Painless swelling of the forefoot and recurrent subcutaneous abscesses of the lower leg—Two distinct presentations illustrating the spectrum of eumycetoma in a nonendemic country

Schibli, Adrian; Goldenberger, Daniel; Krieg, Andreas H.; Hirschmann, Anna; Bruder, Elisabeth; Osthoff, Michael

doi:10.1371/journal.pntd.0005360

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…For that, there are much more therapeutic molecules to target actinomycetoma germs than eumycetoma ones. Moreover, eumycetoma is usually refractory to medications and an extended duration of treatment for at least 1 year is needed, against 3 months for bacterial mycetoma [19]. Indeed, we noticed in the first episode of mycetoma (ten years ago) in our patient a necessary duration of two years and a half for total healing of the fungal lesions.…”

Section: Discussionmentioning

confidence: 63%

Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region

et al. 2020

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Background: Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible. Case presentation: Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn't any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome. Conclusion: Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.

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Section: Discussionmentioning

confidence: 63%

Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region

et al. 2020

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“…16 , 17 In Sudan, Madurella mycetomatis is the leading causative agent of eumycetoma, while Streptomyces somaliensis, Actinomadura madurae and Actinomadura pelletierii are the most frequently reported actinomycetoma causative organisms. 18–21 …”

Section: Introductionmentioning

confidence: 99%

Modelling the spatial distribution of mycetoma in Sudan

Hassan

Simpson

Cano

et al. 2021

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background Mycetoma is a neglected tropical disease that is reported worldwide and Sudan has the highest reported number of mycetoma infections across the globe. The incidence, prevalence and burden of mycetoma globally are not precisely known and its risk factors remain largely unelucidated. Methods This study aimed to identify the environmental predictors of fungal and bacterial mycetoma in Sudan and to identify areas of the country where these niche predictors are met. Demographic and clinical data from confirmed mycetoma patients seen at the Mycetoma Research Centre from 1991 to 2018 were included in this study. Regression and machine learning techniques were used to model the relationships between mycetoma occurrence in Sudan and environmental predictors. Results The strongest predictors of mycetoma occurrence were aridity, proximity to water, low soil calcium and sodium concentrations and the distribution of various species of thorny trees. The models predicted the occurrence of eumycetoma and actinomycetoma in the central and southeastern states of Sudan and along the Nile river valley and its tributaries. Conclusion Our results showed that the risk of mycetoma in Sudan varies geographically and is linked to identifiable environmental risk factors. Suitability maps are intended to guide health authorities, academic institutes and organisations involved in planning national scale surveys for early case detection and management, leading to better patient treatment, prevention and control of mycetoma.

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“…In February 2017, 14,927 refugees from Eritrea were in the process of asylum requirement, making it the biggest refugee community in Switzerland [8]. Although data regarding the burden of mycetoma in Eritrea are quite scarce, the geographic proximity to Sudan should raise awareness of this neglected tropical disease that is now appearing in European countries [5, 7]. The close collaboration between primary care physicians and dermatologists was important in diagnosing the eumycetoma infection in this patient, since this infection was not initially considered by the family doctor.…”

Section: Discussionmentioning

confidence: 99%

“…There is scarce literature regarding this infection and there are very few published cases of mycetoma by Madurella mycetomatis in Switzerland in the medical literature [5, 6]. This case illustrates one patient with eumycetoma of the buttock, an atypical location, who was treated in the Department of Ambulatory Care and Community Medicine of the University of Lausanne and in the Department of Dermatology of the University Hospital of Lausanne.…”

Section: Introductionmentioning

confidence: 99%

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

2019

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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.

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Painless swelling of the forefoot and recurrent subcutaneous abscesses of the lower leg—Two distinct presentations illustrating the spectrum of eumycetoma in a nonendemic country

Cited by 10 publications

References 9 publications

Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region

Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region

Modelling the spatial distribution of mycetoma in Sudan

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

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