ABSTRACT
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.
El micetoma es una lesión subcutánea inflamatoria granulomatosa crónica causada por hongos (eumiceto-ma) o bacterias filamentosas (actinomicetoma). Afecta a adultos entre los 20-40 años y el sitio más comúnmente afectado es el pie. La tríada característica es un aumento de volumen del tejido afectado, con trayectos sinuosos y gránulos excretados. Comunicamos el caso de un hombre de 31 años, sano, con una historia de 6 años de un tumor asociado a trayectos sinuosos y gránulos en la región plantar izquierda. El diagnóstico clínico de micetoma fue confirmado mediante estudio microbiológico e histológico. La amplificación y secuenciación del AlDN bacteriano identificó Actinomadura madurae. Es el segundo caso de actinomicetoma reportado en Chile. Consideramos importante considerar este diagnóstico en pacientes con enfermedad granulomatosa crónica asociado a trayectos sinuosos, fístulas y gránulos.
Subject(s)
Adult , Humans , Male , Actinomycetales Infections/pathology , Foot Dermatoses/microbiology , Mycetoma/pathology , Actinomycetales Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Biopsy , Foot Dermatoses/pathology , Mycetoma/drug therapy , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
Mycetoma is a pathological process in which eumycotic (fungal) or actinomycotic causative agents from exogenous source produce grains. It is a localized chronic and deforming infectious disease of subcutaneous tissue, skin and bones. We report the first case of eumycetoma of the oral cavity in world literature. CASE REPORT: A 43-year-old male patient, complaining of swelling and fistula in the hard palate. On examination, swelling of the anterior and middle hard palate, with fistula draining a dark liquid was observed. The panoramic radiograph showed extensive radiolucent area involving the region of teeth 21-26 and the computerized tomography showed communication with the nasal cavity, suggesting the diagnosis of periapical cyst. Surgery was performed to remove the lesion. Histopathological examination revealed purulent material with characteristic grain. Gram staining for bacteria was negative and Grocott-Gomori staining for the detection of fungi was positive, concluding the diagnosis of eumycetoma. The patient was treated with ketoconazole for nine months, and was considered cured at the end of treatment. CONCLUSION: Histopathological examination, using histochemical staining, and direct microscopic grains examination can provide the distinction between eumycetoma and actinomycetoma accurately.
Micetoma é um processo patológico no qual agentes eumicóticos (fungos) ou actinomicóticos de origem exógena podem causar formação de grãos. É uma doença infecciosa localizada, crônica e deformante do tecido subcutâneo, pele e ossos. Relatamos o primeiro caso de eumicetoma da cavidade bucal da literatura mundial. RELATO DE CASO: Paciente masculino, de 43 anos, com queixa de edema e fístula no palato duro. Ao exame clínico, observava-se edema da região anterior e média de palato duro, com fístula drenando líquido escuro. A radiografia panorâmica mostrou área radiolúcida extensa, envolvendo a região dos dentes 21 ao 26 e a Tomografia computadorizada evidenciou comunicação com a cavidade nasal, sugerindo o diagnóstico de cisto periapical. Foi realizada cirurgia para remoção da lesão. O exame histopatológico revelou material purulento com grãos característicos. A coloração de Gram para pesquisa de bactérias foi negativa e a coloração de Gomori-Grocott para pesquisa de fungos foi positiva, concluindo o diagnóstico de eumicetoma. O paciente foi tratado com Cetoconazol durante nove meses, obtendo cura ao final do tratamento. CONCLUSÃO: O exame histopatológico, usando colorações histoquímicas, e o exame dos grãos por microscopia direta podem proporcionar adequada distinção entre eumicetoma e actinomicetoma.
Subject(s)
Adult , Humans , Male , Mouth Diseases/microbiology , Mycetoma/microbiology , Antifungal Agents/therapeutic use , Ketoconazole/therapeutic use , Mouth Diseases/drug therapy , Mycetoma/drug therapy , Treatment OutcomeABSTRACT
Mycetoma is a chronic granulomatous infection. Lower extremities are commonly involved. A 20-year-old male came with complaints of multiple sinuses on scalp, left eyelid swelling with a sinus and dystopia, since one year. On examination there was relative proptosis in left eye of 2 mm. Computed tomography scan showed soft tissue swelling of the pre-septal area of the left upper eyelid with orbital involvement. Magnetic resonance imaging showed increased left orbital volume and evident dystopia. Microbiology testing of the erosive scalp and lid lesions showed genus Nocardia, suggestive of actinomycetoma. This case is presented as it shows an unusual involvement of the orbit.
Subject(s)
Adolescent , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Mycetoma/diagnosis , Mycetoma/drug therapy , Mycetoma/microbiology , Nocardia asteroides/isolation & purification , Orbit/microbiology , Orbit/pathology , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , Orbital Diseases/microbiology , Tomography, X-Ray ComputedABSTRACT
Mycetoma is a chronic infection that affects skin, subcutaneous tissue and bone. Its etiology can be mycotic or bacterial. It affects mainly the lower extremities ofmiddie age men livingin tropical climates. We repon a 44 year-old male ¡ivingin a template zone, consulting for swelling and pain in the left foot, lasting for 10 years. Physical examination showed a swollen left foot with hyperpigmented skin and a few crustedpapules. Radiology showed an extensive bone involvement of the midfoot with several oval and radiolucid images. Magnetic resonance showed son and bone tissue involvement, with múltiple oval and low intensity images in TI and T2. The biopsy was compatible with an unspecific chronic osteomyelitis. A bacterial identification by polymerase chain reaction and sequencing in the biopsy determined the presence of an Actinomadura madurae. Treatment with cotrimoxazol was started).
Subject(s)
Adult , Humans , Male , Actinomycetales/genetics , Foot Dermatoses/microbiology , Mycetoma/microbiology , Actinomycetales/classification , Actinomycetales/isolation & purification , Anti-Infective Agents/therapeutic use , Foot Dermatoses/diagnosis , Foot Dermatoses/drug therapy , Mycetoma/diagnosis , Mycetoma/drug therapy , Polymerase Chain Reaction , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
We describe a patient with mycetoma or Madura foot, in which histopathological stains of the bone and surface cultures suggested three different organisms including Nocardia species as the cause. Criteria for the diagnosis of the organisms, differentiation between colonizer and pathogen, and significance of mixed infections are discussed.
Descrevemos um paciente com micetoma ou maduromicose de pé, no que colorações histopatológicos de osso e de culturas superficiais sugeriram três organismos diferentes, incluindo espécies de Nocardia como causador. Os critérios de diagnóstico dos organismos, a diferenciação entre colonizador e patógeno, e a significância das infecções mistas são discutidos.
Subject(s)
Humans , Male , Middle Aged , Foot Dermatoses/microbiology , Leg Dermatoses/microbiology , Mycetoma/microbiology , Anti-Infective Agents/therapeutic use , Chronic Disease , Doxycycline/therapeutic use , Foot Dermatoses/drug therapy , Foot Dermatoses/pathology , Leg Dermatoses/drug therapy , Leg Dermatoses/pathology , Mycetoma/drug therapy , Mycetoma/pathology , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
BACKGROUND: Combination antibiotic regimens are effective in the treatment of actinomycetoma but many treatment schedules require supervised parenteral therapy for prolonged periods. We describe a schedule that includes parenteral medication in an initial, short phase followed by a longer phase of oral medication. METHODS: Sixteen patients with clinically diagnosed mycetoma, who did not show any evidence of a fungal etiology, were treated presumptively for actinomycetoma. Evidence of actinomycotic infection was found on microscopy of granules / discharge and / or histopathological examination in eight (50%) patients. The treatment consisted of an intensive phase (Step 1) with gentamicin, 80 mg twice daily, intravenously and cotrimoxazole, 320/1600 mg twice daily orally for four weeks. This was followed by a maintenance phase with cotrimoxazole and doxycycline, 100 mg twice daily till all sinuses healed completely. The treatment was continued for 5-6 months. RESULTS: Treatment response was assessed monthly. At the end of the intensive phase, there was a significant improvement in all 16 patients. Nine patients who continued the maintenance phase of the regimen had complete healing of sinuses with marked reductions in swelling and induration in 2.4 +/- 1.7 months. Maintenance treatment was continued for a mean of 9.1 +/- 4.3 months in these patients. Six patients have remained free of disease activity during a follow-up period of 11.1 +/- 4.2 months after treatment was stopped. Two patients developed leucopenia and thrombocytopenia necessitating withdrawal of cotrimoxazole. CONCLUSION: This regimen was effective in treating actinomycetoma. The short duration of the phase requiring parenteral therapy makes it convenient to administer.
Subject(s)
Actinomycosis/drug therapy , Adolescent , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Doxycycline/administration & dosage , Drug Administration Schedule , Female , Gentamicins/administration & dosage , Humans , Male , Middle Aged , Mycetoma/drug therapy , Skin Diseases, Bacterial/microbiology , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosageABSTRACT
Endogenous intraocular infection of fungal etiology is extremely rare in an immunocompetent individual. Usually, an antecedent history of trauma, surgery, intravenous drug abuse or an immunocompromized state can be elicited. Scedosporium apiospermum is a known cause of keratomycosis after traumatic implantation and can cause fatal disseminated infection in immunocompromized patients. However, cases of S. apiospermum intraocular infection in immunocompetent individuals have been very rarely reported in literature. We report here a case of an anterior chamber exudative mass due to S. apiospermum in an immunocompetent individual which was managed successfully with anterior chamber wash and intravitreal injection of voriconazole.
Subject(s)
Anterior Chamber/metabolism , Antifungal Agents/administration & dosage , Exudates and Transudates/metabolism , Eye , Eye Infections, Fungal/drug therapy , Humans , Immunocompetence , Injections , Male , Middle Aged , Mycetoma/drug therapy , Pyrimidines/administration & dosage , Scedosporium , Triazoles/administration & dosage , Vitreous BodyABSTRACT
A case of eumycetoma of foot in an 8-year old male child was clinically diagnosed as chronic osteomyelitis and was microbiologically confirmed as eumycetoma. The case is being reported for its uncommon clinical presentation and etiological agent, Exophiala jeanselmei. The patient recovered completely after treatment with ketoconazole.
Subject(s)
Antifungal Agents/therapeutic use , Child , Exophiala/isolation & purification , Foot Dermatoses/drug therapy , Histocytochemistry , Humans , Ketoconazole/therapeutic use , Leg/pathology , Male , Mycetoma/drug therapy , PhotographyABSTRACT
Antecedentes: El tratamiento estándar del actinomicetoma es dapsona con trimetoprim/sulfametoxazol. En casos seleccionados amikacina, estreptomicina, kanamicina, amoxicilina/ácido clavulánico o fosfomicina. El imipenem ha mostrado tener actividad in vitro e in vivo contra algunos actinomicetos; tiene un efecto sinérgico combinado con amikacina. Objetivos: Comunicar la respuesta al tratamiento con imipenem solo o combinado con amikacina en micetomas por Nocardia sp graves o multirresistentes. Material y métodos: Presentamos cinco pacientes con actinomicetoma que habían recibido múltiples tratamientos. Se hospitalizaron tres semanas para recibir imipenem (500 mg cada ocho horas) intravenoso por vía periférica por 21 días. En dos casos se combinó con amikacina. Resultados: Tres pacientes fueron hombres y dos mujeres. En tres casos la localización fue en el dorso, uno de ellos con afección ósea y pulmonar; en un caso hubo afección de la pared abdominal y en otro en la región cervical posterior. La evolución promedio fue de 7.4 años. En dos casos se logró curación clínica y bacteriológica a un año de seguimiento. En el paciente con afección pulmonar también hubo mejoría radiográfica. En el resto de los casos se logró cierre de la mayoría de las fístulas y una disminución importante de la inflamación, aunque hubo presencia de granos con cultivo negativo. Ningún tratamiento provocó efectos colaterales. Conclusiones: El imipenem es un antibiótico de amplio espectro y consideramos que es una buena alternativa para tratar actinomicetomas graves, resistentes al tratamiento habitual o con complicaciones viscerales.
INTRODUCTION: Dapsone with trimethoprim-sulfamethoxazol is currently the standard treatment for actinomycetoma. In select cases, amikacin, streptomycin, kanamycin, amoxicillin/clavulanic acid or phosphomycin may be also added. Imipenem has shown to be effective both in vitro and in vivo against some actinomycetes. Amikacin with Imipenem has a synergistic effect. OBJECTIVES: To report our preliminary findings using imipenem alone or with amikacin for severe or multi-resistant mycetomas due to Nocardia sp. MATERIAL AND METHODS: We present 5 cases of chronic mycetoma infection previously treated with anti-bacterial multidrug regimens. All patients were hospitalized and treated with imipenem 500 mg IV, three times a day for three weeks. Three patients received in addition amikacin. RESULTS: We included 3 male and 2 female patients. The average length of disease duration was 7.4 years. In 3 cases mycetoma was located on the back; one of them involved the rib and the lung. One case was localized in the abdominal wall, and another one involved the posterior side of the cervical region. Two patients achieved clinical and bacteriological cure one year after treatment with Imipenem, and the remaining three displayed clinical improvement, even though grains were observed, cultures where negative. None of the 5 patients studied showed clinical evidence of adverse reactions to Imipenem. CONCLUSIONS: Imipenem is a strong antibiotic and constitutes an important treatment alternative for severe or multi-resistant mycetoma especially for cases with bone and visceral involvement.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anti-Bacterial Agents/administration & dosage , Amikacin/administration & dosage , Imipenem/administration & dosage , Mycetoma/drug therapy , Nocardia Infections/drug therapy , Drug Therapy, CombinationABSTRACT
Se presentan las características clínicas, microbiológicas y los resultados del tratamiento de 76 casos de micetomas observados en el período 1989-2004 en el Hospital Muñiz. Cuarenta y nueve fueron varones y 27 mujeres, con una edad promedio de 43,4 años. La mayor parte de los pacientes adquirió la infección en nuestro país, las provincias más afectadas fueron Santiago del Estero con 31 casos y el Chaco con 11; 8 enfermos procedían del exterior, 6 de Bolivia y 2 de Paraguay. El promedio de evolución de la enfermedad fue de 9,2 años. Las localizaciones más comunes fueron las de los miembros inferiores: pies 63, tobillos 3 y rodillas 2. Se comprobó compromiso óseo en 48 casos y adenomegalias en 5. Fueron identificados los siguientes agentes causales: Madurella grisea 29 casos, Actinomadura madurae 26, Scedosporium apiospermum 5, Nocardia brasiliensis 5, Acremoniun spp. 4 (Acremonium falciforme 2, Acremonium kiliense 1 y Acremonium recifei 1), Madurella mycetomatis 3, Fusarium solani 2, Nocardia asteroides y Streptomyces somaliensis 1 caso cada uno. Los tratamientos más frecuentemente utilizados fueron ketoconazol o itraconazol en los micetomas maduromicósicos y la asociación de cotrimoxazol con ciprofloxacina o amicacina en los micetomas actinomicéticos. La amputación del miembro afectado se realizó en 6 casos, 25 pacientes alcanzaron la remisión clínica completa y 34 presentaron mejorías importantes.
This work presents clinical, microbiological and outcome data collected from 76 patients with mycetomas at the Muñiz Hospital from 1989 to 2004. Forty-nine patients were male and 27 female; the mean age was 43.4 years. The majority of the patients acquired the infection in Argentina: the most affected provinces were Santiago del Estero with 31 cases, and Chaco with 11; 8 cases came from other countries (Bolivia 6 and Paraguay 2). The mean evolution of the disease was 9.2 years. The most frequently observed sites were: feet 63 cases, ankles 3, and knees 2. Forty-eight patients had bone lesions and 5, adenomegalies. The following etiological agents were identified: Madurella grisea 29 cases, Actinomadura madurae 26, Scedosporium apiospermum 5, Nocardia brasiliensis 5, Acremonium spp. 4 (Acremonium falciforme 2, Acremonium kiliense 1, Acremonium recifei 1), Madurella mycetomatis 3, Fusarium solani 2, Nocardia asteroides 1 and Streptomyces somaliensis 1. The main drugs used in the treatments were ketoconazole and itraconazole for maduromycotic mycetomas, and cotrimoxazole associated with ciprofloxacin or amikacin for actinomycetic mycetoma. Six patients had to undergo amputation, 25 cases achieved complete clinical remission and 34 showed remarkable improvement.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Actinomycetales Infections/epidemiology , Mycetoma/epidemiology , Amputation, Surgical , Actinomycetales Infections/drug therapy , Actinomycetales Infections/microbiology , Actinomycetales Infections/surgery , Actinomycetales/isolation & purification , Agricultural Workers' Diseases/drug therapy , Agricultural Workers' Diseases/epidemiology , Agricultural Workers' Diseases/microbiology , Agricultural Workers' Diseases/surgery , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Argentina/epidemiology , Combined Modality Therapy , Fusarium , Foot Dermatoses/drug therapy , Foot Dermatoses/epidemiology , Foot Dermatoses/microbiology , Foot Dermatoses/surgery , Madurella/drug effects , Madurella/isolation & purification , Mitosporic Fungi/isolation & purification , Mycetoma/drug therapy , Mycetoma/microbiology , Mycetoma/surgery , Nocardia Infections/drug therapy , Nocardia Infections/epidemiology , Nocardia Infections/microbiology , Nocardia Infections/surgery , Osteitis/drug therapy , Osteitis/etiology , Osteitis/microbiology , Osteitis/surgery , Remission Induction , Retrospective Studies , Treatment OutcomeABSTRACT
Eumicetoma e cromoblastomicose são infecções fúngicas crônicas do tecido subcutâneo que evoluem com aspecto desfigurado, raramente involuindo espontaneamente. A maioria dos pacientes não apresenta melhora sustentada por longo tempo com os tratamentos disponíveis, sendo de grande importância as novas opções terapêuticas. A eficácia do posaconazol, um novo agente antifúngico de amplo espectro do grupo dos triazóis, foi estudada em 12 pacientes com eumicetoma ou cromoblastomicose refratária às terapêuticas antifúngicas disponíveis. Os pacientes receberam por no máximo 34 meses, doses divididas de 800 mg/dia de posaconazol. Resposta clínica parcial ou completa foi considerada como sucesso; doença estável ou falha terapêutica foi considerada como insucesso. Todos os 12 pacientes tinham infecções comprovadas ou prováveis, refratárias à terapêutica padrão preconizada. Sucesso clínico foi registrado em cinco de seis pacientes com eumicetoma e cinco de seis pacientes com cromoblastomicose. Em dois pacientes observou-se doença estável. Como parte do protocolo de extensão do tratamento, dois pacientes com eumicetoma que inicialmente tinham tido sucesso terapêutico e que após um intervalo maior de 10 meses apresentaram recidiva da micose, foram retratados com sucesso com posaconazol. Posaconazol foi bem tolerado durante o longo período de administração (até 1015 dias). A terapêutica com posaconazol foi seguida de sucesso na maioria dos pacientes com eumicetoma ou cromoblastomicose refratária à terapêutica padrão, sugerindo que tal droga possa ser uma importante opção no tratamento de tais doenças.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antifungal Agents , Chromoblastomycosis/drug therapy , Mycetoma/drug therapy , Triazoles/therapeutic use , Antifungal Agents , Chromoblastomycosis/microbiology , International Cooperation , Mycetoma/microbiology , Treatment Outcome , Triazoles/adverse effectsABSTRACT
El actinomiocetoma es una enfermedad crónica de la piel y tejidos subcutáneos de evolución muy lenta y por tanto poco invalidante durante los primeros meses o años de su aparición. Esto ocasiona que su diagnóstico y tratamiento resulten una desventaja para el individuo que la padece y favorece al progreso de la enfermedad. Un problema adicional es que la incidencia de esta patología en nuestro país es baja y se presenta preferentemente en poblaciones que trabajan en el campo; por esta razón, el presente trabajo de revisión bibliográfica tiene como principal objetivo actualizar la información acerca de las principales características de este padecimiento, las estrategias de diagnóstico y tratamiento, así como las evidencias experimentales que permiten su estudio en un modelo animal
Subject(s)
Humans , Animals , Actinomycetales Infections/diagnosis , Mycetoma/diagnosis , Actinomycetales Infections/drug therapy , Amikacin/therapeutic use , Disease Models, Animal , Magnetic Resonance Imaging , Mycetoma/drug therapy , Mycetoma/etiology , Prognosis , Tomography, X-Ray ComputedABSTRACT
El actinomicetoma es un síndrome de localización subcutánea de evolución crónica. Se presenta el caso de un paciente con micetoma abdominal causado por Nocardia brasiliensis, que había sido resistente a diferentes esquemas terapéuticos durante varios años y que, además, presentaba deficiencia en la función fagocitaria. En este caso, la curación se obtuvo con la administración de dos ciclos (con duración de 23 días cada uno); se administró cefotaxima (1g cada 8 horas) y amikacina (50 mg cada 12 horas). La inmunomodulación se llevó a cabo mediante la administración de una dosis semanal de levamisol de 300 mg, durante cuatro semanas, y la aplicación dos veces por semana de 1 ml de antígeno bacteriano a una concentración 600,000,000 de bacterias por ml durante 20 meses. Se discute la utilidad del antibiograma en estos pacientes y la importancia de la investigación de la función inmunológica en pacientes con resistencia a los tratamientos convencionales