ABSTRACT
Histopathologic analysis of 73 cases of mycetoma occurring in western Rajasthan was done from January 2001 to December 2005. Maduromycotic mycetoma remains commonest in this region as compared to actinomycotic mycetoma, which is more common in the southern part of Rajasthan. The incidence of actinomycotic mycetoma has increased during the last five years in this part of Rajasthan due to changes in climatic conditions, like heavy rainfall, increased irrigation by Rajasthan Canal, urbanization of villages, and modification in agriculture. The ratio of prevalence of maduromycotic mycetoma to the prevalence of actinomycotic mycetoma has decreased from 4:1 to 1.91:1 during the last five years in western Rajasthan.
Subject(s)
Actinomyces/isolation & purification , Adult , Climate , Female , Geography , Humans , Incidence , India/epidemiology , Madurella/isolation & purification , Male , Mycetoma/epidemiologyABSTRACT
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
Mycetoma due to Madurella grisea has not been previously reported from Gujarat. We report a case in whom identification of the strain was made through the structure and texture of grains, morphology in Sabouraud's dextrose agar and histopathology.
Subject(s)
Adult , Amputation, Surgical , Female , Foot , Humans , India , Madurella/isolation & purification , Mycetoma/pathologyABSTRACT
E relatado o primeiro caso de eumicetoma por Madurella grisea ocorrido na Regiao Sul (Brasil). Alem disso, a literatura brasileira correspondente foi revisada e a distribuicao geografica deste tipo de eumicetoma e apresentada