Actinomycetoma of the scalp after a car accident

Welsh, Oliverio; Morales-Toquero, Amelia; Vera-Cabrera, Lucio; Vazquez-Martínez, Osvaldo; Gómez‐Flores, Minerva; Ocampo‐Candiani, Jorge

doi:10.1111/j.1365-4632.2011.04874.x

Cited by 10 publications

(5 citation statements)

References 13 publications

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“…have been reported until 2019. 4,5,11,[16][17][18][19] Only one of these case reports was due to N. nova. 19 Our case is the first reported on pediatric age group in an immunocompetent patient.…”

Section: Discussionmentioning

confidence: 99%

“…1,4 The disorder occurs most commonly on the extremities, especially the foot, while the scalp is rarely affected. 5 In a Spanish epidemiology study on Nocardia spp. infections (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014), Nocardia nova was responsible for 10.6% (7/66) of the isolates in soft tissue/bone, and was not detected in central nervous system (CNS).…”

Section: Introductionmentioning

confidence: 99%

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A Case Report of Mycetoma and Cranial Osteomyelitis by Nocardia nova

Vilardouro

Ferreira

Alpalhão

et al. 2021

J Pediatr Infect Dis

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Mycetoma is a chronic, localized, slowly progressive, granulomatous infection of the skin that may progress to subcutaneous tissue, muscle and bone. It is an infrequent manifestation of Nocardia infection that predominantly occurs on the lower extremities.A previously healthy, 17-year-old boy presented with a 3-month history of scalp abscesses. On physical examination he had numerous, large left parietal and occipital inflammatory nodules on the scalp covered by alopecic skin and several sinuses discharging a purulent and serosanguinous material. He underwent a CT-scan and an MRI of the skull that revealed signs of cranial osteomyelitis and epidural empyema. Polymerase chain reaction assay of the purulent exudate was performed and identified Nocardia nova. The patient was discharged from the hospital after 8 weeks of antibiotherapy with meropenem and TMP-SMX with clinical, laboratorial and imaging improvement. He completed 12 months of outpatient oral therapy with TMP-SMX, after which cranial CT-scan showed a significant reduction of soft tissue thickening and bone reconstitution, with no relapses after stopping the treatment.The best antibiotic regimen and length of treatment are not established for the management of nocardiosis. This is an unusual and severe presentation of infection by Nocardia nova with extent to the bone and epidural space, with full recovery under standard antibiotic therapy. This case shows that a good outcome may be achieved with prolonged antimicrobial treatment in an immunocompetent patient.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Case Report of Mycetoma and Cranial Osteomyelitis by Nocardia nova

Vilardouro

Ferreira

Alpalhão

et al. 2021

J Pediatr Infect Dis

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“…In regions such as Mexico where labourers carry woods and other agricultural materials on their back, mycetoma commonly affects this area with subsequent complication of paraplegia due to direct spread to the vertebral bone and spinal cord [ 1 ]. Cases of mycetoma affecting the scalp [ 55 – 57 ] and cerebrum have also been documented [ 58 – 61 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

Mycetoma: a clinical dilemma in resource limited settings

Pembi

Dumre

John

et al. 2018

Ann Clin Microbiol Antimicrob

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BackgroundMycetoma is a chronic mutilating disease of the skin and the underlying tissues caused by fungi or bacteria. Although recently included in the list of neglected tropical diseases by the World Health Organization, strategic control and preventive measures are yet to be outlined. Thus, it continues to pose huge public health threat in many tropical and sub-tropical countries. If not detected and managed early, it results into gruesome deformity of the limbs. Its low report and lack of familiarity may predispose patients to misdiagnosis and delayed treatment initiation. More so in situation where diagnostic tools are limited or unavailable, little or no option is left but to clinically diagnose these patients. Therefore, an overview of clinical course of mycetoma, a suggested diagnostic algorithm and proposed use of materials that cover the exposed susceptible parts of the body during labour may assist in the prevention and improvement of its management. Furthermore, early reporting which should be encouraged through formal and informal education and sensitization is strongly suggested.Main textAn overview of the clinical presentation of mycetoma in the early and late phases, clues to distinguish eumycetoma from actinomycetoma in the field and the laboratory, differential diagnosis and a suggested diagnostic algorithm that may be useful in making diagnosis amidst the differential diagnosis of mycetoma is given. Additionally, a proposed preventive measures which may be helpful in the community is also provided. Since treatment is currently based on expert opinion, we encourage active research to establish treatment guideline for it.ConclusionSince delay in visiting health facility results into gruesome complication, early presentation, recognition and initiation of appropriate choice of regimen is helpful in reducing complications. The clinical overview of mycetoma and the suggested algorithm may enhance suspicion and possibly increase recognition of mycetoma in the community and further guide in differentiation of eumycetoma from actinomycetoma. There is an urgent need for research funding for mycetoma, a disease plagued by severe physical disabilities and social stigma leading to isolation.Electronic supplementary materialThe online version of this article (10.1186/s12941-018-0287-4) contains supplementary material, which is available to authorized users.

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“…Puncture or other contaminated traumatic inoculum, such as thorn, insect or animal bite, scratch, bullet injury, intravenous drug abuse [9,19,47,48]. Occupation like farmer, shepherd, gardener, and an history of rural background or barefoot walking may help in typical pedal mycetoma, but unusual site are also to be considered, such as the face, neck, breast, back or even the scalp, after a car incident, and the vulva simulating an advanced carcinoma [31,[49][50][51][52].…”

Section: Considering the Necessity Of A Port Of Entry Main Risks Facmentioning

confidence: 99%

Cutaneous Nocardiosis

Atzori¹

2014

SOJ Microbiol Infect Dis

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Open Access Review Article cutaneous inoculation. Primary cutaneous nocardiosis is more common, with incidence rates ranging from 5% to 24% in various countries like India, UK, and Spain [10-12]. A major problem is correct identification, as clinical presentation is not peculiar as well as histological findings, suggestive of an infective process, but not able to detect the microorganisms, unless a tissue culture has been performed and Gram stained. The laboratory should be advised of the clinical suspicion, as Nocardia is a slow-growing bacterium, and cultures are often discarded when no growth is seen within 48 hours, or obscured by rapidly growing bacteria [1]. Once the Nocardiosis is presumed, speciation might take 1-3 weeks, and each strain has individual antibiotic susceptibility pattern, conditioning empiric treatment and possible fatal course. Newer molecular technologies promise to provide rapid and accurate identification [13], but first of all have revolutionized taxonomy, and we have to face with currently more than 30 species. Clinical relevance has been determined for about seventeen species [14,15] in respect to the 4 pathogens identified by traditional hydrolysis patterns: N. asteroides, N. brasiliensis, N. otitidiscaviarum, and N. transvalensis. Distinct serotypes and biotypes might share the same antibiotic susceptibility profile [8,13-18]. In western Europe and USA, the term "N.asteroides complex" is frequently used, failing to differentiate the strain cluster (N.asteroides sensu strictu) from N. cyriacigeorgica, N. farcinica, N. nova, N. abscessus, Nocardia brasiliensis, which is the second most common isolates in the majority of countries [14,16], differs from N.pseudobrasiliensis in mycolic acid pattern, adenine decomposition, nitrate reduction, and antimicrobial agent susceptibilities [18] For all these issues, clinical management and treatment of patients with nocardial disease remain a challenge. This review characterizes the cutaneous manifestations and related risk factors, to suggest clues in clinical diagnosis, raise physicians alert to avoid delayed recognition and address the correct assessments. Skin manifestations From a general health perspective, cutaneous nocardiosis (CN) traditionally occurs with 3 main patterns: (1) actinomycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection (Table 1). Some classification adds a distinct 4 th pattern, corresponding to the secondary skin

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Actinomycetoma of the scalp after a car accident

Abstract: This is a rare presentation of mycetoma of the scalp that was cured in 12 weeks with a combination of amikacin and SXT.

Cited by 10 publications

References 13 publications

A Case Report of Mycetoma and Cranial Osteomyelitis by Nocardia nova

A Case Report of Mycetoma and Cranial Osteomyelitis by Nocardia nova

Mycetoma: a clinical dilemma in resource limited settings

Cutaneous Nocardiosis

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