Eumycetoma of the Hand Caused by Leptosphaeria tompkinsii and Refractory to Medical Therapy with Voriconazole

Cartwright, Katharine; Clark, Tristan; Hussain, Abid; Wiselka, Martin; Borman, Andrew M.; Johnson, Elizabeth

doi:10.1007/s11046-011-9432-8

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…Reviewing the medical literature revealed several hand mycetoma cases caused by other causative organisms. Pupaibul in 1982, reported hand mycetoma caused by Phialophora Jeanselmei [ 30 ] while Leptosphaeria tompkinsii , black grain causative organisms, was reported by Cartwright and colleagues [ 31 ] and by Machmachi and associates [ 32 ]. Hand mycetoma caused by Nocardia caviae was reported in few patients as well [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Hand Mycetoma: The Mycetoma Research Centre Experience and Literature Review

Omer¹,

Din²,

Rahim³

et al. 2016

PLoS Negl Trop Dis

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Mycetoma is a devastating, neglected tropical disease characterised by extensive tissue involvement resulting in destruction, deformities and disabilities in the affected patients. The hand is commonly affected by mycetoma thus compromises its functionality and hinder the patient’s daily activities of living. In this communication, we report on 533 patients with hand mycetoma managed over a period of 24 years at the Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan. Eumycetoma was the commonest type of mycetoma (83.3%) encountered. Males were predominately affected (69.2%) with a sex ratio of 2.2:1. The majority of the patients (84%) were young adult below the age of 40 years old at presentation. The generality of patients (86.4%) were from the Sudan mycetoma belt. Children and adolescents (28.1%), farmers (18.2%) and workers (17.4%) were more frequently affected. The majority of patients (67.4%) had disease duration of less than 5 years at presentation. The study, did not document significant history of local trauma, familial tendency, concomitant medical diseases or other predisposing cause for mycetoma in this population. Pain (23.1%) was not a disease feature in this series and 52% of patients had past surgery for mycetoma and recurrence. The right hand was affected most (60.4%), and 64% of them had small lesion at presentation. Conventional x-ray was only helpful in patients with advanced disease and the MRI accurately determined the disease extension. Cytological smears, surgical biopsies histopathological examination and grains culture were the principal diagnostic tools for causative organisms’ identification. In the present series it was difficult to determine the treatment outcome due to high patients follow up dropout.

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Section: Discussionmentioning

confidence: 99%

Hand Mycetoma: The Mycetoma Research Centre Experience and Literature Review

Omer¹,

Din²,

Rahim³

et al. 2016

PLoS Negl Trop Dis

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“…77 Finally, Cartwright et al reported a case of hand mycetoma from Leptosphaeria tompkinsii. 78 It developed in the palm of a clothing manufacturer with no significant past medical history. It presented as palm swelling with multiple sinus tracts.…”

Section: Mycetomamentioning

confidence: 99%

“…Treatment with oral itraconazole followed by oral voriconazole at dose of 200 mg twice daily at first and consequently 300 mg twice daily was unsuccessful, as symptoms insisted, and MRI illustrated carpal and metacarpal bone involvement at 12 months' time. 78 Cases of mycetoma infections are presented on Table 8 .…”

Section: Mycetomamentioning

confidence: 99%

Deep Fungal Infections of the Upper Extremity - A Review

Ditsios,

Katsimentzas,

Pitsilos

et al. 2024

Orthopedic Reviews

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Deep fungal infections are rare in the upper extremity. Vessel and nerve infection, synovitis, tenosynovitis, myofasciitis, arthritis and osteomyelitis have been discovered in literature. Treatment in most cases includes surgical procedure and antifungal agent use. Amputation is the final, most devastating for patient’s functionality, solution. Intravenous antifungal drugs, frequently followed by oral administration, are important ancillary agents both for the initial treatment and the prevention of recurrence. We therefore performed a review of the current literature, in order to assemble the dispersed results of different studies and clarify the various aspects of upper extremity fungal infections.

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“…Cartwright et al report eumycetoma of the hand caused by Leptosphaeria tompkinsii refractory to medical therapy with voriconazole [19]. A case of atypical eumycetoma caused by Phialophora parasitica was successfully treated with itraconazole and flucytosine [20].…”

Section: Managementmentioning

confidence: 99%

Black Grain Eumycetoma Revisited: Enhanced Fungal Isolation by Use of a Novel Technique

Hazra¹

2017

JBMOA

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Background: Dematiaceous fungi or brown-black fungi distributed worldwide are being increasingly recognized as pathogens of importance. Found in soil, they have unique pathogenic mechanisms owing to the presence of melanin in their cell walls, which imparts the characteristic dark color to their spores and hyphae. Eumycetoma is a common, chronic, granulomatous infection that is present worldwide and endemic in tropical and subtropical regions. Black grain eumycetoma accounts for about 95% of eumycetomas in India. Isolation of the causative fungus from the coloured grains in the laboratory is an arduous task resulting in empirical treatment. At present, clear evidence based treatment recommendations are unavailable and it becomes pertinent to identify, isolate and speciate the causative fungus so that appropriate treatment can be instituted for complete resolution.Objective: This article revisits black grain mycetoma in the larger spectrum of phaeohyphomycosis, describes four patients with black grain mycetoma and elaborates on a novel technique developed in our laboratory for assured isolation of fungi from eumycotic "grains".Clinical management: All four patients gave a clinical history of mycetoma, having observed intermittent discharge of black grains from lesions. Processing of grains was comprehensively carried out with direct KOH preparation, mycological analysis of the grains and histology. All patients were started on oral itraconazole 200-400 mg twice daily, post wide excision of soft tissue that resulted in near complete regression of the lesion. Summary:Timely identification of the fungal isolate based on grain morphology and culture in a setting where molecular setup and techniques are not available is crucial to ensure guided therapy and best clinical outcomes for the patient.

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Eumycetoma of the Hand Caused by Leptosphaeria tompkinsii and Refractory to Medical Therapy with Voriconazole

Cited by 6 publications

References 23 publications

Hand Mycetoma: The Mycetoma Research Centre Experience and Literature Review

Hand Mycetoma: The Mycetoma Research Centre Experience and Literature Review

Deep Fungal Infections of the Upper Extremity - A Review

Black Grain Eumycetoma Revisited: Enhanced Fungal Isolation by Use of a Novel Technique

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