''Prototheca wickerhamii'' is a ubiquitous

green alga The green algae (singular: green alga) are a group consisting of the Prasinodermophyta and its unnamed sister which contains the Chlorophyta and Charophyta/Streptophyta. The land plants (Embryophytes) have emerged deep in the Charophyte alga as ...

that does not have

chlorophyll Chlorophyll (also chlorophyl) is any of several related green pigments found in cyanobacteria and in the chloroplasts of algae and plants. Its name is derived from the Greek words , ("pale green") and , ("leaf"). Chlorophyll allow plants to a ...

. It is widely present in the environment but is a rare cause of infection in humans (

protothecosis Protothecosis, otherwise known as Algaemia, is a disease found in dogs, cats, cattle, and humans caused by a type of green alga known as ''Prototheca'' that lacks chlorophyll and enters the human or animal bloodstream. It and its close relative '' ...

) and most commonly presents as nodules of the skin. Most cases reported have a suppressed immune system (from drugs or disease). Infection usually results by direct traumatic inoculation.

Identification

Diagnosis can be made through culture of diseased tissue in

Sabouraud dextrose agar Sabouraud agar or Sabouraud dextrose agar (SDA) is a type of agar growth medium containing peptones. It is used to cultivate dermatophytes and other types of fungi, and can also grow filamentous bacteria such as '' Nocardia''. It has utility ...

or by visualization of sporangia containing sporangiospores on tissue

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

(using

hematoxylin Haematoxylin or hematoxylin (), also called natural black 1 or C.I. 75290, is a compound extracted from heartwood of the logwood tree (''Haematoxylum campechianum'') with a chemical formula of . This naturally derived dye has been used as a h ...

/eosin, GMS, or PAS histochemical stains). The organism incites a chronic granulomatous inflammation with infiltrate of histiocytes, lymphocytes, giant cells and occasional eosinophils. The organism has thick wall, internal septations, measures 3–11 µm in diameter. The

sporangia A sporangium (; from Late Latin, ) is an enclosure in which spores are formed. It can be composed of a single cell or can be multicellular. Virtually all plants, fungi, and many other lineages form sporangia at some point in their life cy ...

have very small wedge-shaped endospores arranged radially and moulded (morula-like form). Differential diagnosis: Protothecal sporangia may be confused with ''Coccidioides immitis'', which are much larger

Antimicrobial therapy

Treatment is not standardized.

Amphotericin B Amphotericin B is an antifungal medication used for serious fungal infections and leishmaniasis. The fungal infections it is used to treat include mucormycosis, aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, and cryptococcosis. Fo ...

itraconazole Itraconazole, sometimes abbreviated ITZ, is an antifungal medication used to treat a number of fungal infections. This includes aspergillosis, blastomycosis, coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis. It may be given by mouth ...

posaconazole Posaconazole, sold under the brand name Noxafil among others, is a triazole antifungal medication. It was approved for medical use in the United States in September 2006, and is available as a generic medication. Medical uses Posaconazole is u ...

and

voriconazole Voriconazole, sold under the brand name Vfend among others, is an antifungal medication used to treat a number of fungal infections. This includes aspergillosis, candidiasis, coccidioidomycosis, histoplasmosis, penicilliosis, and infections by '' ...

have all been tried.

References

Chlorellaceae {{green algae-stub