New radiographic classification of bone involvement in pedal mycetoma.

OBJECTIVE: The purpose of this study was to classify the pattern, extent, and severity of bone involvement in mycetoma of the foot. CONCLUSION: In this classification, stage 0 indicates the presence of soft-tissue swelling without bone involvement. Stage I refers to the extrinsic pressure effects on the intact bones in the vicinity of an expanding granuloma. Stage II results from irritation of the bone surface without actual intraosseous invasion. Cortical erosion and central cavitation occur in stage III. If the disease spreads longitudinally along a single ray, stage IV is established; horizontal spread along a single row represents stage V. Multidirectional spread due to uncontrolled infection is classified as stage VI.

Fungal infections of the paranasal sinuses.

Fungal infections can be mainly grouped into four types. The invasive forms are acute sinusitis (fulminant), chronic sinusitis (indolent), whereas the non-invasive forms are mycetoma and allergic fungal sinusitis. From December 1993 to December 1997, 27 cases of fungal sinusitis, 22 of which were noninvasive forms, and 5 of which were invasive forms, were treated and are presented in this study. When we classified the patients with fungal sinusitis, 11 were diagnosed as mycetoma, 9 as allergic fungal sinusitis, 3 as acute fulminant sinusitis and 2 as chronic indolent sinusitis, while 2 patients were not included in our four groups of sinusitis. In all mycetoma cases the active agent was Aspergillus. Patients with non invasive forms of sinusitis were all treated with endoscopic sinus surgery. 2 of the patients with invasive forms of sinusitis underwent maxillectomy and they were given Amphotericin-B. With a mean follow up of 20 months, only 3 recurrences were seen. The infection recurred in 2 patients with allergic fungal sinusitis and 1 patient with chronic invasive sinusitis. However, 2 patients with acute fulminant invasive sinusitis died before they were operated on, and 1 patient died postoperatively.

[Scapulo-thoracic mycetoma. A rare localization, a particular form]. / Mycétome scapulo-thoracique. Une localisation rare, une forme particulière.

INTRODUCTION: An uncommon form and a rare localization of mycetoma is reported. The aim of this report was to distinguish this inhabitual form of mycetoma from some tropical diseases like onchocerca and other fungal diseases. CASE REPORT: A 55 year old man was admitted 10 years after a septic worm-hole for a scapulo-thoracic tumor. This encapsulated mass was a bending and rounded polyfistular one attached to the dorsal aspect of left shoulder. The fistula discharge a serosanguineous or purulent exudate. The characteristic red granule was not visible. The tumor was removed and histological examination was performed. A typical granuloma of red granule of streptomyces pelletieri was found. A good result was obtained with associated cotrimoxazole treatment. DISCUSSION: Scapulo-thoracic form included: scapular, axillary and chest form of mycetoma. All these localizations are rare. One of them can be complicated by osteitis or pleuro-pulmonary localization. Streptomyces pellitieri is the actinomycetic causal agent. This encapsulated form is uncommon. CONCLUSION: Scapulo-thoracic mycetoma is rare. Encapsulated and pedicular form is uncommon. Around Sahel areas, differential diagnosis must be evoked such as parasitic and mycobacterial infections.

The spectrum of pulmonary aspergillosis.

Aspergillus species can produce a wide range of pulmonary disorders. Classically, pulmonary aspergillosis has been categorized into invasive, saprophytic, and allergic forms, all of which differ in their manifestations and therapy. More recently, however, other types of infection by this fungus have been recognized that do not fit into these traditional categories; an example is semi-invasive (chronic necrotizing) aspergillosis. In fact, these forms have features that are intermediate between those of the invasive and saprophytic types. The various types of aspergillosis can be regarded as constituting a continuous spectrum, ranging from invasive disease in the severely immunosuppressed patient to hypersensitivity reactions such as allergic bronchopulmonary aspergillosis (and bronchocentric granulomatosis) in the hyperreactive patient. Between these extremes are chronic necrotizing disease seen in midly immunocompromised hosts, and the noninvasive aspergilloma, which is due to saprophytic growth within a previously diseased area of lung in an otherwise normal host. Other intermediate forms may be encountered, their behavior being determined by the host immune status in combination with the underlying lung morphology. The radiographic and clinical features of these various forms of pulmonary aspergillosis are reviewed, including the more recently reported forms of infection such as Aspergillus tracheobronchitis and aspergillosis associated with acquired immunodeficiency syndrome and cystic fibrosis. The proposed concept of a disease spectrum is emphasized.

Mycetoma: infection with tumefaction, draining sinuses, and "grains".

Mycetoma is a tumorous infection of skin and subcutaneous tissue. It is caused by either actinomycotic bacteria or eumycotic fungi. The three cardinal features are tumefaction or the appearance of indolent inflammatory nodules and secondary fibrosis, formation of sinus tracts and fistulas that may have the ability to penetrate deep tissue, and the presence of grains or granules in the affected tissue and discharge. Although mycetoma is relatively uncommon in the United States, increasing mobility and changes in demographic characteristics should lead to a greater awareness of this disease. Characteristic histopathologic findings and microbiological identification establish the diagnosis. Consequently, when evaluating what might seem like an ordinary skin or fungal infection, we must widen our differential diagnosis to include mycetoma. Effective treatments for actinomycetoma are available, whereas eumycetoma is often difficult to treat.

The histopathological features of pale grain eumycetoma.

Histological findings in 24 cases of pale grain eumycetoma have been compared. The inflammatory response and morphology of grains caused by different organisms are very similar. However the histological appearances of Neotestudina rosatii infections, although reminiscent of dermatophyte mycetomas, are distinctive. The characteristic features include the presence of cement and the short swollen hyphal segments. Petriellidium boydii grains are more likely to contain numerous vesicles or swollen hyphae and be surrounded by a prominent eosinophilic fringe. In contrast, Fusarium and Acremonium grains usually have a minimal fringe and contain a dense mass of intermeshing hyphae. However the features separating P. boydii and Fusarium/Acremonium grains are not invariable and can only be used as an approximate guide to the correct identity of the organism.

[Classification and treatment of maduromycosis of the limbs]. / O klassifikatsii i lechenii maduromikoza konechnostei

Basing on studies of the comprehensive material comprising 344 cases of Maduromycosis (Madura foot) in Somaly Republic, its classification, grounded on the anatomical principle is given. Whereas, the currently used classifications are grounded only on the clinical principle. Investigations and experience have shown that the classification of Maduromycosis grounded just on clinical signs is but poorly suitable for surgical therapy of such patients. The anatomical principle seems to be more advantageous, since it provides an indication to localization and depth of the lesion, thus determining the character of an operative intervention.