Outcomes and factors influencing prognosis in patients with vascular pythiosis
© 2016 Society for Vascular Surgery Objective Vascular pythiosis, caused by Pythium insidiosum, is associated with a high mortality rate. We reviewed the outcomes and established the factors predicting prognosis of patients treated in our institution with surgery, antifungal therapy, or immunotherap...
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th-mahidol.412422019-03-14T15:02:10Z Outcomes and factors influencing prognosis in patients with vascular pythiosis Nuttawut Sermsathanasawadi Banjerd Praditsuktavorn Kiattisak Hongku Chumpol Wongwanit Khamin Chinsakchai Chanean Ruangsetakit Suteekhanit Hahtapornsawan Pramook Mutirangura Mahidol University Medicine © 2016 Society for Vascular Surgery Objective Vascular pythiosis, caused by Pythium insidiosum, is associated with a high mortality rate. We reviewed the outcomes and established the factors predicting prognosis of patients treated in our institution with surgery, antifungal therapy, or immunotherapy. Methods We undertook a retrospective record review of patients with vascular pythiosis treated in Siriraj Hospital, Bangkok, Thailand, between January 2005 and January 2015. Patient characteristics, type of surgery, adjunctive antifungal treatment, adjunctive immunotherapy, and disease status of surgical arterial and surrounding soft tissue margins were recorded. We calculated the mortality rate and established factors predicting prognosis. Results The records of 11 patients were reviewed. All patients had thalassemia. Nine patients (81.8%) had a history of contact with contaminated water. The clinical presentations were chronic ulcers (45.5%), toe gangrene (27.3%), pulsatile mass (27.3%), and acute limb ischemia (27.3%). Above-knee amputation was required in 10 patients (90.9%). The mortality rate was 36.4%. Independent variables between survivors and nonsurvivors were lack of an arterial disease-free surgical margin (P =.003), lack of a surrounding soft tissue disease-free surgical margin (P <.05), a suprainguinal lesion (P <.05) and duration of symptoms (P <.05). Adjuvant itraconazole, terbinafine, and Pythium vaccine have a role to play in patients with a disease-free arterial surgical margin but in whom infected surrounding soft tissue could not be completely excised. Conclusions Achieving adequate disease-free surgical margins—especially the arterial margin—at amputation or débridement is the most important prognostic factor in patients with vascular pythiosis. Early detection combined with a multidisciplinary approach to treatment, including surgery, antifungal agents, and immunotherapy, allows the best possible outcome to be obtained. 2018-12-11T03:31:52Z 2019-03-14T08:02:10Z 2018-12-11T03:31:52Z 2019-03-14T08:02:10Z 2016-08-01 Article Journal of Vascular Surgery. Vol.64, No.2 (2016), 411-417 10.1016/j.jvs.2015.12.024 10976809 07415214 2-s2.0-84959487493 https://repository.li.mahidol.ac.th/handle/123456789/41242 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84959487493&origin=inward |
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Medicine Nuttawut Sermsathanasawadi Banjerd Praditsuktavorn Kiattisak Hongku Chumpol Wongwanit Khamin Chinsakchai Chanean Ruangsetakit Suteekhanit Hahtapornsawan Pramook Mutirangura Outcomes and factors influencing prognosis in patients with vascular pythiosis |
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© 2016 Society for Vascular Surgery Objective Vascular pythiosis, caused by Pythium insidiosum, is associated with a high mortality rate. We reviewed the outcomes and established the factors predicting prognosis of patients treated in our institution with surgery, antifungal therapy, or immunotherapy. Methods We undertook a retrospective record review of patients with vascular pythiosis treated in Siriraj Hospital, Bangkok, Thailand, between January 2005 and January 2015. Patient characteristics, type of surgery, adjunctive antifungal treatment, adjunctive immunotherapy, and disease status of surgical arterial and surrounding soft tissue margins were recorded. We calculated the mortality rate and established factors predicting prognosis. Results The records of 11 patients were reviewed. All patients had thalassemia. Nine patients (81.8%) had a history of contact with contaminated water. The clinical presentations were chronic ulcers (45.5%), toe gangrene (27.3%), pulsatile mass (27.3%), and acute limb ischemia (27.3%). Above-knee amputation was required in 10 patients (90.9%). The mortality rate was 36.4%. Independent variables between survivors and nonsurvivors were lack of an arterial disease-free surgical margin (P =.003), lack of a surrounding soft tissue disease-free surgical margin (P <.05), a suprainguinal lesion (P <.05) and duration of symptoms (P <.05). Adjuvant itraconazole, terbinafine, and Pythium vaccine have a role to play in patients with a disease-free arterial surgical margin but in whom infected surrounding soft tissue could not be completely excised. Conclusions Achieving adequate disease-free surgical margins—especially the arterial margin—at amputation or débridement is the most important prognostic factor in patients with vascular pythiosis. Early detection combined with a multidisciplinary approach to treatment, including surgery, antifungal agents, and immunotherapy, allows the best possible outcome to be obtained. |
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Mahidol University Nuttawut Sermsathanasawadi Banjerd Praditsuktavorn Kiattisak Hongku Chumpol Wongwanit Khamin Chinsakchai Chanean Ruangsetakit Suteekhanit Hahtapornsawan Pramook Mutirangura |
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Nuttawut Sermsathanasawadi Banjerd Praditsuktavorn Kiattisak Hongku Chumpol Wongwanit Khamin Chinsakchai Chanean Ruangsetakit Suteekhanit Hahtapornsawan Pramook Mutirangura |
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Nuttawut Sermsathanasawadi |
title |
Outcomes and factors influencing prognosis in patients with vascular pythiosis |
title_short |
Outcomes and factors influencing prognosis in patients with vascular pythiosis |
title_full |
Outcomes and factors influencing prognosis in patients with vascular pythiosis |
title_fullStr |
Outcomes and factors influencing prognosis in patients with vascular pythiosis |
title_full_unstemmed |
Outcomes and factors influencing prognosis in patients with vascular pythiosis |
title_sort |
outcomes and factors influencing prognosis in patients with vascular pythiosis |
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2018 |
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https://repository.li.mahidol.ac.th/handle/123456789/41242 |
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1763491226151026688 |