Pythiosis

Ulcerative and destructive skin lesion on a dog caused by Pythium insidiosum

Pythium hyphae

Pythiosis is a form of infectious disease caused by Pythium insidiosum. It occurs most commonly in dogs and horses, but is also found in cats, cattle, and humans.^[1] The disease is typically found in young, large breed dogs.^[2] Pythium occupies swamps in late summer and infects dogs who drink water containing it. Pythium insidiosum is different from other members of the genus in that human and horse hair, skin, and decaying animal and plant tissue are chemoattractants for its zoospores.^[3]

Epidemiology

Pythiosis occurs in areas with mild winters because the organism survives in standing water that does not reach freezing temperatures.^[4] In the United States it is most commonly found in the Gulf states, especially Louisiana, but has also been found in midwest and eastern states. A cluster of cases of gastrointestinal pythiosis in dogs has been identified in the Sutter Bypass area in Northern California. ^[5] It is also found in southeast Asia, eastern Australia, New Zealand, and South America.

Pathophysiology

It is suspected that pythiosis is caused by invasion of the organism into wounds, either in the skin or in the gastrointestinal tract.^[4] The disease grows slowly in the stomach and small intestine, eventually forming large lumps of granulation tissue. It can also invade surrounding lymph nodes.

Pythiosis in different animals

• Pythiosis of the skin in dogs is very rare, and appears as ulcerated lumps. Primary infection can also occur in the bones and lungs. Dogs with the gastrointestinal form of pythiosis will have severe thickening of one or more portions of the GI tract that may include the stomach, small intestine, colon, rectum, or in rare cases, even the esophagus. The resulting pathology will result in anorexia (no appetite), vomiting, diarrhea (sometimes bloody), and abdominal straining. Extensive weight loss may be evident.^[6]

• In horses, subcutaneous pythiosis is the most common form and infection occurs through a wound while standing in water containing the pathogen.^[3] The disease is also known as leeches, swamp cancer, and bursatti. Lesions are most commonly found on the lower limbs, abdomen, chest, and genitals. They are granulomatous and itchy, and may be ulcerated or fistulated. The lesions often contain yellow, firm masses of dead tissue known as kunkers.^[7] It is possible with chronic infection for the disease to spread to underlying bone.^[8] In humans it can cause arteritis, keratitis, and periorbital cellulitis.^[9]

• In cats pythioisis is almost always confined to the skin as hairless and edematous lesions. It is usually found on the limbs, perineum, and at the base of the tail.^[10] Lesions may also develop in the nasopharynx.^[7]

Treatment

Use of potassium iodide, amphotericin B, and terbinafine has been described in the cutaneous form.^[11]

Aggressive surgical resection is the treatment of choice for pythiosis in dogs and cats.^[12] Because it provides the best opportunity for cure, complete excision of infected tissue should be pursued whenever possible. When cutaneous lesions are limited to a single distal extremity, amputation is often recommended. In animals with gastrointestinal pythiosis, segmental lesions should be resected with 5-cm margins whenever possible. Unfortunately, in many dogs pythiosis is not diagnosed until late in the course of disease, when complete excision is not possible. In addition, the location of the lesion may prevent complete surgical excision.

Medical therapy for non-resectable pythiosis is usually unsuccessful. However, clinical and serologic cures have been obtained using antifungal drugs in a small number of dogs with pythiosis.^[13]

An immunotherapy product derived from antigens of P. insidiosum has been used successfully to treat pythiosis in horses and people. Unfortunately, although controlled trials have not been completed, the efficacy of this product in dogs appears to be poor.^[14]

A new formulation of this therapeutic vaccine has been introduced by us and PavLab (www.pavlab.com). This new formulation cured 50% of the chronic cases that the early vaccine failed to cure. The overall rate of cure of this vaccine (acute plus chronic cases) was 75%. The vaccine cured a case of human pythiosis in a Thailand boy with pythiosis in his arteries (Clin. Infect. Dis. 27:1394;1998).

References