{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:19:04Z","timestamp":1788913144630,"version":"build-2803163510"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100010724","name":"Health Systems Research Institute","doi-asserted-by":"publisher","award":["HSRI 63-003"],"award-info":[{"award-number":["HSRI 63-003"]}],"id":[{"id":"10.13039\/501100010724","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010724","name":"Health Systems Research Institute","doi-asserted-by":"publisher","award":["HSRI 64-087"],"award-info":[{"award-number":["HSRI 64-087"]}],"id":[{"id":"10.13039\/501100010724","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010724","name":"Health Systems Research Institute","doi-asserted-by":"publisher","award":["HSRI 66-053"],"award-info":[{"award-number":["HSRI 66-053"]}],"id":[{"id":"10.13039\/501100010724","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ratchadapiseksompotch Research Fund"},{"DOI":"10.13039\/501100002873","name":"Chulalongkorn University","doi-asserted-by":"publisher","award":["RA-MF-27\/64"],"award-info":[{"award-number":["RA-MF-27\/64"]}],"id":[{"id":"10.13039\/501100002873","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002873","name":"Chulalongkorn University","doi-asserted-by":"publisher","award":["RA-MF-28\/65"],"award-info":[{"award-number":["RA-MF-28\/65"]}],"id":[{"id":"10.13039\/501100002873","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Vascular pythiosis, caused by Pythium insidiosum, is a life-threatening disease with high mortality rate in patients with residual disease post-surgery. This study evaluated the effectiveness of a combination therapy of surgery, azithromycin, doxycycline, and itraconazole.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this open-label, Phase II multicenter trial, 51 patients were enrolled. Patients were categorized based on residual disease post-surgery (unresectable lesions, incomplete resection, or persistent symptoms). Patients with residual disease received azithromycin (500\u2005mg daily), doxycycline (100\u2005mg twice daily), and itraconazole (200\u2005mg thrice daily) until beta-d-glucan (BDG) levels were negative (&amp;lt;80\u2005pg\/mL) for 3 months. Those without residual disease received the same regimen for 6 months. Outcomes included all-cause mortality at 6 months, adverse events, changes in BDG levels over time, and factors associated with residual disease and mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At 6 months, the all-cause mortality rate was 15.7%. Mortality in patients with residual disease was 31.5% compared to 6.25% for those without (P = .04). Lesions above the popliteal artery were a significant predictor of residual disease (incidence rate ratio [IRR] 3.20, 95% confidence interval [CI]: 1.08\u201311.70). BDG levels decreased over time (odds ratio [OR] 0.82, 95% CI: .77\u2013.88 per week, P &amp;lt; .001) but remained higher in the residual disease group (OR 4.29, 95% CI: 1.55\u201311.92)<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The combination therapy of surgery, azithromycin, doxycycline, and itraconazole improves survival in patients with vascular pythiosis, including those with residual disease. This regimen is well tolerated and should be considered a standard of care, with further research needed for long-term outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaf062","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T23:36:08Z","timestamp":1738971368000},"page":"1281-1289","source":"Crossref","is-referenced-by-count":7,"title":["Improved Survival in Vascular Pythiosis With Surgery and Azithromycin, Doxycycline, and Itraconazole Therapy: A Phase II Multicenter, Open-Label, Single-Arm Trial"],"prefix":"10.1093","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9507-6339","authenticated-orcid":false,"given":"Pattama","family":"Torvorapanit","sequence":"first","affiliation":[{"name":"Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital , Bangkok ,","place":["Thailand"]},{"name":"Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5055-6830","authenticated-orcid":false,"given":"Navaporn","family":"Worasilchai","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine and Clinical Microbiology, Faculty of Allied Health Sciences, Chulalongkorn University , Bangkok ,","place":["Thailand"]},{"name":"Research Unit of Medical Mycology Diagnosis, Chulalongkorn University , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2446-143X","authenticated-orcid":false,"given":"Kasama","family":"Manothummetha","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jackson Memorial Hospital\/University of Miami , Miami, Florida ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9296-6344","authenticated-orcid":false,"given":"Karan","family":"Srisurapanont","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Chiang Mai University , Chiang Mai ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7279-1062","authenticated-orcid":false,"given":"Achitpol","family":"Thongkam","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1889-7122","authenticated-orcid":false,"given":"Nattapong","family":"Langsiri","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0854-3056","authenticated-orcid":false,"given":"Surachai","family":"Leksuwankun","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9544-7096","authenticated-orcid":false,"given":"Tanaporn","family":"Meejun","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Chulalongkorn University , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1880-5387","authenticated-orcid":false,"given":"Jaedvara","family":"Thanakitcharu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University , Nonthaburi ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0143-6407","authenticated-orcid":false,"given":"Bhoowit","family":"Lerttiendamrong","sequence":"additional","affiliation":[{"name":"Siriraj Medical Simulation for Education and Training, Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1128-8113","authenticated-orcid":false,"given":"Nuttapon","family":"Susaengrat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Khonkaen Hospital , Khonkaen ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9474-637X","authenticated-orcid":false,"given":"Nipat","family":"Chuleerarux","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jackson Memorial Hospital\/University of Miami , Miami, Florida ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirada","family":"Siriyakorn","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rajavithi Hospital , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sureerat","family":"Watcharasuwanseree","sequence":"additional","affiliation":[{"name":"Department of Medicine, Udon Thani hospital , Udon Thani ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinyo","family":"Suparatanachatpun","sequence":"additional","affiliation":[{"name":"Department of Surgery, Udon Thani hospital , 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,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7874-2651","authenticated-orcid":false,"given":"Watchara","family":"Wattanasoontornsakul","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maharat Nakhon Ratchasima Hospital , Nakhon Ratchasima ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratiporn","family":"Bansong","sequence":"additional","affiliation":[{"name":"Department of Medicine, Sunpasitthiprasong Hospital , Ubonratchathani ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1481-1950","authenticated-orcid":false,"given":"Parichart","family":"Sakulkonkij","sequence":"additional","affiliation":[{"name":"Department of Medicine, Lampang Hospital , Lampang 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