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Annales de Dermatologie Et de... Jan 2003Mycetoma is a pathological process in which eumycotic (fungal) or actinomycotic causative agents from exogenous source produce grains. It follows penetrating injury...
BACKGROUND
Mycetoma is a pathological process in which eumycotic (fungal) or actinomycotic causative agents from exogenous source produce grains. It follows penetrating injury inoculating soil organisms, occurring preferentially in rural areas usually among labourers who work barefoot. Mycetoma is a localized chronic, and deforming infectious disease of subcutaneous tissues, skin and bones. We report 130 cases of mycetoma in Senegal from 1983 to 2000.
PATIENTS AND METHODS
There were 130 patients with mycetoma. Clinical diagnosis of mycetoma was based on open tract sinuses, tumefaction or discharge of grain. Diagnosis confirmation was based on mycology and histology. An X-ray was preformed to detect bone lesions. Treatment was medical for actinomycetoma and surgical for eumycetoma.
RESULTS
We observed 76 actinomycetoma and 54 eumycetoma (Sex ratio M/F=6.6; mean age=34.7 +/- 14.8 years). The mean duration before the first medical evaluation was 4.8 +/- 5.6 years. Actinomycetoma was due to Actinomadura pelletieri, (54 cases), Actinomadura madurae (17 cases) and Streptomyces somaliensis (5 cases). Eumycetoma was due to Madurella mycetomatis (38 cases), Leptospahria senegalensis (9 cases), Pseudoallescheria boydii (6 cases) and Rhinoclediella atrovirens (1 case). Clinical inflammatory features significantly associated with actinomyces (p<0.001 OR=2.64) were predominant (85 cases). Tumoral and cystic features were found in the others forms. Lesions were located on the foot in 81 patients. Bone lesions, depending on the duration, were observed in 68 patients. Neurological damage occurred in 3 patients with dorsolumbar actinomycetoma. Sixty-six patients with actinomycetoma were cured by medical treatment.
DISCUSSION
The 130 cases of mycetoma were remarkable by the long duration of the disease before the first medical evaluation. Pain and tumor were the two main symptoms which brought the patients to the hospital and had appeared after 5 years duration and the predominance of actinomadura pelletieri actinomycetoma was responsible for 41.3 p. 100 of our cases. In Niger and Mauritania, mycetoma were actinomycetoma in respectively 71.2 p. 100 and 25 p. 100 of cases. The geographic distribution of pathogenic mycetoma agents was determined by the annual rainfall. Distinction between eumycetoma and actinomycetoma is very important for the treatment.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Mycetoma; Retrospective Studies
PubMed: 12605151
DOI: No ID Found -
Indian Journal of Dermatology,... 2022Background Mycetoma is widespread in Yemen; however, there are only a few documented reports on the entity from this geographical area. Methods A prospective study of...
Background Mycetoma is widespread in Yemen; however, there are only a few documented reports on the entity from this geographical area. Methods A prospective study of 184 cases of mycetoma (male 145 and female 39) from different regions of north-western Yemen was conducted between July 2000 and May 2014. Clinical profile was recorded in a standardized protocol. The diagnosis was based on clinical features, X-ray studies, examination of grains, and histopathology. Results Eumycetoma was diagnosed in 129, caused by Madurella mycetomatis in 124, Leptosphaeria senegalensis in one and pale grain fungus in four, whereas actinomycetoma occurred in 55, caused by Streptomyces somaliensis in 29, Actinomadura madurai in nine, Actinomadura pelletieri in one, and Nocardia in sixteen. Eumycetoma cases were treated with prolonged course of antifungal drugs, mostly ketoconazole, with itraconazole being used in four patients, along with excision or debulking. Results were better when antifungal drugs were given two to three months before surgery and in those who received itraconazole. Actinomycetoma cases were initially treated with co-trimoxazole monotherapy; later streptomycin was added in 30 cases. Six patients who did not show adequate improvement and two others from the start were treated with modified Welsh regimen and with good results. Limitations Identification of different causative agents was done by histopathology and could not be reconfirmed by culture. Conclusion Mycetoma is widespread in north-western Yemen with a higher incidence of eumycetoma and a majority of the cases were caused by Madurella mycetomatis. Modified Welsh regimen in actinomycetoma and itraconazole with excision in eumycetoma showed the best results.
Topics: Antifungal Agents; Female; Humans; India; Itraconazole; Madurella; Male; Mycetoma; Prospective Studies; Yemen
PubMed: 35389029
DOI: 10.25259/IJDVL_500_2021 -
The Pan African Medical Journal 2019Mycetoma is a chronic inflammatory process during which exogenous fungal or actinomycosic agents produce grains. The infection involves the skin, the subcutaneous...
Mycetoma is a chronic inflammatory process during which exogenous fungal or actinomycosic agents produce grains. The infection involves the skin, the subcutaneous tissues, the muscles and the bones. We report the case of a 39-year old woman, a teacher, living in Brazzaville, who had regularly resided in the village. She presented with a painless suppurative mass in the left thigh that had been treated with bandages over the past 4 years. The patient didn't have fever. Her general condition was good. Physical examination showed poly-lobed, firm tumor mass in the posterior surface of the left thigh, measuring 11cm in diameter on the major axis, with ulcerations discharging purulent serosity. There was no satellite adenopathy. The remainder of the physical examination was normal. Bacteriological analysis showed sterile serosity. Skin biopsy revealed alteration of the connective tissue and the presence of small foci of grains, typical of Actinomadura pelletieri. CRP level was 48mg/L; blood count, blood glucose, blood lipids and LDH were normal. Standard radiography of the affected thigh was normal. The diagnosis of actinomycosic mycetoma was retained. Patient's outcome, after a 12-month treatment with cotrimoxazole, was marked by the epidermization of the ulcers and the persistence of the tumor mass, justifying secondary surgical resection.
PubMed: 32153703
DOI: 10.11604/pamj.2019.34.163.20300 -
PLoS Neglected Tropical Diseases Aug 2019Mycetoma is a devastating neglected tropical disease, caused by various fungal and bacterial pathogens. Correct diagnosis to the species level is mandatory for proper...
Mycetoma is a devastating neglected tropical disease, caused by various fungal and bacterial pathogens. Correct diagnosis to the species level is mandatory for proper treatment. In endemic areas, various diagnostic tests and techniques are in use to achieve that, and that includes grain culture, surgical biopsy histopathological examination, fine needle aspiration cytological (FNAC) examination and in certain centres molecular diagnosis such as PCR. In this retrospective study, the sensitivity, specificity and diagnostic accuracy of grain culture, surgical biopsy histopathological examination and FNAC to identify the mycetoma causative organisms were determined. The histopathological examination appeared to have better sensitivity and specificity. The histological examination results were correct in 714 (97.5%) out of 750 patients infected with Madurella mycetomatis, in 133 (93.6%) out of 142 patients infected with Streptomyces somaliensis, in 53 (74.6%) out of 71 patients infected with Actinomadura madurae and in 12 (75%) out of 16 patients infected with Actinomadura pelletierii. FNAC results were correct in 604 (80.5%) out of 750 patients with Madurella mycetomatis eumycetoma, in 50 (37.5%) out of 133 Streptomyces somaliensis patients, 43 (60.5%) out of 71 Actinomadura madurae patients and 11 (68.7%) out of 16 Actinomadura pelletierii. The mean time required to obtain the FNAC result was one day, and for the histopathological examinations results it was 3.5 days, and for grain it was a mean of 16 days. In conclusion, histopathological examination and FNAC are more practical techniques for rapid species identification than grain culture in many endemic regions.
Topics: Actinobacteria; Actinomadura; Adolescent; Adult; Aged; Biopsy; Child; Child, Preschool; Diagnostic Tests, Routine; Female; Humans; Madurella; Male; Middle Aged; Mycetoma; Pathology, Molecular; Polymerase Chain Reaction; Retrospective Studies; Sensitivity and Specificity; Streptomyces; Young Adult
PubMed: 31465459
DOI: 10.1371/journal.pntd.0007056 -
PloS One 2020Mycetoma is a chronic, granulomatous infection of subcutaneous tissue, that may involve deep structures and bone. It can be caused by bacteria (actinomycetoma) or fungi...
BACKGROUND
Mycetoma is a chronic, granulomatous infection of subcutaneous tissue, that may involve deep structures and bone. It can be caused by bacteria (actinomycetoma) or fungi (eumycetoma). There is an epidemiological association between mycetoma and the environment, including rainfall, temperature and humidity but there are still many knowledge gaps in the identification of the natural habitat of actinomycetes, their primary reservoir, and their precise geographical distribution. Knowing the potential distribution of this infection and its ecological niche in endemic areas is relevant to determine disease management strategies and etiological agent habitat or reservoirs.
METHODOLOGY/PRINCIPAL FINDINGS
This was an ambispective descriptive study of 31 patients with actinomycetoma. We determined the biophysical characteristics including temperature, precipitation, soil type, vegetation, etiological agents, and mapped actinomycetoma cases in Northeast Mexico. We identified two disease cluster areas. One in Nuevo Leon, with a predominantly kastanozems soil type, with a mean annual temperature of 22°, and a mean annual precipitation of 585.2 mm. Herein, mycetoma cases were produced by Actinomadura pelletieri, Actinomadura madurae, Nocardia brasiliensis, and Nocardia spp. The second cluster was in San Luis Potosí, where lithosols soil type predominates, with a mean annual temperature of 23.5° and a mean annual precipitation of 635.4 mm. In this area, all the cases were caused by N. brasiliensis. A. madurae cases were identified in rendzinas, kastanozems, vertisols, and lithosols soils, and A. pelletieri cases in xerosols, kastanozems, and rendzinas soils. Previous thorn trauma with Acacia or Prosopis plants was referred by 35.4% of subjects. In these states, the presence of thorny plants, such as Acacia spp., Prosopis spp., Senegalia greggi, Vachellia farnesiana and Vachellia rigidula, are common.
CONCLUSIONS/SIGNIFICANCE
Mapping this neglected tropical infection aids in the detection of disease cluster areas, the development of public health strategies for early diagnosis and disease prediction models; this paves the way for more ecological niche etiological agent research.
Topics: Adolescent; Adult; Aged; Climate; Cross-Sectional Studies; Female; Geography, Medical; Humans; Male; Mexico; Middle Aged; Mycetoma; Soft Tissue Infections; Soil; Young Adult
PubMed: 32384126
DOI: 10.1371/journal.pone.0232556 -
PLoS Neglected Tropical Diseases Jul 2019Mycetoma is a persistent, progressive granulomatous inflammatory disease caused either by fungi or by bacteria. Characteristic of this disease is that the causative...
Mycetoma is a persistent, progressive granulomatous inflammatory disease caused either by fungi or by bacteria. Characteristic of this disease is that the causative agents organise themselves in macroscopic structures called grains. These grains are surrounded by a massive inflammatory reaction. The processes leading to this host tissue reaction and the immunophenotypic characteristics of the mycetoma granuloma are not known. Due to the massive immune reaction and the tissue remodeling involved, we hypothesised that the expression levels of interleukin-17 (IL-17) and matrix metalloprotease-9 (MMP-9) in the mycetoma granuloma formation were correlated to the severity of the disease and that this correlation was independent of the causative agent responsible for the granuloma reaction. To determine the expression of IL-17 and MMP-9 in mycetoma lesions, the present study was conducted at the Mycetoma Research Centre, Sudan. Surgical biopsies from 100 patients with confirmed mycetoma were obtained, and IL-17 and MMP-9 expression in the mycetoma granuloma were evaluated immunohistochemically. IL-17 was mainly expressed in Zones I and II, and far less in Zone III. MMP-9 was detected mainly in Zones II and III, and the least expression was in Zone I. MMP-9 was more highly expressed in Actinomadura pelletierii and Streptomyces somaliensis biopsies compared to Madurella mycetomatis biopsies. MMP-9 levels were directly proportional to the levels of IL-17 (p = 0.001). The only significant association between MMP9 and the patients' characteristics was the disease duration (p<0.001). There was an insignificant correlation between the IL-17 levels and the patients' demographic characteristics.
Topics: Actinobacteria; Actinomadura; Adolescent; Adult; Biopsy; Child; Collagen; Female; Gene Expression; Granuloma; Humans; Immunohistochemistry; Interleukin-17; Madurella; Male; Matrix Metalloproteinase 9; Middle Aged; Mycetoma; Qualitative Research; Severity of Illness Index; Streptomyces; Sudan; Young Adult
PubMed: 31295246
DOI: 10.1371/journal.pntd.0007351 -
The Journal of Antibiotics Nov 1990Six strains of Actinomadura pelletieri were shown to produce a novel macrolide antibiotic, designated MM 46115. MM 46115 was active against parainfluenza virus 1 and 2...
MM 46115, a new antiviral antibiotic from Actinomadura pelletieri. Characteristics of the producing cultures, fermentation, isolation, physico-chemical and biological properties.
Six strains of Actinomadura pelletieri were shown to produce a novel macrolide antibiotic, designated MM 46115. MM 46115 was active against parainfluenza virus 1 and 2 and Gram-positive bacteria. Methods are described for the production of MM 46115 by strain IP 729.63, and for the isolation of the compound from a butanol extract of the culture filtrate.
Topics: Animals; Anti-Bacterial Agents; Antiviral Agents; Fermentation; Gram-Positive Bacteria; Humans; Influenza A virus; Leukemia L1210; Macrolides; Mitosporic Fungi; Molecular Structure; Nocardiaceae; Respiratory Syncytial Viruses; Respirovirus; Trichophyton; Tumor Cells, Cultured
PubMed: 2177052
DOI: 10.7164/antibiotics.43.1387 -
PLoS Neglected Tropical Diseases Nov 2013Mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. This disease has been reported from countries between 30°N and 15°S since... (Meta-Analysis)
Meta-Analysis Review
Mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. This disease has been reported from countries between 30°N and 15°S since 1840 but the exact burden of disease is not known. It is currently unknown what the incidence, prevalence and the number of reported cases per year per country is. In order to estimate what the global burden of mycetoma is, a meta-analysis was performed. In total 50 studies were included, which resulted in a total of 8763 mycetoma cases. Most cases were found in men between 11 and 40 years of age. The foot was most commonly affected. Most cases were reported from Mexico, Sudan and India. Madurella mycetomatis was the most prevalent causative agent world-wide, followed by Actinomadura madurae, Streptomyces somaliensis, Actinomadura pelletieri, Nocardia brasiliensis and Nocardia asteroides. Although this study represents a first indication of the global burden on mycetoma, the actual burden is probably much higher. In this study only cases reported to literature could be used and most of these cases were found by searching archives from a single hospital in a single city of that country. By erecting (inter)national surveillance programs a more accurate estimation of the global burden on mycetoma can be obtained.
Topics: Adolescent; Adult; Child; Global Health; Humans; Mycetoma; Young Adult
PubMed: 24244780
DOI: 10.1371/journal.pntd.0002550 -
PLoS Neglected Tropical Diseases Feb 2020Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological...
BACKGROUND
Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological agent. Mycetoma may be caused by true fungi (eumycetoma) or filamentous aerobic bacteria (actinomycetoma). Mycetoma is more frequent in the so-called mycetoma belt (latitude 15° south and 30° north around the Tropic of Cancer), especially in Sudan, Nigeria, Somalia, India, Mexico, and Venezuela. The introduction of new antibiotics with fewer side effects, broader susceptibility profiles, and different administration routes has made information on actinomycetoma treatment and outcomes necessary. The objective of this report was to provide an update on clinical, therapeutic, and outcome data for patients with actinomycetoma attending a reference center in northeast Mexico.
METHODOLOGY/PRINCIPAL FINDINGS
This was a retrospective, cross-sectional, descriptive study of 31 patients (male to female ratio 3.4:1) diagnosed with actinomycetoma by direct grain examination, histopathology, culture, or serology from January 2009 to September 2018. Most lesions were caused by Nocardia brasiliensis (83.9%) followed by Actinomadura madurae (12.9%) and Actinomadura pelletieri (3.2%). About 50% of patients had bone involvement, and the right leg was the most commonly affected region in 38.7% of cases. Farmers/agriculture workers were most commonly affected, representing 41.9% of patients. The most commonly used treatment regimen was the Welsh regimen (35.5% of cases), a combination of trimethoprim/sulfamethoxazole (TMP/SMX) plus amikacin, which had a 90% cure rate, followed by TMP/SMX plus amoxicillin/clavulanic acid in 19.4% of cases with a cure rate of 100%. In our setting, 28 (90.3%) patients were completely cured and three (9.7%) were lost to follow-up. Four patients required multiple antibiotic regimens due to recurrences and adverse effects.
CONCLUSIONS/SIGNIFICANCE
In our sample, actinomycetoma was predominantly caused by N. brasiliensis. Most cases responded well to therapy with a combination of TMP/SMX with amikacin or TMP/SMX and amoxicillin/clavulanic acid. Four patients required multiple antibiotics and intrahospital care.
Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Female; Humans; Longitudinal Studies; Male; Mexico; Middle Aged; Mycetoma; Retrospective Studies; Young Adult
PubMed: 32097417
DOI: 10.1371/journal.pntd.0008123 -
Journal of Postgraduate Medicine 2003An 18-year-old woman from rural West Bengal was affected with mycetoma involving her neck, back, and chest. After an interval of eight years, her younger brother... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
An 18-year-old woman from rural West Bengal was affected with mycetoma involving her neck, back, and chest. After an interval of eight years, her younger brother developed mycetoma on his left arm. No history of trauma or immune deficiency was present in either case. By microscopic examination of sinus-discharged materials from both the cases, identical rusty red, hard grains were demonstrated. Soluble red pigment-producing colonies grew in Sabouraud dextrose-agar medium. Isolates were positive for casein hydrolysis and negative for hydrolysis test of xanthine, hypoxanthine, tyrosine, and nitrate reduction. Thus it differed from the only known red grain mycetoma agent, Actinomadura pelletieri and was provisionally identified as Actinomadura vinacea. Familial affection in mycetoma, that too caused by a new agent, is reported here for its uniqueness.
Topics: Adolescent; Adult; Color; Humans; Male; Mycetoma; Pigments, Biological
PubMed: 14699230
DOI: No ID Found