Actinomycetoma by Actinomadura madurae

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.

A Rare Strain Actinomadura geliboluensis Was First Isolated from the Bronchoalveolar Lavage Fluid of a Patient with Pneumonia

“…3 It was once considered to be filamentous fungi but was later identified as filamentous bacteria by cell ultrastructural analysis and classified as aerobic actinomycetes. 4 Among them were Actinomadura madurae, Actinomadura pelletieri, Actinomadura latina and A. palatopharyngis are associated with human disease. [5][6][7][8][9][10][11] "Actinomadura geliboluensis" + "pulmonary actinomycosis" or "patient" or "human" were used as the search terms, and the search language was Chinese or English.…”

Diagnostics to support mycetoma management—Development of two target product profiles

“…Even a test that can only differentiate between actinomycetoma and eumycetoma would allow health care providers to treat or refer patients early. Although not all forms of actinomycetoma seem to respond equally well to standard treatment [ 4 ], current treatment guidelines do not differentiate the recommended treatment by causative agent. However, in the future, it is plausible that it may be necessary to identify certain causative agents at the species level, requiring a new or updated TPP.…”

“…Actinomycetoma is usually treated with a combination of antibiotics, most often trimethoprim/sulfamethoxazole plus amikacin, but other drug combinations are also in use [ 1 ]. In general, actinomycetoma caused by N. brasiliensis seems to respond better to these drugs than actinomycetoma caused by A. madurae [ 4 ]. Eumycetoma is treated with a combination of antifungals and surgery.…”