Journal Article

An Outbreak of <i>Phialemonium</i> Infective Endocarditis Linked to Intracavernous Penile Injections for the Treatment of Impotence

Jacob Strahilevitz, Galia Rahav, Hans-Josef Schroers, Richard C. Summerbell, Ziva Amitai, Anna Goldschmied-Reouven, Ethan Rubinstein, Yvonne Schwammenthal, Micha S. Feinberg, Yardena Siegman-Igra, Edna Bash, Itzhack Polacheck, Adrian Zelazny, Susan J. Howard, Pnina Cibotaro, Ora Shovman and Nathan Keller

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 6, pages 781-786
Published in print March 2005 | ISSN: 1058-4838
Published online March 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/428045
An Outbreak of Phialemonium Infective Endocarditis Linked to Intracavernous Penile Injections for the Treatment of Impotence

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Background. In March 2002, a patient in Tel Aviv, Israel, died of endocarditis caused by Phialemonium curvatum. As part of his therapy for erectile dysfunction, the patient had been trained to self-inject a compound of vasoactive drugs provided by an impotence clinic into his penile corpus cavernosous.

Methods. We identified the used prefilled syringes as the source of his infection. Similar cases were investigated as a putative outbreak of P. curvatum invasive disease among customers of this impotence clinic. P. curvatum isolates, cultured from samples obtained from the patients and from prefilled syringes, were compared by DNA sequencing of the nuclear ribosomal internal transcribed spacer.

Results. We identified 2 additional customers at the impotence clinic who had P. curvatum endocarditis. In addition, cultures of unused, prefilled syringes and bottles provided by the same clinic to 5 asymptomatic customers tested positive for pathogenic molds (P. curvatum in 4 cases and Paecilomyces lilacinus in 1). All P. curvatum isolates were of a single genetic type that is known only from this outbreak but is closely related to 3 other P. curvatum genotypes associated with pathogenicity in humans.

Conclusions. P. curvatum is an emerging pathogen that can be readily isolated from blood. We identified an outbreak of P. curvatum endocarditis among men who had erectile dysfunction treated by intracavernous penile injections from contaminated prefilled syringes.

Journal Article.  3778 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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