Successful Medical Therapy for Deeply Invasive Facial Infection Due to Pythium Insidiosum in a Child

Clin Infect Dis. 1998 Dec;27(6):1388-93. doi: 10.1086/515042.


Pythiosis occurs in animals and humans who encounter aquatic habitats that harbor Pythium insidiosum. Drug therapy for deeply invasive infections with this organism has been ineffective in humans and animals; patients have been cured only by radical surgical debridement. A 2-year-old boy developed periorbital cellulitis unresponsive to antibiotic and antifungal therapy. The cellulitis extended to the nasopharynx, compromising the airway and necessitating a gastrostomy for feeding. P. insidiosum was isolated from surgical biopsy specimens of the affected tissue. On the basis of in vitro susceptibility studies of the isolate, the patient was treated with a combination of terbinafine and itraconazole. The infection resolved over a period of a few months. The patient remained well 1.5 years after completing a 1-year course of therapy. Cure of deep P. insidiosum infection is feasible with drug therapy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Infective Agents / therapeutic use
  • Cellulitis / diagnostic imaging
  • Cellulitis / drug therapy
  • Cellulitis / microbiology
  • Cellulitis / surgery
  • Child, Preschool
  • Facial Dermatoses / diagnostic imaging
  • Facial Dermatoses / drug therapy
  • Facial Dermatoses / microbiology*
  • Facial Dermatoses / surgery
  • Head
  • Humans
  • Infections / diagnostic imaging
  • Infections / drug therapy
  • Infections / microbiology*
  • Infections / surgery
  • Itraconazole / therapeutic use
  • Male
  • Naphthalenes / therapeutic use
  • Neck
  • Pythium* / isolation & purification
  • Pythium* / pathogenicity
  • Radiography
  • Terbinafine


  • Anti-Infective Agents
  • Naphthalenes
  • Itraconazole
  • Terbinafine