farmacológicoRESUMEN
AIM: Microbial biofilm matrix contains polysaccharides and proteins and can require extracellular nucleic acids for initial formation. Experiments were designed to identify infectious pathogens in human aneurysms and to characterize biofilm formed by calcified human arterial-derived nanoparticles. MATERIALS & METHOD: A total of 26 different microbial pathogens were isolated from 48 inflammatory aneurysms. Consistent amounts (0.49 McFarland units) of nanoparticles derived from similar tissue were seeded into 24-well plates and cultured for 21 days in the absence (control) or presence of RNase, tetracycline or gentamicin. RESULTS: Control biofilm developed within 14 days, as detected by concanavalin A and BacLight Green staining. The formation of biofilm in wells treated with RNase was not different from the control; however, gentamicin partially inhibited and tetracycline completely inhibited biofilm formation. Therefore, nanoparticle biofilm retains some characteristics of conventional bacterial biofilm and requires protein-calcium interactions, although extracellular RNA is not required. CONCLUSION: This model system may also allow study of nanosized vesicles derived from donor tissue, including any microbes present, and could provide a useful tool for in vitro investigation of nanoparticle biofilm formation.
Asunto(s)
Aneurisma/microbiología , Biopelículas/crecimiento & desarrollo , Nanopartículas/microbiología , Humanos , Técnicas In VitroAsunto(s)
Aneurisma de la Aorta Torácica/cirugía , Aspergilosis/cirugía , Prótesis Vascular/efectos adversos , Endocarditis/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Mucormicosis/cirugía , Infecciones Relacionadas con Prótesis/cirugía , Esplenectomía , Aneurisma/microbiología , Antifúngicos/uso terapéutico , Arteriopatías Oclusivas/epidemiología , Arteriopatías Oclusivas/microbiología , Arteriopatías Oclusivas/cirugía , Endocarditis/epidemiología , Arteria Femoral/microbiología , Humanos , Masculino , Persona de Mediana Edad , Arteria Poplítea , Infecciones Relacionadas con Prótesis/microbiología , Triazoles/uso terapéuticoRESUMEN
Pythium insidiosum is a fungus that causes disease in both animals and humans. Human pythiosis is an emerging disease in the tropical, subtropical, and temperate regions of the world, occurring in localized and systemic or vascular forms. Most patients with arterial pythiosis have an underlying hemoglobinopathy, such as thalassemia. A case is presented of a thalassemic horse stable worker who developed an ulcerative cutaneous lesion on the lower left leg followed by progressive ascending involvement of the arteries of that extremity with a necrotizing arteritis with aneurysm formation. P. insidiosum was not isolated from the ulcer by culture or wet potassium hydroxide preparations but was diagnosed by histopathologic study of a biopsy. P. insidiosum infection was quickly confirmed by immunoblot method, aiding in preoperative decision making. Many systemic antibiotics or antimycotics have not been effective in the treatment of systemic pythiosis, and radical surgical removal of all infected tissue is the only method to ensure patient survival. An orally administered saturated solution of potassium iodide, amphotericin B-oral solution, and terbinafine has succeeded only in the cutaneous form but had no favorable effect on vascular pythiosis. It is likely that immunotherapy, successfully used in animal pythiosis, may be beneficial in the treatment of human vascular pythiosis.