Treatment of Madura foot: a systematic review

Actinomycetoma by Cellulosimicrobium cellulans in a Young Man from Guinea-Bissau: Short Literature Review Regarding a Case Report

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).

Mycetoma caused by Madurella mycetomatis in immunocompromised patients – a case report and systematic literature review

Abstract. The aim of this study was to review the available literature concerning Madura foot (“mycetoma”) caused by Madurella mycetomatis in immunocompromised patients. With a systematic literature search, we identified only three papers, describing a total of three immunocompromised patients. Hence, the clinical presentation and prognosis of the disease in this patient population have not yet been well described. In addition, we present a case from our institution, illustrating the complexity of the treatment of this rare disease. Although very rare in non-endemic countries, we emphasize that mycetoma should be included in the differential diagnoses of (immunocompromised) patients who have been residing in a geographical area where the disease is endemic and presenting with soft tissue inflammation of one of the extremities.

Long term follow-up of Maduromycosis treatment: A case review

Maduromycosis is a rare deep fungal infection characterized by painless progressive destruction of limb caused by either fungal or filamentous bacteria. Its presentation is usually initiated by trivial penetration injury in farmers or laborers, worsen by immunocompromised status. Due to its painless course, this infection will severely destruct and deform hence leading to high morbidity of patient. We report a rare presentation of maduromycosis in 49-year-old housewife with no history of penetrating injury and no comorbid. Multi-disciplinary team was involved to establish the accurate diagnosis. The patient underwent surgical debridement and was given prolonged anti-fungal therapy. Combination of the treatments with patient's adherence lead to recovery without further recurrence and the patient was able to perform daily living activity.

18- and 70-MHz Ultrasonography of Actinomycetoma of the Foot Correlated with Clinical and Histologic Findings

We present the ultrasonographic morphology of an actinomycetoma of the foot at 18 and 70 MHz (high-frequency and ultrahigh-frequency ultrasound, respectively), and describe an ultrasonographic sign that may help to discriminate between eumycetoma and actinomycetoma called the "bright hyperechoic halo." To date, this is the first report on the morphology of mycetoma at 70 MHz with a clinical, ultrasonographic, and histologic correlation of the images, which provides ultrasound images that are very similar to the lower magnification of histology.

Subcutaneous Mycoses in Travelers

Purpose of Review

The increase in international travel in recent decades has contributed to the risk of acquiring diseases considered endemic to a region or country and the change in the epidemiology of these diseases. Endemic mycoses that may be acquired by travelers in the short or long term are endemic subcutaneous mycoses such as sporotrichosis and lobomycosis, while endemic systemic mycoses are a group of serious diseases including histoplasmosis and coccidioidomycosis. Herein, we review the current knowledge and highlight the most important aspects of these fungal infections in travelers.

Recent Findings

The most relevant advances in the study of these mycoses involve the epidemiological distribution; human mycoses can be fatal and there are few antifungal drugs available, increasing drug resistance, and a risk of emerging fungal diseases associated with climate change, as well as the increasing virulence, and the diagnostic strategies that may be limited in many countries.

Summary

Although endemic mycoses are relatively rare, they should be considered as potentially travel-related illnesses. A recent or late trip to an endemic country may guide the clinical suspicion, an early diagnosis, and the institution of effective therapy.

The global distribution of actinomycetoma and eumycetoma

Background

Mycetoma, a chronic infection of the skin and underlying structures, affects those with a close relationship to the land, often in resource-poor areas of the world. Whether caused by any one of a variety of fungus or bacteria, mycetoma causes significant disability and mortality. Acknowledged as a neglected tropical disease (NTD) by the World Health Organization (WHO) in 2016, mycetoma is susceptible to being misunderstood, misdiagnosed, and mismanaged. In an effort to shift the balance in favor of recognition and effective treatment, sound epidemiological understanding is required.

Methods and findings

In this paper, a literature review of case reports and series (332 papers in total) is presented as three maps. We identified 19,494 cases dating from 1876 to 2019, with cases contracted in 102 countries. The first map shows where mycetoma has ever been reported, the second shows how many cases have been reported, and the third shows the ratio of eumycetoma (fungal) to actinomycetoma (bacterial). Most cases are found in Mexico, India, and Sudan, where mycetoma is studied rigorously. We identified emergence of new geographical loci, including the United States, Venezuela, Italy, China, and Australia. Notably, mycetoma is reported far outside the tropics. In the Americas, bacterial forms dominate, whereas, in Africa and Asia, the picture is more varied.

Conclusions

With better understanding of the epidemiology of mycetoma, more can be done to direct education, preventive measures, and treatment to at-risk areas, enabling a reduction in disease burden.

Mycetoma is an ancient and misunderstood chronic disease. Affecting the skin and subcutaneous structures, infection often occurs in the feet of land laborers and can be caused by several otherwise rare human pathogens. Traditionally seen as a tropical disease, it affects those in resource-poor regions. The best methods of diagnosis are rarely available in these areas; late diagnosis increases the need for invasive surgical treatment. Available medical treatment can be prohibitively expensive. Early diagnosis and identification of the causative agent is necessary for effective treatment. For this paper, a literature review was undertaken to find all published cases of mycetoma linked to a location and the data used to create three maps. The maps show where mycetoma has ever been reported, how many cases have been reported, and what kind of microorganism was present. We included 19,494 cases, most of which occurred in Mexico, Sudan, and India. Notably, some cases arose far outside the tropics. In the Americas, most cases are bacterial; elsewhere, the picture is more varied. Many gaps remain in the epidemiological study of mycetoma, but this paper aims to shed light on the significant reach of the disease, with a view to increasing its visibility on the global stage and, therefore, the scope for reducing the burden of this neglected tropical disease.

Clinical characteristics and treatment of actinomycetoma in northeast Mexico: A case series

Background

Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological agent. Mycetoma may be caused by true fungi (eumycetoma) or filamentous aerobic bacteria (actinomycetoma). Mycetoma is more frequent in the so-called mycetoma belt (latitude 15° south and 30° north around the Tropic of Cancer), especially in Sudan, Nigeria, Somalia, India, Mexico, and Venezuela. The introduction of new antibiotics with fewer side effects, broader susceptibility profiles, and different administration routes has made information on actinomycetoma treatment and outcomes necessary. The objective of this report was to provide an update on clinical, therapeutic, and outcome data for patients with actinomycetoma attending a reference center in northeast Mexico.

Methodology/principal findings

This was a retrospective, cross-sectional, descriptive study of 31 patients (male to female ratio 3.4:1) diagnosed with actinomycetoma by direct grain examination, histopathology, culture, or serology from January 2009 to September 2018. Most lesions were caused by Nocardia brasiliensis (83.9%) followed by Actinomadura madurae (12.9%) and Actinomadura pelletieri (3.2%). About 50% of patients had bone involvement, and the right leg was the most commonly affected region in 38.7% of cases. Farmers/agriculture workers were most commonly affected, representing 41.9% of patients. The most commonly used treatment regimen was the Welsh regimen (35.5% of cases), a combination of trimethoprim/sulfamethoxazole (TMP/SMX) plus amikacin, which had a 90% cure rate, followed by TMP/SMX plus amoxicillin/clavulanic acid in 19.4% of cases with a cure rate of 100%. In our setting, 28 (90.3%) patients were completely cured and three (9.7%) were lost to follow-up. Four patients required multiple antibiotic regimens due to recurrences and adverse effects.

Conclusions/significance

In our sample, actinomycetoma was predominantly caused by N. brasiliensis. Most cases responded well to therapy with a combination of TMP/SMX with amikacin or TMP/SMX and amoxicillin/clavulanic acid. Four patients required multiple antibiotics and intrahospital care.

Mycetoma is a chronic skin disease that can invade bone or underlying organs. Inadequate treatment may lead to long-lasting disability. Information about treatment is scarce. We report the outcomes of 31 patients with a diagnosis of bacterial actinomycetoma attending a tertiary care hospital in northeast Mexico. Most cases were treated with a combination of antibiotics including TMP/SMX plus amikacin or TMP/SMX plus amoxicillin/clavulanic acid. Cure was achieved in 90% of patients and only one required surgery.