epiglucan and Pythiosis

Pythiosis is an emerging infectious disease caused by the aquatic oomycete Pythium insidiosum, a fungal-like organism. It is believed that P. insidiosum's zoospores, its infected form, play major role in pathogenesis. Vascular and ocular infections are the most common clinical manifestation in humans. It is difficult to establish the diagnosis given its relatively rarity and difficulty to distinguish P. insidiosum from other molds. Delay in diagnosis and treatment has been associated with poor outcomes. High index of suspicion is the key, particularly in thalassemia patients with arterial insufficiency and patients with fungal keratitis/endophthalmitis without improvement on antifungal therapy. Tissue culture and zoospore induction remain gold standard for diagnosis; however, DNA-based method should be performed simultaneously. The combination of radical surgery, antifungal agents, and immunotherapy has been recommended. It was previously believed that surgery with negative surgical margins was the essential to survive in vascular pythiosis; however, it was recently found that patients could have residual disease despite documented negative surgical margins as infected clot may be dislodged to proximal arterial sites prior to surgery. Serum β-D-glucan (BG) has been used to monitor disease response after treatment initiation in vascular pythiosis. A significant decrease in BG levels within 2 weeks after surgery is indicative of the absence of residual infection. Unfortunately, monitoring tools for ocular pythiosis are not yet available. Itraconazole plus terbinafine have generally been used in P. insidiosum-infected patients; however, antibacterial agents, including azithromycin and linezolid, have also been used with favorable outcomes in ocular disease. Recently, azithromycin or clarithromycin plus doxycyclin were used in two relapsed vascular pythiosis patients with good outcomes.

Topics: Anti-Bacterial Agents; Antifungal Agents; beta-Glucans; Communicable Diseases, Emerging; Drug Combinations; Eye Infections, Fungal; Immunotherapy; Itraconazole; Oomycetes; Pathology, Molecular; Pythiosis; Pythium; Serologic Tests; Spores, Fungal; Terbinafine; Thalassemia; Vascular System Injuries

Ocular pythiosis is the second most common form of human pythiosis, and the rates of evisceration/enucleation in Thailand are 55-79%. This prospective study was conducted to evaluate treatment outcomes of the combination therapy protocol and the potential use of serum (1→3)-β-glucan (BG) and Pythium insidiosum-specific antibody (Pi-Ab) as an aid to diagnosis and monitoring of ocular pythiosis. Thirty patients were enrolled in the study and 14 (non-globe salvage) required evisceration/enucleation. The globe salvage group was significantly younger, and first ocular surgeries were performed significantly sooner than in the non-globe salvage group. Serum BG and Pi-Ab levels were similar among the 2 groups over time. In vitro susceptibility testing of antifungal agents revealed relatively high minimum inhibitory concentrations and lack of synergistic effect. Serum BG and Pi-Ab would not be useful in diagnosis and monitoring of ocular pythiosis. Until effective antimicrobial agents are discovered, ocular surgeries are still the mainstay therapy in Thailand.

Topics: Adult; Antibodies, Fungal; Antifungal Agents; Antigens, Fungal; beta-Glucans; Combined Modality Therapy; Diagnostic Tests, Routine; Eye Infections, Fungal; Female; Humans; Immunologic Factors; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Proteoglycans; Pythiosis; Pythium; Thailand; Treatment Outcome; Young Adult

Pythiosis is a life-threatening disease caused by the fungus-like microorganism Pythium insidiosum that can lead to death if not treated. Since P. insidiosum has particular cell wall characteristics, pythiosis is difficult to treat, as it does not respond well to traditional antifungal drugs. In our study, we investigated a new immunotherapeutic approach with potential use in treatment and in the acquisition of immunity against pythiosis. Dendritic cells from both human and mouse, pulsed with P. insidiosum heat-inactivated zoospore, (1,3)(1,6)-β-glucan and the immunotherapeutic PitiumVac

Topics: Animals; Antigen Presentation; beta-Glucans; Cell Differentiation; Cell Proliferation; Cells, Cultured; Cytokines; Dendritic Cells; Hot Temperature; Humans; Immunotherapy; Lymphocyte Activation; Mice; Pythiosis; Pythium; Spores, Fungal; Th1 Cells; Vaccines, Inactivated

Despite aggressive treatment, vascular pythiosis has a mortality rate of 40%. This is due to delays in diagnosis and a lack of effective monitoring tools. To overcome this drawback, serum beta-d-glucan (BG) and

Topics: Adult; Aged; Antibodies, Bacterial; Antifungal Agents; beta-Glucans; Biomarkers; Female; Follow-Up Studies; Humans; Immunoglobulin G; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Pythiosis; Pythium; Young Adult

In vitro experiments were carried out to test the efficacy of GNP (β-D-glucan nanoparticle prepared from mycelium of Pythium aphanidermatum) against rhizome rot disease of turmeric (Curcuma longa L.) caused by P. aphanidermatum. GNP (0.1%, w/v) was applied to rhizome prior to inoculation with P. aphanidermatum (0 h, 24 h). Cell death, activities of defense enzymes such as peroxidase, polyphenol oxidase, protease inhibitor and β-1,3 glucanase were monitored. Prior application of GNP (24 h) to turmeric rhizome effectively controls P. aphanidermatum infection. The increase in defense enzyme activities occurred more rapidly and was enhanced in P. aphanidermatum infected rhizomes that were pre-treated with GNP. Pre-treatment also induced new isoforms of defense enzymes. Increased activities of defense enzymes suggest that they play a key role in restricting the development of disease symptoms in the rhizomes as evidenced by a reduction in cell death. The results demonstrated that GNP can be used as a potential agent for control of rhizome rot disease.

Topics: beta-Glucans; Catechol Oxidase; Cell Death; Curcuma; Enzyme Activation; Mycelium; Nanoparticles; Peroxidase; Plant Diseases; Pythiosis; Pythium