Madurella mycetomatis causing multiple mycetoma lesions: a rareclinical presentation

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Stage III eumycetoma successfully treated with oral ketoconazole and surgical debulking

Mycetoma is a chronic, debilitating, granulomatous disease affecting the subcutaneous tissue, fascia, muscle, bone and adjacent organs characterized by triad of tumefaction, draining sinus, and grains. The ten-year incidence in our institution from 2000 to 2010 is 3 out of 81,015 cases. We present a 33-year-old man with a nine-year history of painless nodules and draining sinuses on the left foot which were unresponsive to oral antibiotics and topical antifungals. Biopsy of a nodule was consistent with mycetoma. Fungal culture revealed Madurella mycetomatis growth confirming eumycetoma. X-ray of the left foot showed poorly marginated lucencies on the calcaneus and navicular bones. Ultrasound revealed mixed hyperreflective echoes and multiple small cavities. We diagnosed the patient with Stage III eumycetoma based on the radiographic classification of bone involvement and prescribed oral ketoconazole 400 mg daily for nine months achieving 50-60% decrease in lesion size. Surgical debulking was done and ketoconazole was continued at the same dose for another nine months. There was good granulation tissue formation and no appearance of new lesions after surgery.

Eumycetoma by Madurella mycetomatis with 30 years of evolution: therapeutic challenge / Eumicetoma por Madurella mycetomatis com 30 anos de evolução: desafio terapêutico

We report a case of eumycetoma by Madurella mycetomatis on the buttocks and thighs in an adult immunocompetent patient, diagnosed after 30 years of clinical development. He was treated over four years with fluconazol and itraconazol associated with five times surgical excisions of subcutaneous nodules. At the eighth year of follow-up, one nodule recurred on the right infragluteal region, which was excised surgically and has remained asymptomatic ever since.

Relatamos o caso de um paciente adulto, imunocompetente, com eumicetoma por Madurella mycetomatis, localizado nos glúteos e coxas, diagnosticado após 30 anos de evolução clínica. Tratado no decorrer de quatro anos com fluconazol e itraconazol, associado a cinco tempos cirúrgicos de exérese dos nódulos subcutâneos. No oitavo ano de follow-up ocorreu recidiva de apenas um nódulo na região infraglútea, o qual foi excisado cirurgicamente, mantendo-se assintomático desde então.

Mycetoma in south Yemen

Mycetoma is one of the chronic,endemic diseases in many tropical and subtropical countries in the world. It is commonly distributed in the rural and high altitude areas. It is caused by true fungi or higher bacteria that gain access to the human body typically via a thorn prick or open wound. This is the first scientific study done about the disease in South Yemen [Hadramout]. To know the extent and to study Mycetoma in South Yemen [Hadramout]. All mycetoma cases who were managed in Ibn-Sinna hospital, Hadramout, from march 2004 to march 2008 were included in this descriptive study.The patients came from three governorates [Hadramout, Shabwa and Al-Mahra].The diagnosis depended on the clinical picture, radiological and histological investigations to confirm the disease and to identify the causative organism. 16 patients were studied in this report, aged between 20 -59 years, their mean age was 34 years. Male to female ratio was 4:1 and the duration of the disease between 1 -18 years [the mean was 9 years]. Half of the patients were farmers. The color of the mycetoma grains was black in 12 patients and white to yellow in 4.The right foot was affected by the disease in 14 patients; the left foot and the right knee was involved in each of the remaining 2 cases. The bone was involved in 6 patients, and 6 patients gave a history of trauma or thorn prick. The causative organism was Eumycetoma in 14 cases and Actinomycetoma in two. Eumycetoma patients were treated with Itraconazole and surgery or Ketoconazole and surgery or Itraconazole only or Ketoconazole only The Actinomycetoma cases were treated with Cotrimoxazole with surgery or with Cotrimoxazole only.11 patients were greatly improved with their treatment. Mycetoma is widespread in Yemen. As it is part of the international mycetoma belt, multi-center studies are needed to evaluate the extent of the disease and to find out a standard policy of management and prevention

Incidence and changing pattern of mycetoma in western Rajasthan.

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.

Estudio clínico y microbiológico de los micetomas observados en el Hospital de Infecciosas Francisco J. Muñiz en el período 1989-2004 / Clinical and microbiological study of mycetomas at the Muñiz Hospital of Buenos Aires between 1989 and 2004

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.

Eumycetoma due to Madurella grisea--a case report.

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.

Eumycetoma by Madurella grisea: report of the first case observed in the Southern Brazilian Region

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

Micetomas en el Hospital de Infecciosas Francisco Javier Muniz de la ciudad de Buenos Aires, Argentina / Mycetomas in the Muniz Hospital of Buenos Aires City

Se presentam las características clínicas, microbiológicas y los resultados terapéuticos de 54 casos de micetoma, disgnosticados en los ultimos 10 anos en le Hospital Muniz. Treita y dos fueron varones y 22 mujeres, la edad promedio fue de 43.4 anos (20-27 anos). La mayoria de los enfermos adquirió la infección en el norte de la Argentina (Santiago del Estero 2o casos, Chaco 9, Formosa 3, Salta 2 y Catamarca1) y 6 pacientes de evolución de la enfermedad fue de 9.1 anos (6 meses a 30 anos)...