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van de Sande WWJ, Fahal AH. An updated list of eumycetoma causative agents and their differences in grain formation and treatment response. Clin Microbiol Rev 2024:e0003423. [PMID: 38690871 DOI: 10.1128/cmr.00034-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
SUMMARYIn 2023, the World Health Organization designated eumycetoma causative agents as high-priority pathogens on its list of fungal priority pathogens. Despite this recognition, a comprehensive understanding of these causative agents is lacking, and potential variations in clinical manifestations or therapeutic responses remain unclear. In this review, 12,379 eumycetoma cases were reviewed. In total, 69 different fungal species were identified as causative agents. However, some were only identified once, and there was no supporting evidence that they were indeed present in the grain. Madurella mycetomatis was by far the most commonly reported fungal causative agent. In most studies, identification of the fungus at the species level was based on culture or histology, which was prone to misidentifications. The newly used molecular identification tools identified new causative agents. Clinically, no differences were reported in the appearance of the lesion, but variations in mycetoma grain formation and antifungal susceptibility were observed. Although attempts were made to explore the differences in clinical outcomes based on antifungal susceptibility, the lack of large clinical trials and the inclusion of surgery as standard treatment posed challenges in drawing definitive conclusions. Limited case series suggested that eumycetoma cases caused by Fusarium species were less responsive to treatment than those caused by Madurella mycetomatis. However, further research is imperative for a comprehensive understanding.
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Affiliation(s)
- Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ahmed H Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
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2
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Trindade Torres M, Sousa Nunes B, Varandas L, Maltez F. Actinomycetoma by Cellulosimicrobium cellulans in a Young Man from Guinea-Bissau: Short Literature Review Regarding a Case Report. ACTA MEDICA PORT 2024; 37:46-50. [PMID: 36919988 DOI: 10.20344/amp.17356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/09/2022] [Indexed: 03/16/2023]
Abstract
Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria. Cellulosimicrobium cellulans is a gram-positive bacterium from the order Actinomycetales that rarely causes human disease. The diagnosis is based on the clinical presentation and identification of the causative microorganism. We present a short literature review regarding the case report of a young man diagnosed with actinomycetoma due to Cellulosimicrobium cellulans and who received treatment with an association of amikacin and sulfamethoxazole/ trimethoprim (Welsh regimen).
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Affiliation(s)
| | - Beatriz Sousa Nunes
- Serviço de Infeciologia Pediátrica. Hospital de Dona Estefânia. Lisboa. Portugal
| | - Luís Varandas
- Serviço de Infeciologia Pediátrica. Hospital de Dona Estefânia. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Lisboa; Instituto de Higiene e Medicina Tropical. Lisboa. Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas. Hospital de Curry Cabral. Lisboa. Portugal
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3
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Milani B, Dagne DA, Choi HL, Schito M, Stone HA. Diagnostic capacities and treatment practices on implantation mycoses: Results from the 2022 WHO global online survey. PLoS Negl Trop Dis 2023; 17:e0011443. [PMID: 37379338 PMCID: PMC10335693 DOI: 10.1371/journal.pntd.0011443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
Between January and March 2022, WHO conducted a global online survey to collect data on diagnostic capacities and treatment practices in different settings for four implantation mycoses: eumycetoma, actinomycetoma, cutaneous sporotrichosis and chromoblastomycosis. The survey investigated the type of diagnostic methods available in countries at various health system levels (tertiary, secondary, primary level) and the medicines used to treat implantation mycoses, with a view to understanding the level of drug repurposing for treatment of these diseases. 142 respondents from 47 countries, including all continents, contributed data: 60% were from middle-income countries, with 59% working at the tertiary level of the health system and 30% at the secondary level. The results presented in this article provide information on the current diagnostic capacity and treatment trends for both pharmacological and non-pharmacological interventions. In addition, the survey provides insight on refractory case rates, as well as other challenges, such as availability and affordability of medicines, especially in middle-income countries. Although the study has limitations, the survey-collected data confirms that drug repurposing is occurring for all four surveyed implantation mycoses. The implementation of an openly accessible global and/or a national treatment registry for implantation mycoses could contribute to address the gaps in epidemiological information and collect valuable observational data to inform treatment guidelines and clinical research.
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Affiliation(s)
- Barbara Milani
- WHO consultant, World Health Organization, Geneva, Switzeland
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases [WHO/NTD], World Health Organization, Geneva, Switzeland
| | - Hye Lynn Choi
- Department of Control of Neglected Tropical Diseases [WHO/NTD], World Health Organization, Geneva, Switzeland
- Department of Regulation and Prequalification [WHO/RPQ], World Health Organization, Geneva, Switzeland
| | - Marco Schito
- CURE Drug Repurposing Collaboratory, Critical Path Institute, Tucson, Arizona, United States of America
| | - Heather Anne Stone
- Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, United States of America
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4
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Musa EA, Abdoon IH, Bakhiet SM, Osman B, Abdalla SA, Fahal AH. Mycetoma management and clinical outcomes: the Mycetoma Research Center experience. Trans R Soc Trop Med Hyg 2023; 117:12-21. [PMID: 35903002 DOI: 10.1093/trstmh/trac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/12/2022] [Accepted: 07/18/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Mycetoma is a chronic granulomatous inflammatory disease that affects the cutaneous and subcutaneous tissues, leading to gruesome complications if not treated early. As a neglected disease, it has received scant attention in developing curable drugs. Mycetoma treatment is still based on expert opinions in the absence of guidelines. METHODS This descriptive, cross-sectional, hospital-based study aimed to determine and assess the disease treatment outcomes observed at Mycetoma Research Center, Sudan. RESULTS In this study, 75% of patients had eumycetoma, all of whom were treated with itraconazole and 37.4% underwent surgical excision, while 25% of the patients had actinomycetoma, 99.2% of whom were treated with a combination of cotrimoxazole and amoxicillin-clavulanate. The cure rate was 12.7% and 14.3% for patients with eumycetoma and actinomycetoma, respectively. Only 6.1% of eumycetoma patients underwent amputation. Remarkably, no patient with actinomycetoma underwent an amputation. Small lesions (OR=10.09, p<0.001) and good follow-up (OR=6.81, p=0.002) were positive predictors of complete cure. In terms of amputation, history of surgical recurrence at presentation (OR=3.67, p=0.020) and presence of grains (OR=7.13, p=0.012) were positive predictors, whereas small lesions were negative predictors (OR=0.06, p=0.009). CONCLUSIONS Treatment of mycetoma was suboptimal, with a low cure rate despite a long treatment duration. Complete cure has a significant association with small lesions and good follow-up.
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Affiliation(s)
- Esraa Abdelgadir Musa
- Clinical Pharmacy Program, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan
| | - Iman Hassan Abdoon
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan
| | | | - Bashier Osman
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan
| | - Safa A Abdalla
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan
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Cruz-Medrano MG, Manzanares-Leal GL, González-Nava J, Moreno-Pérez PA, Sandoval-Trujillo H, Ramírez-Durán N. Genetic variability of the 16S rRNA gene of Nocardia brasiliensis, the most common causative agent of actinomycetoma in Latin America and the Caribbean. Rev Inst Med Trop Sao Paulo 2023; 65:e31. [PMID: 37075338 PMCID: PMC10109444 DOI: 10.1590/s1678-9946202365031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/24/2023] [Indexed: 04/21/2023] Open
Abstract
Mycetoma is a neglected tropical disease (NTD) declared by the World Health Organization (WHO) in 2016. It is characterized by the progressive growth of nodules and granulomatous lesions on the legs, arms, and trunk. It is potentially disfiguring and causes disability or amputations in working-age people from marginalized areas. The causative agents can be fungi (eumycetoma) or actinobacteria (actinomycetoma), the latter being the most common in America and Asia. Nocardia brasiliensis is the most important causal agent of actinomycetoma in the Americas. Taxonomic problems have been reported when identifying this species, so this study aimed to detect the 16S rRNA gene variations in N. brasiliensis strains using an in silico enzymatic restriction technique. The study included strains from clinical cases of actinomycetoma in Mexico, isolated from humans and previously identified as N. brasiliensis by traditional methods. The strains were characterized microscopically and macroscopically, then subjected to DNA extraction and amplification of the 16S rRNA gene by PCR. The amplification products were sequenced, and consensus sequences were constructed and used for genetic identification and in silico restriction enzyme analysis with the New England BioLabs® NEBcutter program. All study strains were molecularly identified as N. brasiliensis; however, in silico restriction analysis detected a diversity in the restriction patterns that were finally grouped and subclassified into 7 ribotypes. This finding confirms the existence of subgroups within N. brasiliensis. The results support the need to consider N. brasiliensis as a complex species.
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Affiliation(s)
- Michele Guadalupe Cruz-Medrano
- Universidad Autónoma del Estado de México, Facultad de Medicina, Laboratorio de Investigación en Microbiología Médica y Ambiental, Toluca, Mexico
| | - Gauddy Lizeth Manzanares-Leal
- Universidad Autónoma del Estado de México, Facultad de Medicina, Laboratorio de Investigación en Microbiología Médica y Ambiental, Toluca, Mexico
| | - Janette González-Nava
- Laboratorio de Ecología Molecular, Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana-Xochimilco, Ciudad de México, Mexico
| | - Pablo Antonio Moreno-Pérez
- Universidad Autónoma del Estado de México, Facultad de Medicina, Laboratorio de Investigación en Microbiología Médica y Ambiental, Toluca, Mexico
| | - Horacio Sandoval-Trujillo
- Universidad Autónoma Metropolitana-Xochimilco, Departamento de Sistemas Biológicos, Laboratorio de Producción de Biológicos, Ciudad de México, Mexico
| | - Ninfa Ramírez-Durán
- Universidad Autónoma del Estado de México, Facultad de Medicina, Laboratorio de Investigación en Microbiología Médica y Ambiental, Toluca, Mexico
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Ahmed SA, El-Sobky TA, de Hoog S, Zaki SM, Taha M. A scoping review of mycetoma profile in Egypt: revisiting the global endemicity map. Trans R Soc Trop Med Hyg 2022; 117:1-11. [PMID: 36084235 PMCID: PMC9808524 DOI: 10.1093/trstmh/trac085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 01/07/2023] Open
Abstract
Mycetoma is a chronic infectious disease endemic in sub-Saharan Africa (SSA), India and parts of South and North America. The epidemiologic profile of the disease in Egypt, which neighbours SSA, has not been explored previously. Therefore we conducted a scoping review of the literature on mycetoma in Egypt. We searched the literature comprehensively on MEDLINE and Google Scholar using free-text words and Medical Subject Headings and terms. Both published and non-peer-reviewed (grey literature) articles were included. The initial search identified 133 reports. Of these, only eight were found to be relevant and were included in the study. The total number of mycetoma patients was 59, reported between 1949 and 2015. There was a predilection for eumycetoma (44 of 59) patients (75%), while actinomycetoma constituted 15 patients (25%). Six patients were female, 28 were male and 25 were unreported. Children and adolescents constituted 3 of 59 (5%), 52 (88%) were adults and age was not provided for 4 patients. Only four patients (7%) were non-autochthonous. The incidence of mycetoma in Egypt is higher than previously reported. Egypt is probably a low-endemic country. An accurate estimate of the prevalence and epidemiology of mycetoma necessitates further research collaboration.
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Affiliation(s)
| | | | - Sybren de Hoog
- Center of Expertise in Mycology Radboudumc, Canisius Wilhelmina Hospital, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands,Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands
| | - Sherif M Zaki
- Mycology Unit, Department of Microbiology, Faculty of Science, Ain Shams University, Cairo Governorate 4392001, Cairo, Egypt
| | - Mohamed Taha
- Department of Microbiology, Zagazig University, Ash Sharqia Governorate 7120001, Zagazig, Egypt
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Hao X, Cognetti M, Burch-smith R, Mejia EO, Mirkin G. Mycetoma: Development of Diagnosis and Treatment. J Fungi (Basel) 2022; 8:743. [PMID: 35887499 PMCID: PMC9323607 DOI: 10.3390/jof8070743] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 12/03/2022] Open
Abstract
Mycetoma describes a heterogeneous group of cutaneous and subcutaneous infections caused by either fungi (eumycetomas) or bacteria (actinomycetomas). It is characterized by a triad of clinical symptoms: painless subcutaneous tumor-like swelling, multiple sinuses and fistulas, and discharged grains in pus. This predominantly affects the feet in more than 70% of patients. It is endemic in the “mycetoma belt” regions, including Africa, South America, and South Asia. Autochthonous mycetoma is rare in the United States of America (USA). We recently reported a Latin American immigrant with eumycetoma in the State of Maryland, USA. With millions of immigrants from endemic regions, the true number of mycetomas in the USA is most likely higher than currently recognized. With the aim to raise the awareness of clinicians about mycetoma, especially dermatologists and podiatrists, we update the development of the epidemiology, etiology, clinical presentations, pathogenesis, diagnosis, differential diagnosis, and treatment of mycetoma.
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Cerrillos‐Gutiérrez JI, Ramírez‐Flores D, Gutiérrez‐Govea A, Andrade‐Sierra J, Medina‐Pérez M, Rojas‐Campos E. Mycetoma by Actinomadura madurae in the central nervous system: Renal transplant receptor disease. Clin Case Rep 2022; 10:e6071. [PMID: 35898749 PMCID: PMC9309743 DOI: 10.1002/ccr3.6071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/11/2022] [Accepted: 06/28/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- José Ignacio Cerrillos‐Gutiérrez
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre Mexican Institute of Social Security Guadalajara Jalisco Mexico
| | - Diana Ramírez‐Flores
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre Mexican Institute of Social Security Guadalajara Jalisco Mexico
| | - Alfredo Gutiérrez‐Govea
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre Mexican Institute of Social Security Guadalajara Jalisco Mexico
- University Health Sciences Center University of Guadalajara Guadalajara Jalisco Mexico
| | - Jorge Andrade‐Sierra
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre Mexican Institute of Social Security Guadalajara Jalisco Mexico
| | - Miguel Medina‐Pérez
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre Mexican Institute of Social Security Guadalajara Jalisco Mexico
- University Health Sciences Center University of Guadalajara Guadalajara Jalisco Mexico
| | - Enrique Rojas‐Campos
- Medical Research Unit in Renal Diseases, Specialties Hospital, National Western Medical Centre Mexican Institute of Social Security Guadalajara Jalisco Mexico
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Siddig EE, van de Sande WWJ, Fahal AH. Actinomycetoma laboratory-based diagnosis: a mini-review. Trans R Soc Trop Med Hyg 2021; 115:355-363. [PMID: 33449118 DOI: 10.1093/trstmh/traa176] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/22/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
Mycetoma is a chronic granulomatous inflammatory disease that is caused either by fungi (eumycetoma) or bacteria (actinomycetoma). The latter is caused by various actinomycetes of the genera Nocardia, Streptomyces and Actinomadura. They have different geographical distributions within mycetoma-endemic regions. In parts of Latin America, Nocardia species are more often encountered while in Africa, Streptomyces species dominate. For instituting a proper patient treatment plan, accurate identification of the causative organism is vital. For actinomycetoma, different laboratory-based techniques have been developed during recent decades. These include direct microscopy, cytology, histopathology and serology. More recently, different molecular techniques and matrix-assisted laser desorption ionisation-time of flight mass spectrometry have been included as diagnostic methods for actinomycetoma. In this review, an update on the laboratory techniques currently in use for the identification of actinomycetoma-causative agents to the species level is presented.
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Affiliation(s)
- Emmanuel Edwar Siddig
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Bonifaz A, Tirado-Sánchez A, Vazquez-Gonzalez D, Araiza J, Hernández-Castro R. Actinomycetoma by Actinomadura madurae: Clinical Characteristics and Treatment of 47 Cases. Indian Dermatol Online J 2021; 12:285-289. [PMID: 33959526 PMCID: PMC8088182 DOI: 10.4103/idoj.idoj_474_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/17/2020] [Accepted: 09/05/2020] [Indexed: 12/02/2022] Open
Abstract
Context: Mycetoma is a chronic, granulomatous disease caused by fungi (eumycetoma) or aerobic filamentous actinomycetes (actinomycetoma). Actinomadura madurae is one of the most frequent actinomycetes. Aim: The study aims to provide an update on clinical, diagnostic, therapeutic, and outcome data for patients with actinomycetoma in a single center in Mexico. Settings and Design: This was a retrospective study of 47 cases diagnosed with actinomycetoma. Subjects and Methods: The cases were selected from a total of 536 mycetoma obtained during 35 years (from 1985 to 2019). Clinical data were retrieved from the clinical records of our department. Microbiological data were obtained from our Mycology laboratory. Statistical Analysis: Frequencies and percentages were used for categorical variables. Normality was determined with the Kolmogorov–Smirnov test. We used means and medians to describe the variables. Results: Forty-seven patients with actinomycetoma were included; female:male ratio 1.9:1; median age 38 years. The foot was the most affected region in 76.5% of cases. The bone invasion was observed in 89%. The time between symptoms onset and diagnosis was 5.5 years. Grain detection by direct examination was positive in 95% of cases. The most commonly used, as well as the most effective treatment scheme was streptomycin + sulfamethoxazole-trimethoprim with dapsone. Sixty-three percent (30 patients) achieved clinical and mycological cure, and 10.6% (5 patients) had treatment failure. Conclusions: We highlight the importance of designing therapeutic strategies to standardize treatments and gain more experience to improve the care of these patients.
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Affiliation(s)
- Alexandro Bonifaz
- Department of Dermatology, Hospital General de México, Mexico City, Mexico.,Mycology Service, Hospital General de México, Mexico City, Mexico
| | - Andrés Tirado-Sánchez
- Department of Dermatology, Hospital General de México, Mexico City, Mexico.,Department of Internal Medicine, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Javier Araiza
- Department of Dermatology, Hospital General de México, Mexico City, Mexico.,Mycology Service, Hospital General de México, Mexico City, Mexico
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Vera-Cabrera L, Cardenas-de la Garza JA, Cuellar-Barboza A, Gallardo-Rocha A, Molina-Torres CA, Escalante-Fuentes W, Ocampo-Candiani J. Case Report: Coral Reef Pathogen Aspergillus sydowii Causing Black Grain Mycetoma. Am J Trop Med Hyg 2021; 104:871-873. [PMID: 33399044 PMCID: PMC7941817 DOI: 10.4269/ajtmh.20-1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/09/2020] [Indexed: 11/07/2022] Open
Abstract
Mycetoma is an infrequent subcutaneous infection caused by true fungi (eumycetoma) or aerobic actinomycetes (actinomycetoma). We report the case of a 62-year-old man with eumycetoma involving the left foot and ankle. Skin biopsy revealed black-brown grains, and in culture, a white colony fungus grew at day 8. Molecular sequencing using ITS1-ITS4 primers identified the species as Aspergillus sydowii. The patient was treated with itraconazole 200 mg twice daily and terbinafine 250 mg daily for 8 months, with complete response and no recurrence after 2.5 years of follow-up. Aspergillus sydowii is a saprotrophic fungus that rarely causes skin or nail disease. No cases of eumycetoma caused by this agent have been previously reported. As its geographic distribution continues to expand, it may increasingly be recognized as a cause of human disease.
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Affiliation(s)
- Lucio Vera-Cabrera
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Adrian Cuellar-Barboza
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Anabel Gallardo-Rocha
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Carmen Amelia Molina-Torres
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Wendy Escalante-Fuentes
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Ocampo-Candiani
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
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12
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Bonifaz A, Tirado-Sánchez A, Vázquez-González D, Fierro-Arias L, Araiza J, González GM. Actinomycetoma by Actinomadura madurae. Clinical and therapeutic characteristics of 18 cases with two treatment modalities. J DERMATOL TREAT 2020; 33:954-958. [PMID: 32643472 DOI: 10.1080/09546634.2020.1793887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Actinomycetoma due to Actinomadura madurae is susceptible to numerous chemotherapeutic agents, however, the response to those treatments is variable and closely related to several factors. OBJECTIVE We aimed to evaluate the clinical-therapeutic characteristics of patients with actinomycetoma due to Actinomadura madurae with two treatment modalities. METHODS This was a retrospective study of eighteen patients with a diagnosis of actinomycetoma. The most widely used therapeutic scheme was streptomycin 1 g every third day plus TMP/SMX 800 mg/160 mg/12h, followed by TMP/SMX with DDS 100 mg/day. In six patients (33%), ciprofloxacin 500 mg every 12 h was used instead of DDS. RESULTS Conventional scheme achieved clinical and mycological cure in 58% of the cases, improvement in 16%, and 25% of the patients failed to treatment; in the cases treated with ciprofloxacin, clinical and microbiological cure was achieved in 83% of patients and clinical improvement in 16%. The treatment time to achieve clinical and mycological did not have a statistically significant difference (median 10 ± 1.38 vs. 12 ± 4.6). CONCLUSION Treatment based on streptomycin + TMP/SMX with ciprofloxacin was found to be effective in treating patients with actinomycetoma, and comparable to the conventional treatment with DDS in actinomycetoma due to A. madurae with minimal bone involvement.
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Affiliation(s)
- Alexandro Bonifaz
- Mycology Department, Hospital General de México. Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Andrés Tirado-Sánchez
- Dermatology Service, Hospital General de México. Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | - Leonel Fierro-Arias
- Mycology Department, Hospital General de México. Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Javier Araiza
- Mycology Department, Hospital General de México. Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Gloria M González
- Microbiology Department, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Cardenas-de la Garza JA, Welsh O, Cuellar-Barboza A, Suarez-Sanchez KP, Cruz-Gomez LG, De la Cruz-Valadez E, Ocampo-Candiani J, Vera-Cabrera L. Climate, soil type, and geographic distribution of actinomycetoma cases in Northeast Mexico: A cross-sectional study. PLoS One 2020; 15:e0232556. [PMID: 32384126 PMCID: PMC7209257 DOI: 10.1371/journal.pone.0232556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Mycetoma is a chronic, granulomatous infection of subcutaneous tissue, that may involve deep structures and bone. It can be caused by bacteria (actinomycetoma) or fungi (eumycetoma). There is an epidemiological association between mycetoma and the environment, including rainfall, temperature and humidity but there are still many knowledge gaps in the identification of the natural habitat of actinomycetes, their primary reservoir, and their precise geographical distribution. Knowing the potential distribution of this infection and its ecological niche in endemic areas is relevant to determine disease management strategies and etiological agent habitat or reservoirs. Methodology/principal findings This was an ambispective descriptive study of 31 patients with actinomycetoma. We determined the biophysical characteristics including temperature, precipitation, soil type, vegetation, etiological agents, and mapped actinomycetoma cases in Northeast Mexico. We identified two disease cluster areas. One in Nuevo Leon, with a predominantly kastanozems soil type, with a mean annual temperature of 22°, and a mean annual precipitation of 585.2 mm. Herein, mycetoma cases were produced by Actinomadura pelletieri, Actinomadura madurae, Nocardia brasiliensis, and Nocardia spp. The second cluster was in San Luis Potosí, where lithosols soil type predominates, with a mean annual temperature of 23.5° and a mean annual precipitation of 635.4 mm. In this area, all the cases were caused by N. brasiliensis. A. madurae cases were identified in rendzinas, kastanozems, vertisols, and lithosols soils, and A. pelletieri cases in xerosols, kastanozems, and rendzinas soils. Previous thorn trauma with Acacia or Prosopis plants was referred by 35.4% of subjects. In these states, the presence of thorny plants, such as Acacia spp., Prosopis spp., Senegalia greggi, Vachellia farnesiana and Vachellia rigidula, are common. Conclusions/significance Mapping this neglected tropical infection aids in the detection of disease cluster areas, the development of public health strategies for early diagnosis and disease prediction models; this paves the way for more ecological niche etiological agent research.
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Affiliation(s)
| | - Oliverio Welsh
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Adrian Cuellar-Barboza
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Karina Paola Suarez-Sanchez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Luis Gerardo Cruz-Gomez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Estephania De la Cruz-Valadez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Lucio Vera-Cabrera
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
- * E-mail:
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