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BMC Infectious Diseases Dec 2012Mycetoma is a chronic, localized, slowly progressing infection of the cutaneous and subcutaneous tissues caused either by fungi (eumycetoma or implantation mycosis) or... (Review)
Review
BACKGROUND
Mycetoma is a chronic, localized, slowly progressing infection of the cutaneous and subcutaneous tissues caused either by fungi (eumycetoma or implantation mycosis) or by aerobic actinomycetes (actinomycetoma). It is acquired by traumatic implantation, most commonly in the tropics and subtropics, especially in rural agricultural communities. Although well recognized elsewhere in Asia, it has not been reported from the Lao People's Democratic Republic (Laos).
CASE PRESENTATION
A 30 year-old female elementary school teacher and rice farmer from northeast Laos was admitted to Mahosot Hospital, Vientiane, with a massive growth on her left foot, without a history of trauma. The swelling had progressed slowly but painlessly over 5 years and multiple draining sinuses had developed. Ten days before admission the foot had increased considerably in size and became very painful, with multiple sinuses and discharge, preventing her from walking. Gram stain and bacterial culture of tissue biopsies revealed a branching filamentous Gram-positive bacterium that was subsequently identified as Actinomadura madurae by 16S rRNA gene amplification and sequencing. She was treated with long-term co-trimoxazole and multiple 3-week cycles of amikacin with a good therapeutic response.
CONCLUSION
We report the first patient with actinomycetoma from Laos. The disease should be considered in the differential diagnosis of chronic skin and bone infections in patients from rural SE Asia.
Topics: Actinomycetales; Adult; Amikacin; Anti-Bacterial Agents; Biopsy; Cluster Analysis; DNA, Bacterial; DNA, Ribosomal; Female; Foot; Humans; Laos; Mycetoma; Phylogeny; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 23234466
DOI: 10.1186/1471-2334-12-349 -
Revista Chilena de Infectologia :... Aug 2012Mycetoma is a chronic, granulomatous, subcutaneous, inflammatory lesion caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Mycetoma commonly...
Mycetoma is a chronic, granulomatous, subcutaneous, inflammatory lesion caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Mycetoma commonly affects young people between 20 and 40 years old. The most common affected site is the foot. The characteristic clinical triad is tumefaction, draining sinuses and discharging grains. We report a healthy 31-year-old male, with a 6-year history of a progressive inflammatory tumor associated with sinus tracts and granules on his left sole. Actinomycetoma was suspected. The clinical diagnosis was confirmed by microbiological and histopathological study. Polymerase chain reaction and DNA sequencing identified Actinomadura madurae. To our knowledge, this is the second case of mycetoma reported in Chile. Our report emphasizes the need to consider this diagnosis in patients with chronic granulomatous disease associated with sinus tracts, fistulas and grains.
Topics: Actinomycetales Infections; Adult; Anti-Bacterial Agents; Biopsy; Foot Dermatoses; Humans; Male; Mycetoma; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 23096551
DOI: 10.4067/S0716-10182012000400018 -
Le Infezioni in Medicina Jun 2018Mycetoma (or "madura foot") is characterized by deformation, cutaneous lesions, infection of tissues extending from the cutaneous layer to the underlying fascia, and an...
Mycetoma (or "madura foot") is characterized by deformation, cutaneous lesions, infection of tissues extending from the cutaneous layer to the underlying fascia, and an indolent course. A number of fungal or bacterial agents that are introduced through traumatic inoculation can be responsible for the disease, but Actinomadura madurae is among the most common agents of mycetoma occurring worldwide. We report a case of madura foot caused by A. madurae in an immunocompetent young Somali man who was admitted with a diagnosis of skin and soft tissue infection of the left foot with osteomyelitis. The present report emphasizes the importance of the knowledge of this infection, which is sporadic but problematic to treat and, above all, difficult to diagnose. Moreover, a multidisciplinary approach with involvement of an infectious diseases specialist with experience in tropical diseases and a microbiology unit performing rapid molecular diagnostic tests is required for early diagnosis and an optimal antibiotic therapy.
Topics: Communicable Diseases, Imported; Humans; Italy; Male; Mycetoma; Somalia; Young Adult
PubMed: 29932092
DOI: No ID Found -
Journal of Clinical Microbiology Dec 2013Next-generation DNA sequencing can be used to catalog individual organisms within complex, polymicrobial specimens. Here, we utilized deep sequencing of 16S rRNA to...
Next-generation DNA sequencing can be used to catalog individual organisms within complex, polymicrobial specimens. Here, we utilized deep sequencing of 16S rRNA to implicate Actinomadura madurae as the cause of mycetoma in a diabetic patient when culture and conventional molecular methods were overwhelmed by overgrowth of other organisms.
Topics: Actinomycetales; Cluster Analysis; DNA, Bacterial; DNA, Ribosomal; Diabetes Complications; Female; Foot; High-Throughput Nucleotide Sequencing; Histocytochemistry; Humans; Microscopy; Middle Aged; Molecular Sequence Data; Mycetoma; Phylogeny; RNA, Ribosomal, 16S
PubMed: 24108607
DOI: 10.1128/JCM.02227-13 -
The Journal of General and Applied... Dec 2008The taxonomic position of one soil isolate 13-12(50)(T) was clarified by a polyphasic study. The organism showed a combination of chemotaxonomic and morphological...
The taxonomic position of one soil isolate 13-12(50)(T) was clarified by a polyphasic study. The organism showed a combination of chemotaxonomic and morphological properties typical of the genus Actinomadura. It formed a distinct phyletic line in the Actinomadura 16S rRNA gene tree and was closely associated with Actinomadura mexicana (sequence similarity 99.5%), Actinomadura glauciflava, Actinomadura citrea (sequence similarity 99.4%) and Actinomadura madurae (sequence similarity 99.2%). The result of DNA-DNA hybridizations between 13-12(50)(T) and Actinomadura mexicana was 49.9%. On the basis of the phenotypic, chemotaxonomic and genotypic properties, the isolate was differentiated from its closest phylogenetic relatives. It is proposed that the organism be classified as a novel species of the genus Actinomadura. The name proposed for the new taxa are Actinomadura maheshkhaliensis sp. nov. [(13-12(50)(T)=JCM 13934(T) =MTCC 8055(T)].
Topics: Actinomycetales; Bacterial Typing Techniques; Bangladesh; DNA, Bacterial; DNA, Ribosomal; Genes, rRNA; Genotype; Molecular Sequence Data; Nucleic Acid Hybridization; Phenotype; Plant Roots; RNA, Ribosomal, 16S; Rhizophoraceae; Sequence Analysis, DNA; Soil Microbiology
PubMed: 19164876
DOI: 10.2323/jgam.54.335 -
The Open Microbiology Journal 2009The aerobic actinomycetes are a large group of soil-inhabiting bacteria that occur worldwide. Some of them are the main cause of two important diseases, nocardiosis and...
The aerobic actinomycetes are a large group of soil-inhabiting bacteria that occur worldwide. Some of them are the main cause of two important diseases, nocardiosis and actinomycetoma. To identify the prevalence and geographic distribution of aerobic actinomycetes in soil of Qazvin province, a study was carried out during 2006-2007. In this study, the incidence and diversity of medically important aerobic actinomycetes was determined in 300 soil samples of different parts of Qazvin. The suspensions of superficial soil samples were prepared by adding of normal saline, streptomycin and chloramphenicol and the supernatants were cultured on brain-heart infusion agar and Sabouraud's dextrose agar contain cycloheximide. The isolated microorganisms were examined by Gram and acid-fast stains and were identified biochemically and morphologically. Of 96 aerobic actinomycetes isolates identified, Actinomadura madurae and Streptomyces somaliensis were the most frequently isolated species each representing 19.8% of isolates, followed by Nocardia asteroides (15.6%), N. otitidiscaviarum (9.4%), N. brasiliensis (7.3%), A. peletieri, S. griseus, and Nocardia spp. (each 5.2%), and N. transvalensis, Nocardiopsis dassonvillei, Actinomadura spp. and Streptomyces spp. (each 3.1%). To the best of our knowledge, this is the first report on epidemiological investigation of medically important aerobic actinomycetes in soil samples from Iran. In recent years, mycetoma and nocardiosis have been increasingly reported in Iran. The results showed that medically important actinomycetes occur in the environment of Iran and soil could be potential source of actinomycotic infections.
PubMed: 19440253
DOI: 10.2174/1874285800903010053 -
PLoS Neglected Tropical Diseases Aug 2014Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found...
Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Male; Mexico; Mycetoma; Young Adult
PubMed: 25144462
DOI: 10.1371/journal.pntd.0003102 -
Journal of Clinical Microbiology Apr 1992Actinomadura madurae is an aerobic actinomycete which is best known worldwide as the cause of actinomycotic mycetomas. It has not previously been reported to have caused...
Actinomadura madurae is an aerobic actinomycete which is best known worldwide as the cause of actinomycotic mycetomas. It has not previously been reported to have caused invasive pulmonary or disseminated infection in humans. We describe an AIDS patient with opportunistic A. madurae-induced pneumonia and bacteremia. The isolate from the patient's blood was subjected to dilutional antimicrobial susceptibility tests with 12 antimicrobial agents and was found to have a wide spectrum of susceptibility. This unusual microorganism may be a cause of infections in severely immunosuppressed patients.
Topics: Acquired Immunodeficiency Syndrome; Actinomycetales; Actinomycetales Infections; Adult; Drug Resistance, Microbial; Fungemia; HIV-1; Humans; Male; Opportunistic Infections; Pneumonia
PubMed: 1572956
DOI: 10.1128/jcm.30.4.1008-1010.1992 -
Indian Journal of Dermatology 2015It is popularly believed that eumycetoma cases should be dealt with using surgical amputation for a better chance of cure especially when chemotherapy has failed....
It is popularly believed that eumycetoma cases should be dealt with using surgical amputation for a better chance of cure especially when chemotherapy has failed. However, amputation leads to disability on one hand and on the other it may also fail to be curative. We present two cases with contrasting treatment options and outcome. In the eumycetoma case reported here, a 40-year-old male presented with right foot swelling for 16 years, from which Scedosporium apiospermum was isolated. He responded poorly to antifungal therapy and refused below-knee amputation 12 years ago. With counseling and wound care his condition improved, and Foot and Ankle Ability Measure (FAAM) score remained almost stable at 90% for 16 years, which is much better than the average functional outcome after amputation. Another 46-year-old female underwent below-knee amputation after receiving incomplete courses of antibiotics and antifungals for mycetoma of unknown etiology. She presented to us after recurrence of mycetoma on an amputated stump and was successfully treated by proper courses of antibiotics after detecting the causal agent, Actinomadura madurae. Her post-amputation disability and depression could have been avoided if the hasty decision of amputation had not been taken. In our opinion, living with drug-non-responsive mycetoma, supported by symptomatic management, may be a better option than amputation and its associated morbidities. So before taking the path of salvage amputation, we must consider many aspects, including patient's livelihood, psychological aspects and chances of recurrence even after the procedure.
PubMed: 25657401
DOI: 10.4103/0019-5154.147799 -
BMC Infectious Diseases Jun 2017Pulmonary nocardiosis mimic pulmonary tuberculosis in most clinical and radiological manifestations. In Tanzania, where tuberculosis is one of the major public health...
BACKGROUND
Pulmonary nocardiosis mimic pulmonary tuberculosis in most clinical and radiological manifestations. In Tanzania, where tuberculosis is one of the major public health threat clinical impact of nocardiosis as the cause of the human disease remains unknown. The objective of the present study was to isolate and identify Nocardia isolates recovered from TB suspects in Northeastern, Tanzania by using biochemical and molecular methods.
METHODS
The study involved 744 sputum samples collected from 372 TB suspects from four periphery diagnostic centers in Northeastern, Tanzania. Twenty patients were diagnosed as having presumptively Nocardia infections based on microscopic, cultural characteristics and biomèrieux ID 32C Yeast Identification system and confirmed using 16S rRNA and hsp65 gene specific primers for Nocardia species and sequencing.
RESULTS
Biochemically, the majority of the isolates were N. asteroides (n = 8/20, 40%), N. brasiliensis (n = 4/20, 20%), N. farcinica (n = 3/20, 15%), N. nova (n = 1/20, 5%). Other aerobic actinomycetales included Streptomyces cyanescens (n = 2/20, 10%), Streptomyces griseus, Actinomadura madurae each (n = 1/20, 5%). Results of 16S rRNA and hsp65 sequencing were concordant in 15/17 (88. 2%) isolates and discordant in 2/17 (11.8%) isolates. Majority of the isolates belonged to N. cyriacigeorgica and N. farcinica, four (23.5%) each.
CONCLUSIONS
Our findings suggest that Nocardia species may be an important cause of pulmonary nocardiosis that is underdiagnosed or ignored. This underscores needs to consider pulmonary nocardiosis as a differential diagnosis when there is a failure of anti-TB therapy and as a possible cause of human infections.
Topics: Actinomycetales; Adult; Bacterial Proteins; DNA, Ribosomal; Diagnosis, Differential; Female; Humans; Lung Diseases; Male; Nocardia; Nocardia Infections; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Sputum; Tanzania; Tuberculosis, Pulmonary
PubMed: 28595598
DOI: 10.1186/s12879-017-2520-8