Madurella mycetomatis infection of the buttock in an Eritrean refugee in Switzerland: a case report

Abstract

BackgroundMycetoma is a neglected infectious disease caused by a fungus (eumycetoma) or bacteria (actinomycetoma); it is characterized by chronic local inflammation with sinus formation and purulent discharge. Its course can be quite devastating because of the difficulty in diagnosing the infection and in eliminating the causative agent. Although endemic in many countries in the tropics and subtropics, the migration of Africans to Europe may increase the presence of this neglected disease in European countries. We present a case of an Eritrean patient living in a non-endemic country who was diagnosed as having an infection of Madurella mycetomatis in an atypical location in his body.Case presentationWe report the case of a 35-year-old African male refugee from Eritrea, living in Switzerland since 2015, who presented with a 1-year history of a painful soft tissue swelling associated with dark nodules in his right buttock. He mentioned having several previous surgeries after 2001 while he was in Eritrea due to recurrent abscess formation on this body area. In the previous months, the swelling had become more significant and nodules started draining a purulent fluid. An initial diagnostic hypothesis of buttock abscess was made and he was referred to a dermatologist for diagnostic confirmation and further specialist care due to the size and atypical presentation. After a punch biopsy, the diagnosis of eumycetoma was confirmed and cultures developed Madurella mycetomatis. The initial treatment approach consisted of oral treatment by itraconazole; however, a surgical resection of the lesions was finally needed.ConclusionsAlthough rare, mycetoma should be diagnosed as early as possible to avoid long-lasting complications. Primary care physicians in European countries are frequently in the first line of care of migrant patients and therefore should be aware of the common and uncommon clinical presentations of mycetoma.

Molecular identification of Actinomadura madurae isolated from a patient originally from Algeria; observations from a case report

“…Contrary to the little information found about the human actinomycetoma, the search for actinomycetes in the environment (water and soils) was performed in several parts of Algeria, in particular in the south and north-eastern regions, allowing to isolate several genera such as Actinomadura, Saccharothrix, and Streptomyces [ 16 – 19 ]. Imported cases of actinomycetoma have been already reported in European countries such as Italy [ 20 ], France [ 21 ] and Switzerland [ 22 ]. Nevertheless, some reports of autochthonous cases from Italy [ 23 ] and France [ 24 ] have been also documented, suggesting the local occurrence of actinomycetoma in Europe.…”

Current situation of fungal diseases in Eritrea

“…Definitive diagnosis of the fungal disease requires expertise as well as laboratory systems and equipment such as microscopy, culture, histopathology, antigen and antibody assays, and Pneumocystis PCR. There is a scarcity of data related to fungal disease in Eritrea although reports of Eritrean migrants who have fungal infections have been published in Europe 8–10 . However, to our knowledge, there are no epidemiological data on the burden of fungal diseases published or generated in Eritrea.…”

“…There is a scarcity of data related to fungal disease in Eritrea although reports of Eritrean migrants who have fungal infections have been published in Europe. [8][9][10] However, to our knowledge, there are no epidemiological data on the burden of fungal diseases published or generated in Eritrea.…”