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1.
PLoS Negl Trop Dis ; 14(4): e0008240, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32348300

RESUMO

Mycetoma is considered a neglected tropical disease globally. However, data on its burden and the associated complications in Uganda are limited. Hence we aimed to estimate its burden in Uganda. Firstly, a systematic PubMed search for all studies of any design on mycetoma in Uganda without restriction to the year of publication was conducted. A retrospective review of all the biopsy reports at the Pathology Reference Laboratory, Department of Pathology, Makerere University, Kampala, Uganda from January 1950 to September 2019 was conducted to identify any reports on mycetoma histological diagnosis. During the 70-years study period, 30 cases were identified by the literature review, with 249 additional cases identified by review of biopsy reports (total of 279 cases). The average incidence was estimated at 0.32/100,000 persons and prevalence of 8.32/100,000 persons per decade. However, there was a general decline in the number of cases detected recently. Males and the age group of 21-30 years were the most affected by mycetoma in Uganda, and only 7% of the cases were children. The highest number of cases was recorded from Kampala (n = 30) and Jinja (n = 19) districts. The majority of the cases (68%) were referred from surgical units. The foot was the most affected part of the body (72%). Ten per cent of the cases had bone involvement of which 58% required amputation. Fungi were the most common causative agents (89%) followed by Nocardia species (5%) and Actinomycetes (4%). The index of clinical suspicion of mycetoma was low (45%) with a very large differential diagnosis. Mycetoma is a relatively rare disease in Uganda, mostly caused by fungi, and there is a big gap in data and epidemiological studies. More systematic studies are warranted to define the true burden of mycetoma in Uganda.


Assuntos
Micetoma/epidemiologia , Doenças Negligenciadas/epidemiologia , Actinomycetaceae/isolamento & purificação , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Fungos/isolamento & purificação , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Micetoma/microbiologia , Doenças Negligenciadas/microbiologia , Nocardia/isolamento & purificação , Prevalência , Fatores Sexuais , Clima Tropical , Uganda/epidemiologia , Adulto Jovem
2.
An Bras Dermatol ; 95(3): 372-375, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32278631

RESUMO

Pseudomycetoma is an extremely rare deep mycosis, caused by dermatophytic fungi that penetrate the tissue from infected follicles of tinea capitis. Both clinically and histopathology are similar to eumycetoma, being distinguished through the isolation of the fungus, which in the case of pseudomycetoma can be Microsporum spp. or Trichophyton spp. genre. We present a 24-year-old man with an exuberant tumor in the occipital region with fistula, whose histopathological examination evidenced grains composed of hyaline hyphae and the culture for fungi isolated the agent Microsporum canis. Combined treatment of surgical excision followed by oral griseofulvin for two years was performed, with resolution of the condition.


Assuntos
Dermatomicoses/microbiologia , Microsporum/isolamento & purificação , Micetoma/microbiologia , Dermatoses do Couro Cabeludo/microbiologia , Dermatomicoses/patologia , Dermatomicoses/cirurgia , Humanos , Imunocompetência , Masculino , Micetoma/patologia , Micetoma/cirurgia , Dermatoses do Couro Cabeludo/patologia , Dermatoses do Couro Cabeludo/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
BMC Dermatol ; 20(1): 1, 2020 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-31918687

RESUMO

BACKGROUND: Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible. CASE PRESENTATION: Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn't any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome. CONCLUSION: Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.


Assuntos
Doenças do Pé/diagnóstico , Madurella/isolamento & purificação , Micetoma/diagnóstico , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Pé/diagnóstico por imagem , Pé/microbiologia , Pé/patologia , Doenças do Pé/microbiologia , Doenças do Pé/patologia , Doenças do Pé/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Marrocos , Micetoma/microbiologia , Micetoma/patologia , Micetoma/terapia , Doenças Negligenciadas , Medicina Tropical
4.
PLoS Negl Trop Dis ; 14(1): e0007845, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31940343

RESUMO

The genus Madurella comprising four species, M. fahalii, M. mycetomatis, M. pseudomycetomatis, and M. tropicana, represents the prevalent cause of eumycetoma worldwide. The four species are phenotypically similar and cause an invariable clinical picture, but differ markedly in their susceptibility to antifungal drugs, and epidemiological pattern. Therefore, specific identification is required for optimal management of Madurella infection and to reveal proper epidemiology of the species. In this study, a novel multiplex real-time PCR targeting the four Madurella species was developed and standardized. Evaluation of the assay using reference strains of the target and non-target species resulted in 100% specificity, high analytical reproducibility (R2 values >0.99) and a lowest detection limit of 3 pg target DNA. The accuracy of the real-time PCR was further assessed using biopsies from eumycetoma suspected patients. Unlike culture and DNA sequencing as gold standard diagnostic methods, the real-time PCR yielded accurate diagnosis with specific identification of the causative species in three hours compared to one or two weeks required for culture. The novel method reduces turnaround time as well as labor intensity and high costs associated with current reference methods.


Assuntos
Madurella/classificação , Madurella/genética , Micetoma/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Biópsia , DNA Fúngico/análise , Humanos , Micetoma/microbiologia , Sensibilidade e Especificidade
5.
Rev Chilena Infectol ; 36(4): 531-535, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31859780

RESUMO

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.


Assuntos
Actinomyces/isolamento & purificação , Doenças do Pé/diagnóstico , Micetoma/diagnóstico , Biópsia , Diagnóstico Diferencial , Doenças do Pé/microbiologia , Doenças do Pé/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/microbiologia , Micetoma/patologia
8.
PLoS Negl Trop Dis ; 13(8): e0007056, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31465459

RESUMO

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.


Assuntos
Testes Diagnósticos de Rotina/métodos , Micetoma/diagnóstico , Micetoma/microbiologia , Micetoma/patologia , Patologia Molecular/métodos , Actinobacteria/isolamento & purificação , Adolescente , Adulto , Idoso , Biópsia , Criança , Pré-Escolar , Feminino , Humanos , Madurella/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Micetoma/cirurgia , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Sensibilidade e Especificidade , Streptomyces/isolamento & purificação , Adulto Jovem
9.
J Infect Chemother ; 25(12): 1065-1069, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31227382

RESUMO

Cunninghamella is a member of the class Zygomycetes. Cunninghamella species include ubiquitous filamentous fungi; infections caused by Cunninghamella species are less frequent but have higher mortality rates than infections caused by Mucorales group members such as Rhizopus and Mucor. Herein, we reported a rare fatal case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae tracheobronchial mycetoma. A 73-year-old female with a history of right-sided breast cancer who had undergone mastectomy 11 years previously and had no recurrence presented to our emergency department with a 1-week history of left-sided back pain. Chest X-ray revealed left lung atelectasis; bronchoscopy revealed an endobronchial mass lesion in the left main bronchus. Pathological examination revealed fungal mycetoma but malignant lesions were not detected. Endobronchial and lung mycetoma caused by Cunninghamella bertholletiae were initially diagnosed; liposomal amphotericin B was administered, but her condition deteriorated. Rigid endoscopy showed growth of hemorrhagic tissue occupying the left main bronchus just under the carina. Pathological examination of the shaved lesion revealed metastasis from breast cancer covered with abundant necrotic tissue. No mold was observed in the necrotic tissue; this was probably due to liposomal amphotericin B treatment. To our knowledge, this is the first case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae mycetoma. Distinguishing endobronchial metastases from breast cancer and atypical presentations of Cunninghamella endobronchial mycetomas can be very difficult. Repeated bronchoscopies maybe helpful in establishing an accurate diagnosis when clinical prognosis does not match the initial diagnosis.


Assuntos
Neoplasias da Mama/patologia , Neoplasias Brônquicas/complicações , Cunninghamella/isolamento & purificação , Pneumopatias Fúngicas/diagnóstico , Mucormicose/diagnóstico , Micetoma/diagnóstico , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Neoplasias da Mama/cirurgia , Brônquios/diagnóstico por imagem , Brônquios/microbiologia , Neoplasias Brônquicas/secundário , Broncoscopia , Evolução Fatal , Feminino , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , Mastectomia , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Micetoma/tratamento farmacológico , Micetoma/microbiologia
10.
PLoS Negl Trop Dis ; 13(5): e0007276, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31145740

RESUMO

In this communication, a case of black grain eumycetoma produced by the fungus C. atrobrunneum is reported. The patient was initially misdiagnosed with M. mycetomatis eumycetoma based on the grains' morphological and cytological features. However, further aerobic culture of the black grains generated a melanised fungus identified as C. atrobrunneum by conventional morphological methods and by internal transcribed spacer 2 (ITS2) ribosomal RNA gene sequencing. This is the first-ever report of C. atrobrunneum as a eumycetoma-causative organism of black grain eumycetoma. It is essential that the causative organism is identified to the species level, as this is important for proper patient management and to predict treatment outcome and prognosis.


Assuntos
Chaetomium/isolamento & purificação , Micetoma/microbiologia , Adulto , Antifúngicos/uso terapêutico , Chaetomium/classificação , Chaetomium/genética , Chaetomium/fisiologia , DNA Fúngico/genética , DNA Espaçador Ribossômico/genética , Humanos , Masculino , Micetoma/diagnóstico , Micetoma/tratamento farmacológico , Filogenia , Sudão
11.
PLoS Negl Trop Dis ; 13(4): e0007098, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946748

RESUMO

Mycetoma is a neglected tropical disease, endemic in many tropical and subtropical regions, characterised by massive deformity and disability and can be fatal if untreated early and appropriately. Interleukins (IL) -35 and IL-37 are newly discovered cytokines that play an important role in suppressing the immune system. However, the expression of these interleukins in patients with Madurella mycetomatis (M. mycetomatis) induced eumycetoma has not yet been explored. The aim of this study is to determine the levels of IL-1 family (IL-1ß, IL-37) and IL-12 family (IL-12, IL-35) in a group of these patients and the association between these cytokines levels and the patients' demographic characteristics. The present, case-control study was conducted at the Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Sudan and it included 140 individuals. They were divided into two groups; group I: healthy controls [n = 70; median age 25 years (range 12 to 70 years)]. Group II: mycetoma patients [n = 70 patients; median age 25 (range 13 to 70 years)]. Cytokines levels were measured in sera using enzyme linked immunosorbent assay (ELISA). There was a significant negative correlation between IL-1ß and IL-12 levels and lesion size and disease duration, while IL-37 and IL-35 levels were significantly positively correlated with both lesion size and disease duration. The analysis of the risk factors of higher circulatory levels of IL-37 in patients of mycetoma showed a negative significant association with IL-1ß cytokine, where a unit increment in IL-1ß will decrease the levels of IL-37 by 35.28 pg/ml. The levels of IL-37 among the patients with a duration of mycetoma infection ≤ 1 year were significantly low by an average of 18.45 pg/ml compared to patients with a mycetoma infection's duration of ≥ 5years (reference group). Furthermore, the risk factors of higher levels of IL-35 in mycetoma patients revealed a negative significant association with IL-12, as a unit increment in IL-12 decreases the levels of IL-35 by 8.99 pg/ml (p < 0.001). Levels of IL-35 among the patients with duration of mycetoma infection ≤ one year were significantly low on average by 41.82 pg/ml (p value = 0.002) compared to patients with a duration of mycetoma infection ≥ 5 years (reference group). In conclusion, this study indicates that both IL-35 and IL-37 are negatively associated with the levels of IL-1ß and IL-12 in eumycetoma mycetoma infection; and high levels of IL-37 and IL-35 may have a negative impact on disease progression.


Assuntos
Interações Hospedeiro-Patógeno , Interleucinas/sangue , Madurella/crescimento & desenvolvimento , Micetoma/patologia , Micetoma/fisiopatologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/microbiologia , Fatores de Risco , Sudão , Adulto Jovem
12.
J Mycol Med ; 29(2): 185-188, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30956063

RESUMO

Dermatophytic mycetoma of the scalp is a rarity, especially when not associated with tinea capitis. Here, we report a case of dermatophytic mycetoma of the scalp, that was not associated with tinea capitis, caused by an atypical Microsporum audouinii strain. To our knowledge, this is the second reported case, thirty-eight years after the first that was published in 1980.


Assuntos
Dermatomicoses/diagnóstico , Microsporum/isolamento & purificação , Micetoma/diagnóstico , Micetoma/microbiologia , Couro Cabeludo/microbiologia , Adulto , Antifúngicos/uso terapêutico , Biópsia , DNA Intergênico/genética , Dermatomicoses/tratamento farmacológico , Feminino , Humanos , Microsporum/efeitos dos fármacos , Microsporum/genética , Micetoma/tratamento farmacológico , Couro Cabeludo/patologia , Senegal , Análise de Sequência de DNA , Pele/patologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
13.
Mycopathologia ; 184(2): 327-334, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30887177

RESUMO

Mycetoma is a chronic granulomatous infectious disease that can affect the skin, subcutaneous tissue, fascia and bone. It can be caused by filamentous bacteria or fungi and usually involves the legs and feet. Mycetoma is endemic in tropical and subtropical regions and is easily misdiagnosed in clinical practice because of its nonspecific clinical features and lack of awareness of the disease. Although mycetoma is very rare in mainland China, an increasing number of cases have been reported in recent years. Here, we report a case of mycetoma in a patient who was misdiagnosed many years before receiving the correct treatment, leading to disease progression and motion limitation. The grains that represent microorganismal colonies were important clues for diagnosis. We also reviewed reported cases of mycetoma in mainland China. The majority of cases were reported from southern regions. Actinomycetoma was more commonly reported than was eumycetoma. The causative agents of actinomycetoma included Nocardia brasiliensis, N. asteroides, N. otitidiscaviarum, N. ninae and Gordonia terrae, and the causative fungi of eumycetoma were identified as Madurella mycetomatis, Fonsecaea pedrosoi and Acremonium falciforme. Notably, the diagnosis of mycetoma was delayed from months to decades in all of the patients, likely due to a lack of clinical experience. Our literature review suggests the importance of increased awareness of mycetoma in clinical practice, especially in non-endemic regions. Further investigative studies are needed to determine the real incidence of the disease in China.


Assuntos
Micetoma/diagnóstico , Micetoma/microbiologia , Micetoma/patologia , Nocardia/isolamento & purificação , Adulto , Idoso , China/epidemiologia , Feminino , Fungos/classificação , Fungos/isolamento & purificação , Histocitoquímica , Humanos , Incidência , Masculino , Microscopia , Pessoa de Meia-Idade , Micetoma/epidemiologia , Nocardia/classificação , Pele/patologia , Adulto Jovem
14.
Clin Exp Dermatol ; 44(2): 123-129, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29808607

RESUMO

Mycetoma caused by either filamentous fungi (eumycotic) or bacteria (actinomycotic) has recently been recognized by the World Health Organization as a neglected tropical disease. Although mycetoma is preventable and treatable, especially in the early stages, it carries high morbidity and a huge socioeconomic burden. Skin and subcutaneous tissue is affected, with a classic presentation of hard woody swellings, discharging sinuses and presence of grains (containing the causative organism). Variants with swelling without sinuses have also been described. Left untreated it may involve underlying bone and muscle, leading to permanent disability. Common actinomycotic species include Streptomyces somaliensis, Actinomadura madurae, Actinomadura pelletieri, Nocardia brasiliensis and Nocardia asteroides, while Madurella mycetomatis, Madurella grisea, Pseudoallescheria boydii and Leptosphaeria senegalensis are common eumycotic agents. Men are more commonly affected than women, and the leg is the most frequently affected site. Diagnosis in suspected lesions is made with the help of grain examination, microscopy, imaging (radiography, ultrasonography, magnetic resonance imaging) and culture, and more recently by molecular methods such as PCR and molecular sequencing. Molecular sequencing for both fungi and bacteria is important for rapid and correct diagnosis, especially in culture-negative cases. Treatment is long, more successful in actinomycetoma than eumycetoma, and may require a holistic approach comprising antimicrobials, surgery and rehabilitation. Mycetoma can be prevented by simple measures such as wearing protective garments and shoes, especially in rural areas and during outdoor activities.


Assuntos
Micetoma/microbiologia , Actinomyces , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Humanos , Micetoma/diagnóstico , Micetoma/tratamento farmacológico , Micetoma/patologia , Pele/microbiologia , Pele/patologia
16.
Med Mycol ; 57(4): 434-440, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30085253

RESUMO

The neglected tropical disease mycetoma is a chronic granulomatous inflammatory and infectious disease affecting various body parts. The most common causative agent is the fungus Madurella mycetomatis. In order to study the genetic diversity of this fungus and to monitor any potential outbreaks, a good typing method that can be used in endemic settings is needed. Previous typing methods developed were not discriminative and not easy to perform in resource-limited laboratories. Variable-Number-Tandem-Repeat (VNTR) typing overcomes these difficulties and further enables interlaboratory data comparison. Therefore, in this study we developed a VNTR method for typing M. mycetomatis. Six tandem-repeats were identified in the genome of M. mycetomatis isolate MM55 using an online tandem repeats software. The variation in these repeats was determined by PCR and gel-electrophoresis on DNA obtained from 81 M. mycetomatis isolates obtained from patients. These patients originated from Sudan, Mali, Peru, and India. The 81 isolates were divided into 14 genotypes which separated into two main clusters with seven and five subdivisions, respectively. VNTR typing confirms the heterogeneity of M. mycetomatis strains and can be used to study the epidemiology of M. mycetomatis. The results presented in this article are made fully available to the scientific community on request from the Eumycetoma Working Group. We hope that this open resource approach will bridge scientific community working with mycetoma from all around the world and lead to a deeper understanding of M. mycetomatis.


Assuntos
Variação Genética , Madurella/classificação , Madurella/genética , Repetições Minissatélites , Tipagem Molecular , Micetoma/microbiologia , Técnicas de Tipagem Micológica , África , Análise por Conglomerados , Eletroforese em Gel de Ágar , Genótipo , Humanos , Índia , Madurella/isolamento & purificação , Peru , Reação em Cadeia da Polimerase
17.
Int J Dermatol ; 58(5): 600-604, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30565209

RESUMO

BACKGROUND: Mycetoma is a chronic, localized infection caused by fungi and bacteria. It usually affects the skin, subcutaneous tissue, and bone of exposed areas with deformity of the affected limb, ulcers, and fistula; however, pain is not severe, therefore the patient comes late to hospital for care. OBJECTIVE: To establish the diagnosis of mycetoma in the foot by imaging and identify the principal radiological signs. MATERIALS AND METHODS: Six patients with foot mycetoma were evaluated with plain x-ray, ultrasound, and magnetic resonance (MR) after confirming the diagnosis by histopathology and culture. RESULTS: All patients presented the MR "dot-in-circle" sign; four presented "punched out" bone lesions on plain x-ray. The six patients had fistulas, ulceration, a seropurulent exudate, edema, and a foot deformity. Four patients had N. brasiliensis infection with positive anti-Nocardia IgG antibodies, and only half presented bone lesions. CONCLUSION: Characteristic findings were foot deformity, edema, bone lesions, ulcers, fistulas and the presence of the "dot-in-circle" sign. We recommend a comprehensive study of patients with plain x-ray and MR.


Assuntos
Doenças do Pé/diagnóstico por imagem , Micetoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Doenças do Pé/diagnóstico , Doenças do Pé/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/diagnóstico , Micetoma/microbiologia
19.
Cornea ; 37(12): 1590-1592, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30234681

RESUMO

PURPOSE: To report an unusual case of isolated Acremonium eumycetoma presenting as a protuberant mass over the cornea. METHODS: Case report and literature review. RESULTS: A 55-year-old male patient referred to our center with a case of perforated corneal ulcer with uveal tissue prolapse was examined in the casualty department and found to have central melt, approximately 8 mm, along with suspected uveal tissue prolapse. A provisional diagnosis of sloughed corneal ulcer with uveal prolapse was made along with differential diagnoses of fungal ball and infected foreign body granuloma. Tectonic penetrating keratoplasty under general anesthesia was planned. Intraoperatively, the suspected uveal (brown colored) tissue was found to be an epicorneal mass growing over an intact and infiltrated cornea. Histopathological and microbiological analysis of the epicorneal mass and host cornea revealed it to be a fungal ball (mass full of septate hyphae) with growth of Acremonium species on culture. The patient was administered topical and oral antifungal agents postoperatively, in addition to topical antibiotics and cycloplegics. CONCLUSIONS: Isolated corneal Acremonium eumycetoma masquerading as a perforated corneal ulcer with prolapsed uveal tissue is a rare entity. Surgical intervention and appropriate antimicrobial therapy are key to successful outcome.


Assuntos
Acremonium/isolamento & purificação , Córnea/microbiologia , Infecções Oculares Fúngicas/microbiologia , Ceratite/microbiologia , Micetoma/microbiologia , Antifúngicos/uso terapêutico , Córnea/patologia , Infecções Oculares Fúngicas/diagnóstico , Humanos , Ceratite/diagnóstico , Ceratite/terapia , Ceratoplastia Penetrante , Masculino , Pessoa de Meia-Idade , Micetoma/diagnóstico , Micetoma/terapia
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