A thorn in the flesh--a study of the pathogenesis of subcutaneous infections

Actinomycetoma-the welsh regimen in a rural Indian scenario

We describe a case of Actinomycetoma foot which presented to us after 3yrs of onset of symptoms.We have attempted a chemotherapeutic treatment regime and are reporting the healing changes that have taken place radiologically and macroscopically. A review of literature has been done of various treatment regimens used for Actinomycetoma foot and used and their practical applications in rural hospital.

Mycetoma caused by Madurella mycetomatis: a neglected infectious burden

Tropical eumycetoma is frequently caused by the fungus Madurella mycetomatis. The disease is characterised by extensive subcutaneous masses, usually with sinuses draining pus, blood, and fungal grains. The disease affects individuals of all ages, although disability is most severe in adults who work outdoors. Compared with major diseases such as tuberculosis, malaria, and HIV, disease from M mycetomatis is underestimated but socioeconomically important. Many scientific case reports on mycetoma exist, but fundamental research was lacking until recently. We present a review on developments in the clinical, epidemiological, and diagnostic management of M mycetomatis eumycetoma. We describe newly developed molecular diagnostic and gene typing procedures, and their application for management of patients and environmental research. Fungal susceptibility tests have been developed as well as a mouse model of infection. These advances should greatly further our understanding of the molecular basis of eumycetoma.

Mycetoma

Mycetoma is a chronic infectious disease, most commonly caused by Madurella mycetomatis, that remains localized, involves cutaneous and subcutaneous tissue, fascia, and bone, and is noncontagious. The disease is characterized by tumefaction, draining sinuses, and the presence of sclerotia. The 31 fungi known to cause mycetoma are associated with soil and woody plants. A chronic, tumor-like deforming disease develops during subsequent years following the introduction of the etiologic agent via localized trauma. Combined surgical and medical management with ketoconazole results in the best outcome.

Mycetoma by Nocardia asteroides: a 9 year follow-up

An extensive and severe actinomycetoma by Nocardia asteroides, a rare etiologic agent of this infection in Brazil, observed during a 9 year follow-up is reported. Unsuitable social and financial conditions led to amputation as the only possible solution for this case, no signs of infection relapse having been observed in three years after his surgery.

Four non-endemic New Zealand cases of chromoblastomycosis

The majority of cases of chromoblastomycosis are reported from tropical to subtropical countries; only one previous case being reported from New Zealand. Four non-endemic cases in Pacific Island patients are described. All of the New Zealand cases were caused by Fonsecaea pedrosoi. In the present report, one patient was successfully treated by excision of the lesion followed by skin grafting. Another was treated with 200 mg ketoconazole daily for 10 weeks with no obvious improvement. No follow-up on the treatment of this case nor of the remaining two patients is available. This disease must be included in the differential diagnosis in patients who present with chronic lesions affecting the skin and subcutaneous tissues.