Micetoma por Nocardia asteroides / Nocardia Asteroids Mycetoma

Introducción: En 1860 Henry Van Carter introdujo la definición del micetoma y desde 1884 se reportan los primeros casos en África (Sudán, Senegal). Estas infecciones afectan la piel, el tejido celular subcutáneo y, en ocasiones, los músculos, los huesos, y pueden diseminarse por la cavidad torácica, la abdominal, y por otras regiones del cuerpo. Objetivo: Presentar un caso de micetoma por Nocardia asteroides con evolución desfavorable y tratamiento. Presentación del caso: Paciente masculino de 47 años de edad que sufrió hace 18 años un trauma en la rodilla izquierda con herida avulsiva y evolución desfavorable por infección. Diez años después presentó en el mismo sitio múltiples lesiones fistulosas con drenaje activo, secreción serohemática escasa y no fétida. En varias ocasiones fue llevado al salón de operaciones para realizarle debridamientos quirúrgicos y toillete y recibió múltiples tratamientos antibióticos y antifúngicos. Se concluyó el caso como un micetoma y se aisló una Nocardia asteroides. El paciente estuvo en desacuerdo con la amputación de la extremidad como tratamiento quirúrgico definitivo. Llegó a nuestro centro en octubre del 2020 con mal estado general y extensión severa del proceso infeccioso en toda la extremidad. Se planificó una hemipelvectomía como tratamiento definitivo, pero desafortunadamente el paciente falleció antes, debido a complicaciones generales. Conclusiones: Ante la aparición del micetoma es importante definir el alcance de la infección para determinar el tipo de tratamiento a utilizar, ya que bien empleado y de forma oportuna, puede salvar la vida al paciente sin dejar graves secuelas(AU)

Introduction: In 1860, Henry Van Carter introduced the definition of mycetoma and since 1884 the first cases have been reported in Africa (Sudan, Senegal). These infections affect the skin, the subcutaneous cellular tissue and, sometimes, the muscles, the bones, and it can spread throughout the thoracic cavity, the abdominal cavity, and other regions of the body. Objective: To report a case of mycetoma due to nocardia asteroides with unfavorable evolution and treatment. Case report: We report the case of a 47-year-old male patient who suffered a left knee trauma 18 years ago with an avulsive wound and unfavorable evolution due to infection. Ten years later, he presented, in the same site, multiple fistulous lesions with active drainage, scant serohematic, non-fetid secretion. On several occasions he was taken to the operating room for surgical debridement and toilette and he received multiple antibiotic and antifungal treatments. The case was concluded as a mycetoma. Nocardia asteroides was isolated. The patient disagreed with limb amputation as definitive surgical treatment. He came to our treatment center in October 2020 with poor general condition and severe extension of the infectious process throughout the limb. A hemipelvectomy was planned as definitive treatment, but unfortunately the patient deceased before due to general complications. Conclusions: Before the appearance of mycetoma, it is important to define the extent of the infection to determine the type of treatment to use, since it can save the patient's life if properly used and in a timely manner without leaving serious sequelae(AU)

Mycetomas: an epidemiological, etiological, clinical, laboratory and therapeutic review

Abstract: Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue, characterized by a symptomatic triad: tumor, fistulas and grains. It can be caused by fungi (eumycetoma) and bacteria (actinomycetoma), with similar clinical features. Diagnosis is based on the clinical presentation and identification of the etiological agents in the tissue, by mycological/bacteriological, histopathological and immunohistochemical tests. It is important to specify the fungal or bacterial etiology, because the treatments are different. An approach that involves early diagnosis, the use of systemic antibiotics or antifungal agents, including surgical removal of lesions, is the basis for the treatment of these diseases. In this review, the most commonly used diagnostic methods and treatments will be discussed. Also, we will review the history of the disease through epidemiological and etiological aspects.

Pie de madura: primer caso en nuestro país y breve actualización (1904-2013) / Foot of madura: first case in our country and brief update (1904-2013)

Presentamos el primer caso de pie de madura publicado en Argentina y realizamos una breve actualización de su diagnóstico y terapéutica.

We presented the first case of feet of Madura published in Argentine. We did a review of diagnostic and treatment.

Eumycetoma by Madurella mycetomatis with 30 years of evolution: therapeutic challenge / Eumicetoma por Madurella mycetomatis com 30 anos de evolução: desafio terapêutico

We report a case of eumycetoma by Madurella mycetomatis on the buttocks and thighs in an adult immunocompetent patient, diagnosed after 30 years of clinical development. He was treated over four years with fluconazol and itraconazol associated with five times surgical excisions of subcutaneous nodules. At the eighth year of follow-up, one nodule recurred on the right infragluteal region, which was excised surgically and has remained asymptomatic ever since.

Relatamos o caso de um paciente adulto, imunocompetente, com eumicetoma por Madurella mycetomatis, localizado nos glúteos e coxas, diagnosticado após 30 anos de evolução clínica. Tratado no decorrer de quatro anos com fluconazol e itraconazol, associado a cinco tempos cirúrgicos de exérese dos nódulos subcutâneos. No oitavo ano de follow-up ocorreu recidiva de apenas um nódulo na região infraglútea, o qual foi excisado cirurgicamente, mantendo-se assintomático desde então.

Mycetoma foot

Mycetoma is an uncommon chronic granulomatous infective disease of the skin, dermis and subcutaneous tissues predominantly seen in tropical countries. A patient presented to our hospital with the swelling of the left foot with a healed sinus and a painful nodule. He gave a history of sinuses in the left foot from which there was discharge of yellow granules. Culture of the ultrasound guided fine needle aspiration cytology of the nodule revealed growths of Nocardia species. The patient was treated with a multi-drug therapy along with debridement of the painful nodule. He experienced symptomatic relief and a regression of the swelling within the three months of follow-up so far. Due to the relatively slow progression of the disease, patients are diagnosed at a late stage. Hence, emphasis should be placed on health education and the importance of wearing footwear

Micetoma por Nocardia sp: reporte del Cusco-Perú / Mycetoma by Nocardia sp: Report from Cusco-Peru

Se reporta el primer caso de micetoma bacteriano por Nocardia sp. en Cusco, Perú. Se trata de un paciente varón de 44 años quien presentó lesión a nivel de extremidad superior derecha. La infección fue controlada con ciprofloxacino en los tres primeros meses, seguido de trimetoprim/ sulfametoxazol por aproximadamente 15 meses. Se observó cicatrización completa de la lesión con formación de cicatrices queloides como secuela en la visita de control a los 20 meses...

We report the first case of bacterial mycetoma caused by nocardia sp., in Cusco, Peru. A 44 years-old male patient presented with a lesion in the upper right limb. Infection was controlled after a 3 month course of ciprofloxacin, followed by trimethoprim/sulfamethoxazole for approximately 15 months. Complete healing of the lesion with keloid scarring as sequel was observed after 20 months...

Bola fúngica dos seios paranasais: Relato de dois casos e revisão de literatura / Fungus ball of the paranasal sinuses: Report of two cases and literature review

Introdução: Bola fúngica dos seios paranasais é uma infecção não invasiva que se caracteriza por sua cronicidade, sendo a maioria relacionada com tratamento endodôntico prévio. Acomete principalmente o seio maxilar, embora todos os seios possam ser envolvidos. O principal agente etiológico é o Aspergillus spp. A tomografia computadorizada, devido às apresentações radiológicas características, sugere o diagnóstico que é realizado definitivamente através de análises histopatológicas. O tratamento padrão-ouro é a cirurgia sinusal endoscópica com antrostomia meatal média. Objetivo: Relatar dois casos de bola fúngica dos seios paranasais e ressaltar aspectos importantes desta patologia. Relato dos Casos: Caso 1) Paciente do sexo feminino, 78 anos, apresentou-se com queixas de dor facial há 6 meses e história prévia de tratamento endodôntico. Ao exame físico constatou-se a presença de secreção purulenta em meato médio esquerdo. O Raio X apresentou velamento completo do seio maxilar esquerdo, enquanto a tomografia computadorizada mostrou lesão calcificada neste local. Realizou-se sinusotomia que evoluiu bem. Caso 2) Paciente do sexo feminino, 70 anos, procurou atendimento por história de sinusites de repetição. Ao exame físico não se percebeu nenhuma particularidade. A tomografia computadorizada, assim como a ressonância magnética, detectou espessamento da parede mucosa do seio maxilar esquerdo, além de uma massa calcificada. Realizou-se a mesma sequência de tratamento e a paciente também evoluiu bem. Considerações finais: A infecção fúngica deve ser considerada nos pacientes que se apresentam com sinusite crônica, que não respondem ao uso de antibióticos e que possuem história de manipulação endodôntica...

Introduction: Fungal ball of the sinuses is a not invasive infection that if characterizes for its chronicity, being the majority related with previous endodontic treatment. Affect mainly the breasts to maxillary; even so all the breasts can be involved. The main etiological agent is the Aspergillus spp. The computed tomography, had to characteristic the radiological presentations, suggests the diagnosis that is carried through definitively through histopathological analyses. The treatment standard-gold is the sinus surgery with average meatal antrostomy. Objective: Reporting two cases of fungal ball of the sinuses and to stand out important aspects of this pathology. Story of the Cases: Case 1) Patient of the feminine sex, 78 years old, presented itself with complaints of face pain has 6 months and previous history of endodontic treatment. To the physical examination it was evidenced purulent secretion presence in left average meatus. Ray X presented complete veiling of the breasts to maxillary left, while the computed tomography showed injury calcified in this place. Sinusotomy was become fulfilled that evolved well. Case 2) Patient of the feminine sex, 70 years old, looked attendance for history of sinusitis of repetition. To the physical examination no particularity was not perceived. The computed tomography, as well as the magnetic resonance, detected thickening of the mucous wall of the breasts to maxillary left, beyond a calcified mass. It was become fulfilled same sequence of treatment and the patient also evolved well. Final Considerations: The fungal infection must be considered in the patients who if present with chronic sinusitis, that they do not answer to the antibiotic use and that they possess history of endodontic manipulation...

Minimicetoma por Nocordia brasiliensis: un caso infantil en Veracruz / Minimicetoma by Nocordia brasiliensis: a children's event in Veracruz

El término minimicetoma designa a los micetomas de pequeño tamaño, con morfología atípica y superficial, causados por Nocardia brasiliensis. Se comunica un paciente de sexo masculino, de 10 años de edad, originario y residente de Xalapa (Veracruz), que presentó un minimicetoma por N. brasiliensis, confirmado por estudio micológico e histopatológico. El tratamiento con penicilina procaínica durante 10 días, en conjunto con trimetoprima/sulfametoxazol y diaminodifenisulfona por 6 meses, tuvo resultados satisfactorios.

Minimycetoma is an atypical small mycetoma usually caused by Nocardia brasiliensis. We report a 10-year-old male from Xalapa (Veracruz) with a minimycetoma due to N. brasiliensis confirmed by mycological and histopathological studies. Simultaneous treatment with procainic penicillin for ten days and trimethoprim/sulfamethoxazol and dapsone showed satisfactory results after 6 months.

Infecções causadas por fungos demácios e suas correlações anátomo-clinicas / Infections caused by dematiaceous fungi and their anatomoclinical correlations

O gênero Exophiala é composto por fungos melanizados dimórficos, responsáveis por um espectro de doenças, incluindo feohifomicoses, micetomas, cromoblastomicoses e fungemia. A espécie E. jeanselmei é a predominante nestas infecções, seguida de E. dermatitidis. Este trabalho tem como objetivo relatar quatro casos e discutir aspectos clínicos, histológicos, micológicos e epidemiológicos para o seu diagnóstico.

The Exophiala genus comprises dimorphic melanized fungi responsible for a spectrum of diseases including phaeohyphomycosis, mycetoma, chromoblastomycosis and fungemia. The E. jeanselmei species is predominant in such infections, followed by E. dermatitidis. This paper aims at reporting four cases and at discussing clinical, histologycal, mycologycal and epidemiologycal aspects for its diagnosis.

Eumycetoma by Madurella grisea: report of the first case observed in the Southern Brazilian Region

E relatado o primeiro caso de eumicetoma por Madurella grisea ocorrido na Regiao Sul (Brasil). Alem disso, a literatura brasileira correspondente foi revisada e a distribuicao geografica deste tipo de eumicetoma e apresentada

Diecisiete casos de micetomas actino y eumicóticos en Rosario, Argentina (1959-1998) / Seventeen cases of actno and eumycotic mycetoma in Rosario, Argentina (1959-1998)

Se comunican diecisiete casos de micetomas estudiados en el período comprendido entre enero de 1958 y noviembre de 1998, 10 eumicóticos (59 porciento) y 7 actinomicóticos (41 porciento) madurella grisea fue el agente más aislado (29.5 porciento) en los primeros y nocardia asteroides (17.6 porciento) en los segundos. Los agentes restantes fueron pseudallescheria boidii, madurella mycetomatis, fusarium solani, mocardia brasiliensis y actinomadura madurae. A pesar que los micetomas son afecciones benignas, las dificultades terapéuticas los transforman en cuadros clínicos más serios

Micetomas en el Hospital de Infecciosas Francisco Javier Muniz de la ciudad de Buenos Aires, Argentina / Mycetomas in the Muniz Hospital of Buenos Aires City

Se presentam las características clínicas, microbiológicas y los resultados terapéuticos de 54 casos de micetoma, disgnosticados en los ultimos 10 anos en le Hospital Muniz. Treita y dos fueron varones y 22 mujeres, la edad promedio fue de 43.4 anos (20-27 anos). La mayoria de los enfermos adquirió la infección en el norte de la Argentina (Santiago del Estero 2o casos, Chaco 9, Formosa 3, Salta 2 y Catamarca1) y 6 pacientes de evolución de la enfermedad fue de 9.1 anos (6 meses a 30 anos)...

Micetomas por microsporum canis: caso clínico / Mycetomas by microsporum canis: report of one case

We report and eight years old boy presenting with a pyogenic granuloma of the scalp, generalized alopecia, descamative plates in the neck, trunk and limbs and nail involvement. Cultures for fungus of all these lesions disclosed Microspore canis. The patient was treated with oral griseofulvin, miconazole and topical tolnaftate. Five years later and after several incomplete treatments, the patient returns with a fistulous mass of 12 x 8 cm in the dorsal area whose culture revealed Microspore canis. The mass was excised and oral ketoconazole was indicated. After three months of follow up, the patient was lost from control

Micetoma por nocardia: presentación de un caso / Nocardia mycetoma: report of one case

Una mujer de 32 años desarrolló una lesión con inflamación local, nódulos linfáticos agrandados en cadena que ascendían proximalmente, seguido de una picadura de una hormiga gigante. Seguidamente desarrollo vesículas que segregaban material purulento. Clínicamente de sospechó infección micótica por esporotricosis. Se realizó biopsia y cultivo y se aisló un bacilo Gram (+) y filamentoso, que después de la clasificación por cultivo reveló ser nocardia brasiliensis, produciendo una lesión linfocutánea localizada (micetoma).

Micetoma: reporte de tres casos en el estado Falcón, Venezuela / Mycetome: report of three cases in Falcon state, Venezuela

Se reportan tres casos nuevos de micetoma estudiados en nuestro laboratorio durante los últimos 4 años. Se informa sobre la evolución del primer caso por pyrenochaeta romeroi nova species reportado por Borelli en 1959Los pacientes hombres agricultores con edades de 18, 42 y 54 años proceden de las zonas semiárida y subhúmeda del Estado Falcón. Al exámen clínico presentaron síndrome de micetoma (edema, fístulas y granos); de 6 meses a 3v años de evolución. Las lesiones se localizaron en los miembros inferiores en dos pacientes y en dos de ellos en el torax. El diagnóstico clínico fue confirmado por estudio micribiológico y micológico, aislándose en dos casos Nocardia brasilenzis y en uno Madurella grisea. Dos de los pacientes recibieron terapia a base de Sulfas con remisión de su enfermedad en dos años de seguimiento

Treatment of acinomycetoma

We report the excellent therpeutic responce of actinomycetoma treated with amikacin-trimethroprim-sulfamethoxazole. The medication was given in cycles for-5 weeks. Ninety-five percent of all cases were cured after 5, 10 or 15 weeks treatment