Diagnosis and Management of Fungal Neglected Tropical Diseases In Community Settings—Mycetoma and Sporotrichosis

Abstract

Background: This is a retrospective, analytic observational study where we describe cases of sporotrichosis and mycetoma from Acapulco General Hospital and Community Dermatology Mexico C.A. over 25 years. Analysis of environmental features that favour the development of such diseases has been made, as well as the limitations in the study and treatment of such diseases in resource poor settings. Methods: We reviewed the information on 76 sporotrichosis and 113 mycetoma patients out of a total of 14,000 consultations at Acapulco General Hospital and from Community Dermatology clinics. We analysed the epidemiological and mycological characteristics and the investigations used for diagnosis such as direct examination, culture, intradermal test reactions, and biopsy. Results: In total 91 confirmed cases of actinomycetoma, 22 of eumycetoma and 76 of sporotrichosis have been identified including diagnostic studies for both diseases and their treatment. Discussion: The results obtained have been analysed and interpreted in patients with mycetoma and sporotrichosis in the state of Guerrero, México, along with limitations in their management in areas with limited economic and logistical resources. The prevalence of mycetoma in our setting is compared with other centres where patients from all over the country are seen. The possible causes for variations in prevalence in specific areas has been looked for, in one of the poorest states of the Mexican Republic.

Diagnostic implications of mycetoma derived from Madurella pseudomycetomatis isolates from Mexico

“…23 The few isolates from South and Central America identified by molecular techniques were found to be M. pseudomycetomatis instead of M. mycetomatis. 24 Therefore, it cannot be excluded that M. pseudomycetomatis is the dominant Madurella species in Latin-America, 11 rather than M. mycetomatis. Our specific molecular assay was able to discriminate M. pseudomycetomatis from the other Madurella species with a high degree of specificity.…”

“…6 In Mexico, particularly M. mycetomatis has been reported. 11 Recently, novel Madurella agents causing mycetoma have been recognized, i.e. Madurella fahalii, Madurella tropicana and Madurella pseudomycetomatis.…”

“…Madurella mycetomatis is the main causative agent globally, 10 while Nigrograna mackinnonii predominates in Latin America 6 . In Mexico, particularly M. mycetomatis has been reported 11 …”

Epidemiology of Clinical Sporotrichosis in the Americas in the Last Ten Years

“…A total of 48 publications related to sporotrichosis were found in North America [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. There were 1460 patients in total associated with infection caused by species of the genus Sporothrix .…”

“…Of these, seven cases came from California, three from Oklahoma, two cases from Kansas, Texas, Arizona, Minnesota, and Florida, one case from Michigan, Nebraska, Oregon, Pennsylvania, and finally, one case without a specific city or region. In Mexico, there were 19 reports registered with 1431 reported cases (84.7% Sporothrix spp., 14.47% S. schenckii , 0.55% S. globosa , 0.21% S. schenckii sensu stricto, 0.07% S. mexicana ) [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Jalisco reported 1060 cases, Guerrero 150, Nayarit 23, Zacatecas 21, Michoacan 20, Guanajuato 14, Oaxaca 9, Puebla, and San Luis Potosí 8 each, Mexico City 6, Chihuahua, Nuevo León, Querétaro, and Veracruz 2 each, Baja California, Durango, State of Mexico, and Morelos 1 each, and 99 cases were reported with an unspecified city ( Table 1 ).…”