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IDCases 2021 12;24:e01121. Epub 2021 Apr 12.

Mycology Section, Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia.

Prototheca species have been reported to cause infections in human. Typically, clinical symptoms of protothecosis include cutaneous infection, olecranon bursitis, tenosynovitis and disseminated systemic disease. We report a case of septic arthritis in which was isolated from blood. Read More

J Vet Diagn Invest 2021 Jan 3;33(1):156-161. Epub 2020 Dec 3.

Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy.

Protothecosis is an uncommon disease caused by algae of the genus . In dogs, the infection is usually first localized to the colon but has the propensity to later disseminate hematogenously to many other organs, with marked tropism for the eyes and central nervous system. Diagnosis is established by culture and/or evidence of organisms in cytologic or histologic preparations. Read More

Skinmed 2020 1;18(5):312-314. Epub 2020 Oct 1.

Pathology Department, University Hospital Crosshouse, NHS Ayrshire & Arran, Scotland, UK;

A 67-year-old Scottish woman presented to her general practitioner with a subcentimeter lump between her shoulder blades. The lump was suspected to be an epidermal cyst and was excised. The patient had a history of controlled diabetes. Read More

J Clin Lab Anal 2020 Nov 21;34(11):e23492. Epub 2020 Jul 21.

Department of Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

Background: Prototheca species are a group of organisms ubiquitously existing in nature but have become a pathogenic threat to public health, which has aroused wide attention. Species identification and antifungal susceptibility have essential and valuable meanings to clinical diagnosis and treatment.

Methods: A case of an 84-year-old patient who had suffered from multiple cutaneous infections was reported. Read More

Indian J Dermatol Venereol Leprol 2020 Jul-Aug;86(4):414-417

Department of Dermatology, Goa Medical College, Bambolim, Goa, India.

Mycopathologia 2020 06 17;185(3):595-596. Epub 2020 May 17.

Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China.

Australas J Dermatol 2020 Aug 5;61(3):277-279. Epub 2020 Mar 5.

Private practice, Bankstown, NSW, Australia.

Front Cell Infect Microbiol 2020 7;10:31. Epub 2020 Feb 7.

Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.

(formerly genotype-II) is an opportunistic, achlorophyllous alga that causes mastitis in cows and skin disease in cats and dogs, as well as cutaneous lesions in both immunocompetent and immunosuppressed humans. Antifungal medications are commonly ineffective. This study aimed to investigate innate immune responses contributed by cathelicidins to in the mammary gland using a mastitis model in mice deficient in the sole murine cathelicidin (). Read More

An Bras Dermatol 2020 Mar - Apr;95(2):210-213. Epub 2020 Jan 21.

Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Protothecosis is a rare condition caused by the aclorophylated algae of the genus Prototheca. In humans, protothecosis, caused mainly by P. wickerhamii, manifests itself in three forms: cutaneous, articular and systemic. Read More

J Clin Aesthet Dermatol 2019 Dec 1;12(12):13-16. Epub 2019 Dec 1.

Drs. El Hoshy, Abdel-Halim, El-Nabarawy, and Shalaby are with the Dermatology Department at Cairo University in Cairo, Egypt.

A 77-year-old female patient presented with bilateral tender, swollen, erythematous, focally crusted cheeks with a discharge of pus and necrotic material, which had developed one month after autologous fat transfer and a corrective injection procedure conducted to correct an overdone fat transfer. Histopathological examination of the discharged material using routine hematoxylin and eosin staining revealed degenerated collagen admixed with three different filler materials. Scattered all throughout the specimen were numerous thick-walled, basophilic, nonbudding spherical bodies of variable sizes. Read More

Photodiagnosis Photodyn Ther 2019 Mar 23;25:280-284. Epub 2018 Dec 23.

Department of Dermatology, Affiliated Third Hospital of Hangzhou, Anhui Medical University, West Lake Rd 38, Hangzhou, China. Electronic address:

Background: Antimicrobial photodynamic therapy(aPDT) has been used to treat localized cutaneous fungal infections that have an enhanced antifungal susceptibility profile. The aim of this study was to evaluate the effect of ALA aPDT on both the growth and the antimicrobial and antifungal susceptibility of Prototheca wickerhamii.

Methods: Six isolates of P. Read More

Mycopathologia 2018 Oct 16;183(5):821-828. Epub 2018 Aug 16.

Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Er Road, Guangzhou, 510080, China.

We present a case of cutaneous protothecosis caused by Prototheca wickerhamii infection. The patient was a 72-year-old man with hypoalbuminemia. He responded well to fluconazole treatment. Read More

J Clin Microbiol 2018 10 25;56(10). Epub 2018 Sep 25.

Department of Molecular Phylogenetics and Evolution, Biological and Chemical Research Centre, Faculty of Biology, University of Warsaw, Warsaw, Poland.

Achlorophyllous unicellular microalgae of the genus (, ) are the only known plants that cause infections in both humans and animals, collectively referred to as protothecosis. Human protothecosis, most commonly manifested as cutaneous, articular, and disseminated disease, is primarily caused by , followed by and, sporadically, by and In veterinary medicine, however, is a major pathogen responsible for bovine mastitis, which is a predominant form of protothecal disease in animals. Historically, identification of spp. Read More

Int J Dermatol 2018 10 30;57(10):1246-1248. Epub 2018 Mar 30.

Department of Dermatology, Dell Medical School at The University of Texas at Austin, Austin, TX, USA.

J Eur Acad Dermatol Venereol 2018 08 5;32(8):e327. Epub 2018 Mar 5.

Department of Dermatology, Affiliated Third Hospital of Hangzhou, Anhui Medical University, West Lake Rd 38, Hangzhou, Zhejiang, 310009, China.

J Eur Acad Dermatol Venereol 2018 Sep 12;32(9):1575-1583. Epub 2018 Feb 12.

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

Background: Protothecosis is an uncommon infection caused by the achlorophyllic algae found more commonly in tropical areas. Only a limited number of cases have been reported.

Objective: We aimed to evaluate the clinicopathological features and treatment outcomes of cutaneous protothecosis. Read More

J Dermatol 2018 Jan 16;45(1):67-71. Epub 2017 Aug 16.

Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

An 85-year-old Japanese woman presented with infiltrative erythema and ulceration on the extensor surface of her right forearm. Direct microscopic examination demonstrated spherical and morula-like sporangia, while histopathology revealed numerous microorganisms with a mulberry-like appearance in the dermis. Staining of the microorganisms also showed mulberry-like sporangia that resembled the spokes of a wheel. Read More

Med Mycol J 2017 ;58(2):E71-E77

Department of Dermatology, Kitasato University Kitasato Institute Hospital.

Understanding deep cutaneous fungal infection requires not only reading many case reports and checking the typical clinical images of skin lesions, but also managing the patients properly to prevent misdiagnosis. Herein, I review my recent experiences with eight typical cases of deep cutaneous infections (including protothecosis and nocardiosis) in Japan. It is very important to do the four management processes; namely, KOH direct microscopic examination, skin biopsy, fungal culture, and microscopic examination of the histopathological specimen of PAS and Grocott staining. Read More

Arkh Patol 2017;79(1):52-55

M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia.

The paper describes a case of a rare opportunistic infection, such as skin lesion caused by achlorophyllic unicellular algae of the genus Prototheca. It provides a detailed pathologic description of the foci of cutaneous protothecosis, such as pandermal inflammatory infiltrate, granulomas, pseudoepitheliomatous hyperplasia, and intraepidermal abscesses. Criteria for pathogen detection in histological sections are given. Read More

Pediatr Infect Dis J 2017 07;36(7):687-689

From the *Department of Laboratory Medicine, †Department of Pediatrics, and ‡Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Human protothecosis is mainly a cutaneous infection caused by the Prototheca species. Prototheca wickerhamii is an established pathogen of eosinophilic meningoencephalitis in dogs, but no eosinophilic pleocytosis of the cerebrospinal fluid has been reported in human cases of meningitis. Herein, we report a case of chronic protothecosis manifesting eosinophilic meningoencephalitis in an immunocompetent boy. Read More

Clin Exp Dermatol 2017 Jan;42(1):72-74

National Skin Centre, Singapore, Singapore.

Cutaneous protothecosis is caused by the achlorophyllic algae Prototheca, typically presenting as a localized plaque in immunocompetent individuals. We report a patient with bilateral erythematous plaques and pustules on her forearms, which had initially been treated with steroids for presumed eczema. Histology showed spherical spore-like bodies with internal morula-like septation, which were positive for periodic-acid-Schiff (PAS) staining, consistent with cutaneous protothecosis. Read More

Mycopathologia 2017 Jun 26;182(5-6):603-608. Epub 2016 Dec 26.

General Diagnostic Department, Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411, 00178, Rome, Italy.

Protothecosis is a disease caused by saprophyte aerobic unicellular algae belonging to the genus Prototheca. In dogs, it mainly occurs as a disseminated form, with initial clinical manifestations often referable to the gastrointestinal tract, followed by typical ocular and neurological signs. So far, Prototheca zopfii genotype 2 infection has been reported in severe forms of disseminated protothecosis, while in dogs has never been associated with cutaneous forms. Read More

Int J Dermatol 2016 Dec 23;55(12):1373-1377. Epub 2015 Dec 23.

Department of Dermatology, Gil Medical Center, Gachon University School of Medicine, Incheon, South Korea.

Med Mycol Case Rep 2016 Jun 3;12:21-3. Epub 2016 Aug 3.

Westmead Hospital, Sydney 2145, Australia.

Protothecosis is a rare algal infection, affecting primarily immunocompromised hosts. Optimal management is unclear: in-vitro antimicrobial breakpoints are not established and therapeutic decisions are primarily based on case reports. We present a case of cutaneous Prototheca wickerhamii infection in an immunosuppressed 63 year old male, successfully treated with liposomal amphotericin and prolonged itraconazole. Read More

Ann Dermatol 2016 Apr 31;28(2):273-4. Epub 2016 Mar 31.

Department of Dermatology, Ewha Womans University School of Medicine, Seoul, Korea.

Case Rep Vet Med 2016 29;2016:2878751. Epub 2016 Feb 29.

Quality Veterinary Practice, 383 33 Volos, Greece.

is ubiquitous, saprophytic achlorophyllous algae that cause opportunistic infections in the dog and cat and disseminated disease usually in immunocompromised animals. In this report an uncommon case of canine cutaneous protothecosis is presented. A 6-year-old female boxer was brought in with skin lesions that consisted of nodules and generalized footpad hyperkeratosis, depigmentation, and erosion. Read More

Transpl Infect Dis 2015 Aug 7;17(4):599-604. Epub 2015 Jul 7.

Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA.

Prototheca wickerhamii is an alga that rarely causes human disease but has been reported increasingly among immunocompromised individuals. We report a fatal case of P. wickerhamii in a renal transplant recipient who presented with a cutaneous lesion that led to disseminated disease despite treatment with voriconazole. Read More

J Comp Pathol 2015 May 23;152(4):287-90. Epub 2015 Mar 23.

Institute of Pathology, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 33, Leipzig, Germany. Electronic address:

Few published cases of feline protothecosis exist; all of these were restricted to the skin and speciation of the causative organism revealed an infection with Prototheca wickerhamii in each case. This report describes Prototheca zopfii genotype 2-induced inflammation of the nasal skin and cutaneous mucosa of the right nostril in a 14-year-old neutered female domestic shorthair cat. Microscopical examination revealed marked pyogranulomatous inflammation with numerous intralesional algae. Read More

J Fungi (Basel) 2015 Jan 14;1(1):4-12. Epub 2015 Jan 14.

Department of Dermatology, Baylor College of Medicine, 1977 Butler Blvd, Suite E6.200, Houston, TX 77030, USA.

Protothecosis is a rare infection, which has the potential to cause severe disease in patients with underlying immunosuppression. We describe a case of an elderly female with chronic lymphocytic leukemia (CLL), as well as other risk factors, who presented with pustular and erythematous plaques, initially presumed to be leukemia cutis. A biopsy with special stains revealed the lesions to be cutaneous protothecosis, thus presenting a most unusual concurrence of disease entities. Read More

Mycopathologia 2015 Feb 9;179(1-2):163-6. Epub 2014 Sep 9.

Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, China,

We report a case of cutaneous protothecosis due to Prototheca wickerhamii in an immunocompetent man presented with a specific eczema-like lesions. Dermatological examination revealed erythematous plaques, dark red papules with some coalescence, and a few superficial ulcerations, covered with less scales on his right side chest and neck. Fungal culture, histopathological examination and molecular identification confirmed the organism. Read More