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

Abstract

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.

Clinical characteristics and treatment of actinomycetoma in northeast Mexico: A case series

“…The male to female ratio in our series was 3.4:1, similar to other Mexican series reporting predominantly actinomycetoma and a male to female ratio of 3.1 and 2.8 to 1 [2,4]. A review of 21 cases in Rio de Janeiro, Brazil had a male to female ratio of 1.3:1 [7], while data from Africa on predominantly eumycetomas reported a ratio male to female ratio of 3.9, 3.1, and 1.5 to 1 in Senegal, Sudan, and Togo, respectively [9- 11]. Only data from Thailand and Tunisia have reported a female predominance [12].…”

“…In our patients, bone involvement including periostitis, bone erosions, or cavitations was documented by imaging studies in 48.4% of patients, similar to the prevalence encountered in Brazil [7] but much lower than in Togo and Sudan (17-18%) [10,11]. Many factors influence bone invasion including the osteophilic affinity of the microorganism, the host immune status, and evolution time [14].…”

“…The World Health Organization (WHO) included mycetoma as a neglected tropical disease in 2016 [7], which has encouraged research into the topic and identified several knowledge gaps. Epidemiological changes due to urbanization and migration have influenced a shift in mycetoma patient demographics.…”

Nocardia spp.: A Rare Cause of Pneumonia Globally

“…[21][22][23][24]165 Manifestations may include pustules (►Fig. 3), abscesses, necrosis, 166 and nodular pustular pyoderma with sporotrichoid spreading 22,29,37,57,72,167,168 ; infection may extend into contiguous tissues (e.g., muscle, 169 fascia, 170 bone, 29,168 and lymphatics). 37,171 Chronic subcutaneous infections known as mycetomas can occur; these may have draining sinus tracts and result from skin inoculation by filamentous fungi or aerobic filamentous bacteria including Nocardia spp.…”

“…Mycetomas often occur in tropical regions, typically in males of low socioeconomic status working in agricultural, hunting, or outdoor activities. 29,57,168 The feet are most often infected, and bone destruction may occur. 168 Antimicrobial therapy is usually efficacious for nocardial SSTIs, but some cases also require surgical debridement, drainage, or even amputation.…”