Micetomas actinomicóticos no Rio Grande do Sul: relato de quatro casos

Londero, A. T.; Ramos, Cecy D.; Matte, Shirley W.

doi:10.1590/s0074-02761986000100010

Cited by 7 publications

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“…Mycetomas cases caused by Nocardia sp. have been described in São Paulo and other cities [41], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75].…”

Section: Discussionmentioning

confidence: 99%

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

et al. 2013

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Background Nocardia sp. causes a variety of clinical presentations. The incidence of nocardiosis varies geographically according to several factors, such as the prevalence of HIV infections, transplants, neoplastic and rheumatic diseases, as well as climate, socio-economic conditions and laboratory procedures for Nocardia detection and identification. In Brazil the paucity of clinical reports of Nocardia infections suggests that this genus may be underestimated as a cause of human diseases and/or either neglected or misidentified in laboratory specimens. Accurate identification of Nocardia species has become increasingly important for clinical and epidemiological investigations. In this study, seven clinical Nocardia isolates were identified by multilocus sequence analysis (MLSA) and their antimicrobial susceptibility was also determined. Most Nocardia isolates were associated to pulmonary disease.Methodology/Principal FindingsThe majority of Brazilian human isolates in cases reported in literature were identified as Nocardia sp. Molecular characterization was used for species identification of Nocardia nova, Nocardia cyriacigeorgica, Nocardia asiatica and Nocardia exalbida/gamkensis. Data indicated that molecular analysis provided a different Nocardia speciation than the initial biochemical identification for most Brazilian isolates. All Nocardia isolates showed susceptibility to trimethoprim-sulfamethoxazole, the antimicrobial of choice in the treatment nocardiosis. N. nova isolated from different clinical specimens from one patient showed identical antimicrobial susceptibility patterns and two distinct clones.Conclusions/SignificanceAlthough Brazil is the world's fifth-largest country in terms of land mass and population, pulmonary, extrapulmonary and systemic forms of nocardiosis were reported in only 6 of the 26 Brazilian states from 1970 to 2013. A least 33.8% of these 46 cases of nocardiosis proved fatal. Interestingly, coinfection by two clones may occur in patients presenting nocardiosis. Nocardia infection may be more common throughout the Brazilian territory and in other developing tropical countries than is currently recognized and MLSA should be used more extensively as an effective method for Nocardia identification.

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“…Mycetomas cases caused by Nocardia sp. have been described in São Paulo and other cities [41], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75].…”

Section: Discussionmentioning

confidence: 99%

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

et al. 2013

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Mycetoma: a retrospective study of 41 cases seen in São Paulo, Brazil, from 1978 to 1989

Castro

Belda

Salebian

et al. 1993

Mycoses

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Summary. Clinical and epidemiological aspects of 41 cases of mycetoma seen in São Paulo city from January 1978 to December 1989 are presented. Twenty‐eight cases (68%) were caused by actinomycetes, while 13 (32%) were caused by true fungi. In only 22 (78%) actinomycetoma cases was it possible to identify the agent. Nocardia brasiliensis, by far the commonest actinomycete isolated, was responsible for 13 cases. Among eumycetomata, Madurella grisea was isolated from 3 cases, Scedosporium apiospermum from 2 cases, and Madurella mycetomatis from 1 case, and in 7 cases the agent was not identified. Distribution by sex and age was similar to that reported in the literature. Feet and legs were the commonest sites affected. The mean age of actinomycetoma patients was 33.2 years, while patients with eumycetoma were an average of 32.8 years. Mean duration of the disease was 6.8 and 9.8 years respectively. Most patients came from rural areas in the north‐eastern region of the country and worked as field labourers. Bone involvement was frequent for both actinomycetomata and eumycetomata and was characterized by osteoporosis, periostal reaction and cavitation. The authors' elected treatment consists of combining sulfamethoxazole (800 mg) and trimethoprim (100 mg) with prednisone (10 mg) orally, daily. Zusammenfassung. Es werden die klinischen und epidemiologischen Aspekte von 41 Myzetompatienten vorgestellt, die in São Paulo in der Zeit von Januar 1978 bis Dezember 1989 beobachtet wurden. Achtundzwanzig Fälle wurden durch Aktinomyzeten verursacht (68%), 13 durch Eumyzeten (32%). Nur bei 22 Aktinomyzetomen (78%) war es moglich, den Erreger zu identifizieren. Nocardia brasiliensis stellte mit 13 Fällen den größten Anteil. Bei den Eumyzetomen wurde Madurella grisea dreimal, Scedosporium apiospermum zweimal und Madurella mycetomatis einmal isoliert, in sieben Fällen konnte der Erreger nicht identifiziert werden. Die Geschlechts‐ und Altersverteilung entsprach den Literaturangaben. Die unteren Extremitäten waren die am häufigsten befallenen Bereiche. Das Durchschnittsalter der Aktinomyzetom‐Patienten lag bei 33.2 Jahren, das der EumyzetomPatienten bei 32.8 Jahren. Die mittlere Dauer der Krankheit lag bei 6.8 Bzw. 9.8 Jahren. Die meisten Patienten kamen von ländlichen Gegenden der Nordostregion des Landes, bei der Mehrzahl handelte es sich um Landarbeiter. Knochenbeteiligung war häufig und war charakterisiert durch Osteoporose, periostale Reaktionen und Kavitätenbildung. Die Autoren behandelten mit Sulfamethoxazol (800 mg) und Trimethoprim (100 mg) kombiniert mit Prednison (10 mg) täglich oral.

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Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

et al. 2017

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Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria that form grains in the tissue. The purpose of this study is to describe the epidemiologic, clinic, laboratory, and therapeutic characteristics of patients with mycetoma at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil, between 1991 and 2014. Twenty-one cases of mycetoma were included in the study. There was a predominance of male patients (1.3:1) and the average patient age was 46 years. The majority of the cases were from the Southeast region of Brazil and the feet were the most affected anatomical region (80.95%). Eumycetoma prevailed over actinomycetoma (61.9% and 38.1% respectively). Eumycetoma patients had positive cultures in 8 of 13 cases, with isolation of Scedosporium apiospermum species complex (n = 3), Madurella mycetomatis (n = 2) and Acremonium spp. (n = 1). Two cases presented sterile mycelium and five were negative. Six of 8 actinomycetoma cases had cultures that were identified as Nocardia spp. (n = 3), Nocardia brasiliensis (n = 2), and Nocardia asteroides (n = 1). Imaging tests were performed on all but one patients, and bone destruction was identified in 9 cases (42.68%). All eumycetoma cases were treated with itraconazole monotherapy or combined with fluconazole, terbinafine, or amphotericin B. Actinomycetoma cases were treated with sulfamethoxazole plus trimethoprim or combined with cycles of amikacin sulphate. Surgical procedures were performed in 9 (69.2%) eumycetoma and in 3 (37.5%) actinomycetoma cases, with one amputation case in each group. Clinical cure occurred in 11 cases (7 for eumycetoma and 4 for actinomycetoma), and recurrence was documented in 4 of 21 cases. No deaths were recorded during the study. Despite of the scarcity of mycetoma in our institution the cases presented reflect the wide clinical spectrum and difficulties to take care of this neglected disease.

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Micetomas actinomicóticos no Rio Grande do Sul: relato de quatro casos

Abstract: São relatados quatro casos de micetoma causados por Nocardia brasiliensis, ocorridos no Rio Grande do Sul. É revista a literatura rio-grandense-do-sul.

Cited by 7 publications

References 0 publications

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

Mycetoma: a retrospective study of 41 cases seen in São Paulo, Brazil, from 1978 to 1989

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

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