Mycetoma in north-western Yemen: Clinico-epidemiological and histopathological study

Background: Mycetoma is widespread in Yemen; however, there are only a few documented reports on the entity from this geographical area. Methods: A prospective study of 184 cases of mycetoma (male 145 and female 39) from different regions of north-western Yemen was conducted between July 2000 and May 2014. Clinical profile was recorded in a standardized protocol. The diagnosis was based on clinical features, X-ray studies, examination of grains, and histopathology. Results: Eumycetoma was diagnosed in 129, caused by Madurella mycetomatis in 124, Leptosphaeria senegalensis in one and pale grain fungus in four, whereas actinomycetoma occurred in 55, caused by Streptomyces somaliensis in 29, Actinomadura madurai in nine, Actinomadura pelletieri in one, and Nocardia in sixteen. Eumycetoma cases were treated with prolonged course of antifungal drugs, mostly ketoconazole, with itraconazole being used in four patients, along with excision or debulking. Results were better when antifungal drugs were given two to three months before surgery and in those who received itraconazole. Actinomycetoma cases were initially treated with co-trimoxazole monotherapy; later streptomycin was added in 30 cases. Six patients who did not show adequate improvement and two others from the start were treated with modified Welsh regimen and with good results. Limitations: Identification of different causative agents was done by histopathology and could not be reconfirmed by culture. Conclusion: Mycetoma is widespread in north-western Yemen with a higher incidence of eumycetoma and a majority of the cases were caused by Madurella mycetomatis. Modified Welsh regimen in actinomycetoma and itraconazole with excision in eumycetoma showed the best results.

Fungal infection in surgical pathology – Our institutional experience

Background: Fungal infection has a worldwide prevalence and it affects almost all age groups and both the sexes. Due to neoteric treatment modalities nowadays, people are enjoying longevity of life. However, on the other hand, immune status is compromised that has resulted in increased prevalence of fungal infection in society. Fungi reported by surgical pathologist, either incidentally or in clinically suspicious cases, greatly improve morbidity and outcome of the patients. Objective: The objective of this study is to study the prevalence of fungal infection in surgical pathology tissue and frequency and spectrum-based analysis in relation to age, gender, and systemic involvement. Materials and Methods: Ethically approved retrospective observational secondary data analysis is done based on histomorphological and cytomorphological evaluation of 17 fungal cases diagnosed at the Department of Pathology, New Civil Hospital, Surat, from January 2015 to January 2017. Results: Out of 17 cases, most common fungus seen was Candida albicans mainly affecting gastrointestinal tract. Common age group affected was 41–60 years and few rare fungi, i.e., mucormycosis and tinea corporis were also reported. Conclusion: Distribution of fungi in tissue section in relation to frequency, age, sex, various organs, and its correlation with clinical symptoms is analyzed in our study and results are found to be yielding that provided outlook in the prevalence of infectious agent.

A chronic case of Madurella mycetoma involving left foot

Mycetoma is a localized chronic, suppurative, and deforming granulomatous disorder of subcutaneous tissue, skin and bones. Mycetoma is endemic in tropical and subtropical areas, where it is a real public health issue. It is a rare and neglected disease in our country. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is completely different, a definite diagnosis after microbiological and histopathological examination, though difficult, is important. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Authors report a case of eumycetoma in a 38 year-old male from Bihar, with history of thorn prick 30 yrs back. Madurella mycetomatis was isolated from the granular discharge from sinuses and itraconazole was given followed by surgical debridement of the lesion. The patient recovered well and is still on follow up.

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.

A case of eumycetoma on the submaxilla due to Madurella / 中华皮肤科杂志

Objective To investigate the clinicopathological features,diagnosis,treatment,prognosis and causative agent of a case of eumycetoma on the submaxilla.Methods A case of eumycetoma diagnosed in our department was assessed for its clinical and pathological features as well as mycologic and molecular identification.Related literature was reviewed.Results The patient was primarily characterized by swelling of the submaxilla,with multiple sinuses draining many black granules.Pathologic examination revealed a pyogenic granulomatous inflammation,and a number of lotus rhizome node-like hypha were observed in tissue samples through PAS staining.Sequence analysis of multiple loci of the isolates,including ITS 1,ITS2 and D1/D2,showed that it was mostly similar to Madurella mycetomatis with a homology of 97%.Conclusion This is a case ofeumycetoma on the submaxilla induced by a novel species of Madurella.