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

Abstract

Background Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological agent. Mycetoma may be caused by true fungi (eumycetoma) or filamentous aerobic bacteria (actinomycetoma). Mycetoma is more frequent in the so-called mycetoma belt (latitude 15˚south and 30˚north around the Tropic of Cancer), especially in Sudan, Nigeria, Somalia, India, Mexico, and Venezuela. The introduction of new antibiotics with fewer side effects, broader susceptibility profiles, and different administration routes has made information on actinomycetoma treatment and outcomes necessary. The objective of this report was to provide an update on clinical, therapeutic, and outcome data for patients with actinomycetoma attending a reference center in northeast Mexico. Methodology/principal findings This was a retrospective, cross-sectional, descriptive study of 31 patients (male to female ratio 3.4:1) diagnosed with actinomycetoma by direct grain examination, histopathology, culture, or serology from January 2009 to September 2018. Most lesions were caused by Nocardia brasiliensis (83.9%) followed by Actinomadura madurae (12.9%) and Actinomadura pelletieri (3.2%). About 50% of patients had bone involvement, and the right leg was the most commonly affected region in 38.7% of cases. Farmers/agriculture workers were most commonly affected, representing 41.9% of patients. The most commonly used treatment regimen was the Welsh regimen (35.5% of cases), a combination of trimethoprim/sulfamethoxazole (TMP/SMX) plus amikacin, which had a 90% cure rate, followed by TMP/SMX plus amoxicillin/clavulanic acid in 19.4% of cases with a cure rate of 100%. In our setting, 28 (90.3%) patients were completely cured and three (9.7%) were lost to followup. Four patients required multiple antibiotic regimens due to recurrences and adverse effects.

Climate, soil type, and geographic distribution of actinomycetoma cases in Northeast Mexico: A cross-sectional study

“…; and 1 (3.2%) by A. pelletieri. Complete clinical, diagnostic and therapeutic information of these cases has been reported previously [9]. The mean annual temperature and mean annual precipitation from 1925 to 2015 from the nearest climate stations where cases occurred in Nuevo Leon, San Luis Potosi, Tamaulipas, Coahuila, Veracruz and Hidalgo was obtained as follows, the mean annual temperature ranged from 17.2 to 25.8˚C with a mean of 22.9˚(SD = 2.07) and a mean annual precipitation of 373.5 to 2713.3 mm with a mean of 1043.4 (SD = 690.6) ( Table 1).…”

Mycetoma by Actinomadura madurae in the central nervous system: Renal transplant receptor disease

“…Mycetoma caused by Actinomadura madurae is characterized by a continuous secretion, 1 , 10 suspected by the development of abscess. A bypass valve was needed to treat hydrocephaly.…”

Actinomycetoma by Actinomadura madurae

“…The male to female ratio in our series was 1:1.9, similar to a case-series from Tunisia reporting a male to female ratio of 1:1.5,[ 8 ] however, different from several studies pointing male predominance for actinomycetoma. [ 4 5 9 ] Outdoor activities may influence this trend, and also the host genetic variation to susceptibility to actinomycetoma,[ 10 ] as well as the hormonal levels, since estrogens may protect against this disease, while progesterone and testosterone may cause proinflammatory response. [ 11 ] Most of our female patients were housewives; however, they may perform additional, outdoor activities that may increase the risk of infection.…”