{"doi":"10.1093/jpids/piaa049","title":"Chronic Meningitis Due to <i>Prototheca zopfii</i> in an Adolescent Girl","abstract":"Prototheca species are unicellular, achlorophyllic algae that are ubiquitously distributed in nature [1]. Human protothecosis typically involves the cutaneous and subcutaneous tissues, and rarely causes systemic disease [2]. We report here a case of chronic meningitis due to Prototheca zopfii in an immunocompetent adolescent girl. The patient is an Amish girl who was in her usual state of health until the age of 13 (in 2014) when she developed increasing fatigue. In the fall of 2015, she developed a shuffling gait and had trouble bending over. In 2016 she started to complain of headaches and had a computed tomographic scan of her head at an outside institution, which was reportedly unremarkable. Later in 2016 she developed pain in her lumbar spine and bilateral lower extremities. The pain appeared gradually, was worse in the popliteal region, and progressed to the point that she had difficulty extending her knees and ambulating despite physical therapy. Given continued symptoms, the patient traveled to Tijuana, Mexico, where she underwent brain imaging showing hydrocephalus, with subsequent placement of a ventriculoperitoneal (VP) shunt in 2016. The patient’s back and bilateral lower extremity pain improved; however, her ability to extend her knees and to ambulate did not. In 2017 she presented to the Clinic for Special Children where she underwent evaluation for failure to thrive and amenorrhea. Repeat brain magnetic resonance imaging (MRI) in May 2017 was remarkable for hydrocephalus and leptomeningeal enhancement over the dorsal and ventral corticomedullary junction and cerebellum. She was subsequently referred to the neurosurgery division at Nemours/Alfred I. duPont Hospital for Children (AIDHC) where aerobic cultures of cerebrospinal fluid (CSF) obtained from her VP shunt did not grow any bacteria. Later in 2017 she returned to Mexico for further evaluation and was treated for a “culture-negative infection” with 1 week of intravenous antibiotics. She returned to the neurosurgery clinic at AIDHC in 2018 with continued headache, lower back and bilateral leg pain, poor appetite, and weight loss. At this time her body mass index was 14 kg/m2, and her examination was notable for Tanner stage 2 breasts and Tanner stage 1 pubic hair, and inability to flex at the waist beyond 15 degrees when her knees were extended. The remainder of her examination, including assessment of cranial nerves, sensation, and strength, were within normal limits. The patient underwent MRI of her brain and spine. The imaging, displayed in Figure 1, showed a flattened and deformed spinal cord due to adjacent septations and loculations with enhancement along the surface of the spinal cord consistent with a chronic inflammatory process. Ventriculomegaly with septations across the lateral ventricles and diffuse meningeal enhancement over the bilateral cerebral hemispheres were also noted. Laboratory studies obtained at the time showed an elevated erythrocyte sedimentation rate to 39 mm/hour, with a normal white blood cell (WBC) count (11 200/µL but with a neutrophilic predominance (80.4%). T2 fast recovery fast spin echo magnetic resonance image of spine showing evidence of chronic meningitis. The patient’s medical history was significant for failure to enter puberty, and her only past surgical history was placement of the previously described VP shunt. The patient was Amish and lived on a farm in rural Pennsylvania with her mother, father, and 8 siblings. Her family history was unremarkable, and immunizations were up to date. Notable exposures included travel to Mexico, swimming in freshwater ponds in Pennsylvania, and working on a farm, including the milking of cows. The patient subsequently underwent a lumbar puncture, which showed 560 WBCs and 3400 red blood cells/μL. A differential and glucose/protein were not performed. Gram stain was negative, as was a BioFire FilmArray Meningitis/Encephalitis panel. Aerobic, mycobacterial, and fungal cultures were ne","journal":"Journal of the Pediatric Infectious Diseases Society","year":2020,"id":110470,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.962,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":526409,"name":"Salwa Sulieman","orcid":null,"position":1,"is_corresponding":false},{"id":525563,"name":"Vincent J. Carson","orcid":"0000-0002-0402-4849","position":2,"is_corresponding":false},{"id":525564,"name":"Michael D. Fox","orcid":"0000-0003-1297-6935","position":3,"is_corresponding":false},{"id":525562,"name":"Torsten Joerger","orcid":"0000-0002-1915-4275","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-18T23:12:57.988348Z","pmid":"32415770","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}