An outbreak of Phialemonium 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, Nathan Keller

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


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.

Original languageAmerican English
Pages (from-to)781-786
Number of pages6
JournalClinical Infectious Diseases
Issue number6
StatePublished - 15 Mar 2005
Externally publishedYes

Bibliographical note

Funding Information:
1Infectious Diseases Unit, 2Laboratory of Microbiology, Departments of 3Neurology and 4Medicine B, and 5Heart Institute, Sheba Medical Center, and 6Infectious Disease Unit and Microbiology Laboratory, Sourasky Medical Center, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, and 7District Health Office, Ministry of Health, Tel Aviv, 8Department of Clinical Microbiology and Infectious Diseases, Hadassah– Hebrew University Medical Center, Jerusalem, Israel; 9CBS Fungal Biodiversity Centre, Utrecht, The Netherlands; and 10Regional Mycology Reference Centre, Hope Hospital, Salford, United Kingdom


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