Actinomycetoma in SE Asia: the first case from Laos and a review of the literature

Abstract

BackgroundMycetoma is a chronic, localized, slowly progressing infection of the cutaneous and subcutaneous tissues caused either by fungi (eumycetoma or implantation mycosis) or by aerobic actinomycetes (actinomycetoma). It is acquired by traumatic implantation, most commonly in the tropics and subtropics, especially in rural agricultural communities. Although well recognized elsewhere in Asia, it has not been reported from the Lao People’s Democratic Republic (Laos).Case presentationA 30 year-old female elementary school teacher and rice farmer from northeast Laos was admitted to Mahosot Hospital, Vientiane, with a massive growth on her left foot, without a history of trauma. The swelling had progressed slowly but painlessly over 5 years and multiple draining sinuses had developed. Ten days before admission the foot had increased considerably in size and became very painful, with multiple sinuses and discharge, preventing her from walking. Gram stain and bacterial culture of tissue biopsies revealed a branching filamentous Gram-positive bacterium that was subsequently identified as Actinomadura madurae by 16S rRNA gene amplification and sequencing. She was treated with long-term co-trimoxazole and multiple 3-week cycles of amikacin with a good therapeutic response.ConclusionWe report the first patient with actinomycetoma from Laos. The disease should be considered in the differential diagnosis of chronic skin and bone infections in patients from rural SE Asia.

Eumycetoma and actinomycetoma – an update on causative agents, epidemiology, pathogenesis, diagnostics and therapy

“…They are endemic in Middle and South America and some cases are reported from Asian countries . Recently, there was a report from Laos …”

Pedal Mycetoma Mimicking Plantar Fibroma

“…The causative organisms of Mycetoma have geographical variations and can be bacterial (actinomycetoma) or fungal (eumycetoma) in origin [6]. The fungal (eumycetoma) organisms include Madurella mycetoma, Madurella grisea, and pseudoalleschia; while the actinomycetoma casued by higher bacteria include Norcadia species and Streptomyces species [1].…”

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“…The causative organisms of mycetoma have geographical variations and can be bacterial (actinomycetoma) or fungal (eumycetoma) in origin 6 . The fungal (eumycetoma) organisms include Madurella mycetoma, Madurella grisea and pseudallescheria, while the actinomycetoma caused by higher bacteria include Norcardia species and Streptomyces species Competing interests: none declared.…”