Actinomicetoma plantar en un paciente sin factores de riesgo / Plantar actinomycetoma in a patient without risk factors

Resumen Se presenta un caso clínico de un actinomicetoma plantar en un paciente sin factores de riesgo, cuyo diagnóstico fue realizado mediante una biopsia de tejido plantar por sospecha de una neoplasia. Dado que el paciente no respondió satisfactoriamente a la terapia de primera línea, debió completar 24 semanas de tratamiento con doxiciclina, a lo cual evolucionó favorablemente. Finalmente, se desarrolla una breve discusión sobre los micetomas plantares.

A case of plantar actinomycetoma without risk factors is presented, which was diagnosed by hystopatological analysis of a foot biopsy because of the suspicion of neoplasia. Since the patient did not fully respond to the first-line therapy antibiotics, a 24-weeks doxycycline regime was started, achieving a satisfactory response. Finally, a brief discussion on plantar mycetomas is presented.

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.

The use of a documentary drama film to improve the knowledge, attitude and practice of an endemic village population towards mycetoma at Sennar State, Sudan

Background: Mycetoma is a badly neglected tropical disease, characterised by enormous deformities, disfigurement and disabilities if untreated early. Frequently, the majority of the mycetoma patients present late with advanced disease, and the only available treatment for them will be amputation of the affected part. Aim: This study aimed at producing a health promoting film to be used to improve the knowledge, attitude and practice (KAP) of a targeted population in one of the mycetoma endemic villages at Sennar State, Sudan.Materials and Methods : A 26 - minute drama film on a mycetoma patient journey from a small painless mass to advanced disease till lower limb amputation due to missinformation and negligence was performed. Professional actors and cinema work team were employed in the film production. It was filmed in one of the mycetoma endemic areas. A cohort of 250 individuals from two mycetoma endemic villages were included in this study. A closed ended pre-designed questionnaire was used to collect data from the targeted population. The collected data included demographic characteristics, knowledge, attitudes and practices towards mycetoma. The data was collected before and after the film was shown.Results: In this study, 218/250 responded to the questionnare with a response rate of 87%. Fifty-five percent of the respondents were males, 21.6% were farmers, 29.4% were students and 29.4% were unemployed.The film had improved the KAP of the targeted population hence it can be used as a health educational material in other mycetoma endemic areas in the Sudan

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.

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...

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.

Concurrent mycetoma and chromomycosis.

Chromoblastomycosis and Madura foot are chronic localised mycotic infection of the skin and subcutaneous tissue that follows the implantation of the fungi through minor trauma, mainly found in persons working outdoors on bare foot. In cases where both Madura and chromoblastomycosis are present, the treatment becomes difficult with low cure rates and frequent relapses. Here, we present such a very rare case of a 38-year-old cattle farmer who presented with verrucose nodules, tumefaction and multiple discharging nodules on the left lower 1/3 rd leg and foot since last 9 years. Direct KOH mount of the verrucose tissue showed Fonsecaea pedrosoi sclerotic muriform bodies and a biopsy of one granule discharging nodule demonstrated fungal mycetoma. He was put on tab. Itraconazole 200 mg o.d. and cotrimoxazole bid for 6 months with very little improvement. The rarity of this combination is most probably due to different geographical distribution.

Eumycetoma in groin and perineum due to madurella mycetomatis.

A case of eumycetoma of groin and perineum region in a 35 yrs old male was reported to Dermatology department of our institute. Patient presented with nodules and multiple discharging sinuses in the groin and perineum region, some of which containing black granules. Granules were collected and processed for bacteriological, mycologieal and histopathological examination. Clinically diagnosed mycetoma case was microbiologically confirmed as eumyeetoma. The case is being reported for its unusual clinical presentation and common etiological agent, Madurella mycetomatis.

Disseminated orbital actinomycetoma: A case report.

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.

Infección rinosinusal por Scedosporium apiospermum en un hospedero inmunocompetente / Scedosporium apiospermum rhinosinusal infection in an immunocompetent host

Scedosporium species can cause colonization, superficial and deep localized infection or systemic disease, espe-cially in irnmunocompromised hosts. We report a case of localized infection due to Scedosporium apiospermum in a 47 year oíd woman, with previous nasal surgery. She consulted for recurrent mucopurulent post-nasal discharge not responding to antibiotics. Computed tomography showed opacification of right maxillary sinus. Surgery was performed to removed abnormal tissue from sinus; biopsy revealed chronic sinusitis with aggregate of tightly packed hyphae suggestive of filamentous fungi. The microbiology fungal culture reported Scedosporium apiospermum.

Las infecciones por Scedosporium sp pueden traducirse en colonización, infecciones localizadas superficiales y profundas, o enfermedad diseminada. Presentamos un caso clínico de infección rinosinusal por Scedosporium apiospermum en una paciente de 47 años, con antecedente de cirugía por cuerpo extraño en la fosa nasal derecha. Consultó por descarga posterior muco-purulenta y recurrente, sin respuesta a tratamiento antibacteriano. Las imágenes de cavidades paranasales mostraron opacidad del seno maxilar derecho. Se realizó cirugía de remoción de contenido sinusal cuyo estudio histológico reveló sinusitis crónica erosiva, colonias de hongos con morfología sugerente de hongo filamentoso y desarrollo de S. apiospermum en el cultivo.

Mycetoma revisited, incidence of various radiographic signs

To define and quantitate various radiographic signs of mycetoma infection. A retrospective study of 516 randomly selected patients seen between December 1996 and December 2004 at the Mycetoma Research Centre of Khartoum University, Khartoum, Sudan. All cases were confirmed by clinical examination, initial pretreatment radiographs, and histopathology. The most common abnormalities in these 516 patients were soft tissue swelling [93%], bone sclerosis [56%], bone cavities [32%], and periosteal reaction [27%]. The incidence of bone expansion [22%], extrinsic cortical scalloping [22%], and fanning of the rays in 10% were reported. Osteoporosis was seen in 19%. Only 3% of the patients had normal radiographs. Maximal scrutiny of radiographs alone by experienced radiologists is vital, as other imaging techniques are not available where mycetoma is prevalent

Micetoma por Actinomadura madurae en el pie: reporte de un caso en Chile / Actinomadura madurae mycetoma of the foot: report of one case

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).

Micetoma: [revisión] / Mycetoma: [review]

El micetoma es una enfermedad crónica, inflamatoria, subcutánea y granulomatosa, causada por diferentes especies de hongos (eumicetoma), actinomicetos (actinomicetoma) o bacterias como Staphylococcus aureus, Pseudomonas aeruginosa (Botriomicosis). Esta patología ocurre entre latitudes15 al sur y 30 Norte y es endémica en áreas relativamente áridas. Los microorganismos causales están presentes en el suelo y pueden entrar al tejido subcutáneo por inoculación traumática. El micetoma comúnmente afecta adultos entre 20 y 40 años, predominantemente hombres. El pie es el sitio más comúnmente afectado. El micetoma se presenta como una inflamación subcutánea progresiva. Se desarrollan múltiples nódulos, los cuales supuran y drenan a través de senos, descargando granos durante la fase activa de la enfermedad. El diagnóstico se basa en radiología, imágenes ultrasónicas, citología, cultivo e inmunodiagnóstico. El actinomicetoma es susceptible a tratamiento antibiótico prolongado, preferiblemente con varias medicaciones. El Eumicetoma se trata con excisión quirúrgica agresiva combinada con tratamiento médico y la botriomicosis se trata con antibióticos una vez establecido el diagnóstico, ojalá con aislamiento del agente causal.

Mycetoma is a chronic, granulomatous, subcutaneous, inflammatory disease caused by different fangal species (Eumycetoma), actinomycetes (Actimonycetoma), or bacteria Staphylococcus aureus, Pseudomonas aeruginosa, (Botryomycosis). It occurs between the latitudes of 15 South and 30. North and is endemic in relatively arid areas. The organisms are present in the soil and may enter the subcutaneous tissue by traumatic inoculation. Mycetoma commonly affects adults aged 20 to 40 years, predominantly males. The foot is most commonly affected. Mycetoma presents itself as progressive, subcutaneous swelling. Multiple nodules develop which may supúrate and drain through sinuses, discharging grains during the active phase of the disease. Diagnosis may involve radiology, ultrasonic imaging, cytology, culture, histology, or immunodiagnosis. Actinomycetoma is amenable to prolonged treatment by antibiotics, preferably by combining several medications. Eumycetoma is usually treated by aggressive surgical excision combined with medical treatment and Botryomycosis is treated with antibiotics upon establushment of the diagnosis preferably after isolation of the causal agent.

Mycetoma sans sinuses.

Mycetoma is a chronic suppurative infection involving the skin, subcutaneous tissue and bone. The hallmark of mycetoma is tumefaction, draining sinuses and the presence of microcolonies called grains. Sinuses develop in all patients with mycetoma within a year of the appearance of the lesion. The following case is reported as no sinuses had developed despite the presence of the lesion for 9 years, posing a diagnostic dilemma.