Management of mycetoma: major challenge in tropical mycoses with limited international recognition

Ahmed, Ayman H.; Sande, Wendy W. J. van de; Fahal, Ahmed H.; Bakker-Woudenberg, Irma A. J. M.; Verbrugh, Henri A.; Belkum, Alex van

doi:10.1097/qco.0b013e32803d38fe

Cited by 96 publications

(77 citation statements)

References 31 publications

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“…Eumycetoma (fungal mycetoma), which is acquired after traumatic inoculation usually on exposed body sites, is characterized by a chronic progressive destruction of soft tissue and adjoining structures with associated tumefaction and purosanguineous sinuses that drain fungal grains (2)(3)(4)(5). Without adequate treatment, the infection eventually invades the skeletal system, and clinical and mycological cure is impossible without extensive debridement/amputation (2)(3)(4)(5).…”

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confidence: 99%

Novel Taxa Associated with Human Fungal Black-Grain Mycetomas: Emarellia grisea gen. nov., sp. nov., and Emarellia paragrisea sp. nov

et al. 2016

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cEumycetoma is a debilitating, chronic, fungal infection that is endemic in India, Indonesia, and parts of Africa and South and Central America. It remains a neglected tropical disease in need of international recognition. Infections follow traumatic implantation of saprophytic fungi and frequently require radical surgery or amputation in the absence of appropriate treatment. Several fungal species can cause black-grain mycetomas, including Madurella spp. (Sordariales), Falciformispora spp., Trematosphaeria grisea, Biatriospora mackinnonii, Pseudochaetosphaeronema larense, and Medicopsis romeroi (all Pleosporales). We performed phylogenetic analyses based on five loci on 31 isolates from two international culture collections to establish the taxonomic affiliations of fungi that had been isolated from cases of black-grain mycetoma and historically classified as Madurella grisea. Although most strains were well resolved to species level and corresponded to known agents of eumycetoma, six independent isolates, which failed to produce conidia under any conditions tested, were only distantly related to existing members of the Pleosporales. Five of the six isolates shared >99% identity with each other and are described as Emarellia grisea gen. nov. and sp. nov; the sixth isolate represents a sister species in this novel genus and is described as Emarellia paragrisea. Several E. grisea isolates were present in both United Kingdom and French culture collections and had been isolated independently over 6 decades from cases of imported eumycetoma. Four of the six isolates involved patients that had originated on the Indian subcontinent. All isolates were all susceptible in vitro to the azole antifungals, but had elevated MICs with caspofungin. D escribed over 3,000 years ago in the Atharva Veda, and present in Mesoamerica during the pre-Hispanic period (1), mycetoma has preponderance for men of working age and children (2). Eumycetoma (fungal mycetoma), which is acquired after traumatic inoculation usually on exposed body sites, is characterized by a chronic progressive destruction of soft tissue and adjoining structures with associated tumefaction and purosanguineous sinuses that drain fungal grains (2-5). Without adequate treatment, the infection eventually invades the skeletal system, and clinical and mycological cure is impossible without extensive debridement/amputation (2-5). The extruded grains are either pale or dark (black), depending on the etiological agent (4, 5). Historically, the most common agents of black-grain eumycetoma were classified within the genus Madurella (Sordariales), which is characterized by organisms that produce dark gray, brown or black colonies, and dematiaceous hyphae which either remain sterile or sporulate only very reluctantly (4). The absence of conidiogenesis in isolates recovered from most black-grain mycetoma infections has historically hindered accurate species identification, and it was only recently that molecular approaches have demonstrated that Madurella mycetomatis (6) (Sord...

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confidence: 99%

Novel Taxa Associated with Human Fungal Black-Grain Mycetomas: Emarellia grisea gen. nov., sp. nov., and Emarellia paragrisea sp. nov

et al. 2016

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“…Similar cases of mycetoma without discharging sinuses were reported separately by Hay et al [5]and Sudipta Saha et al [6]. In the treatment of mycetoma, antibiotic or antifungal like Fluconazole is used, whereas surgery is done in special cases [7]especially for eumycetoma lesions in the extremities [8]. In few selected cases external beam radiotherapy in doses ranging from 3.5-14 Gy has been considered successful [9].…”

Section: Discussionmentioning

confidence: 64%

Rare Case of Mycetoma Foot without any Discharging Sinuses: A Case Report

2016

IJSR

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Mycetoma is a type of a slowly progressive chronic subcutaneous infection caused by actinomycetes or true fungi. A local trauma like cut or splinter can cause the infection leading to a granulomatous reaction. Infection tracks through skin, facial planes and can sometimes involve the underlying bone. Most commonly the foot is involved but also hands, back or shoulders can be involved.A 43 year old male, with ankle and foot swelling, with no discharging sinuses was studied at our institute. Initially, provisional diagnosis of tuberculous osteomyelitis was made, which latter turned out be mycetoma.

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“…2 Mycetoma commonly involves the foot (Madura foot) and also known as maduromycosis, is a chronic subcutaneous polymicrobial bacterial (actinomycetoma) and/or fungal infection (eumycetoma) that is destructive and associated with severe morbidity and disability. 3 The initial event is thought to arise from traumatic inoculation of fungus and bacteria into the skin or subcutaneous tissue. 4 During the initial phases, a hard, painless papule forms that increases in size to form a tumor-like growth termed a mycetoma.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Management of Madura Foot with Oral Posaconazole and Ciprofloxacin

Sharma

Nat

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. Madura foot is a chronic infection caused by fungus and/or bacteria. Traditionally, treatment has been surgical debridement or amputation. Non-invasive management with long-term antimicrobials alone has been reported as successful. We report a case of Madura foot in a Somali refugee successfully managed with oral posaconazole and ciprofloxacin. CASE PRESENTATIONA 22-year-old Somali male presented with right foot pain and swelling for 7 years and "tiny watermelon seeds" extruding out of the "puncture wounds" on the sole of the right foot (Figures 1-3). The patient gave a history of prolonged barefoot outdoor exposure in his native country and at his refugee camp in Kenya. Physical examination revealed swelling of the sole of his right foot and multiple sinus tracts along with evidence of recent drainage (Figures 1 and 2). Magnetic resonance imaging (MRI) of the right foot showed contiguous involvement of the skin and subcutaneous tissue over the medial and plantar aspects of the foot and reactive changes in the bone consistent with an underlying osteomyelitis. Subsequent biopsy showed ulceration and extensive fibrosis (Figure 3), focal granulomas (Figure 4), and clusters of darkly pigmented fungal hyphae ( Figure 5). The patient was hospitalized and initially treated with intravenous trimethoprimsulfamethoxazole (TMP-SMX) and liposomal amphotericin B. The patient was discharged home on an oral regimen of

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Management of mycetoma: major challenge in tropical mycoses with limited international recognition

Cited by 96 publications

References 31 publications

Novel Taxa Associated with Human Fungal Black-Grain Mycetomas: Emarellia grisea gen. nov., sp. nov., and Emarellia paragrisea sp. nov

Novel Taxa Associated with Human Fungal Black-Grain Mycetomas: Emarellia grisea gen. nov., sp. nov., and Emarellia paragrisea sp. nov

Rare Case of Mycetoma Foot without any Discharging Sinuses: A Case Report

Non-Invasive Management of Madura Foot with Oral Posaconazole and Ciprofloxacin

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