Madura foot in Europe: diagnosis of an autochthonous case by molecular approach and review of the literature.

Madura foot is a chronic granulomatous infection of the soft-tissue of the foot and it is endemic in tropical and subtropical countries. Some cases have also been reported in local people or migrants in temperate countries. The microbiological diagnosis requires prolonged bacterial cultures in aerobic and anaerobic conditions, but the use of the molecular approach could be helpful for an early and rapid diagnosis. We describe an autochthonous case of Actinomadura madurae foot infection in an Italian woman. The diagnosis was achieved 36 months after symptoms onset by PCR detection and sequencing of 16S rDNA directly on biopsy. She started therapy with rifampin, trimethoprim-sulfamethoxazole, and amikacin. After 3 months the pain had disappeared and the swelling subsided. We reviewed the literature on Madura foot due to bacterial causative agents in Europe and observed that the median time from onset to diagnosis is high, possibly due to several factors like the difficulties of the microbiological and radiological diagnosis. Our case report and the review of literature point out that the implementation of a surveillance system, the involvement of an infectious diseases specialist, with experience in tropical diseases, and the availability of a microbiology unit to perform feasible and rapid molecular diagnostic tests could result in an earlier diagnosis and an optimal antibiotic therapy of this rare but difficult-to-treat and, above all, difficult-to-diagnose infection.

[Cephalic mycetoma, caused by Streptomyces somaliensis, involving the cranial cavity]. / Micetoma cefálico por Streptomyces somaliensis con penetración a la cavidad craneana

A case of cephalic mycetoma caused by Streptomyces somaliensis which has involved the orbit and craneal cavity with exoftalmus and symptoms of irritation and brain compression is reported. The patient has improved with a medical treatment (sulfomethoxazol-trimetoprim) associated with a descompressive craniectomy. The authors comment the geographic distribution of the agents of mycetoma especially of S. somaliensis very rare specie in America. Only 10 proved cases of Mycetoma caused by this Actinomycete have been found in Mexico. Our patient came from the state of Chihuahua, in the north of Mexico and is the second case from this state and the most septentrional (parallel 32 degrees) in the American continent.