Eumycotic mycetoma caused by Madurella mycetomatis successfully treated with antifungals, surgery, and topical negative pressure therapy

Abstract

401We report a 21-year-old farmer with a 4-year history of a nodular plaque with fistulas and induration of adjacent skin. The lesion had been treated surgically at another hospital, but recurred 2 years later.Black, charcoal-like grains were observed draining through the fistulas. A biopsy specimen showed brown grains with filaments in an abscess surrounded by macrophages, giant cells, and lymphocytes. Culture demonstrated small white colonies of Madurella mycetomatis . The patient was treated with itraconazole for 6 months, followed by surgery. TNP was initiated in the immediate post-operative period, and copious granulation tissue was observed within 1 week.Autologous skin grafting was performed, and itraconazole was continued for an additional 3 months. Although necrosis of the graft ensued, the functional result was acceptable.The patient appeared free of disease at 18 months of follow-up.Eumycotic mycetoma is an infectious and inflammatory process that occurs after traumatic inoculation of fungi through the skin. Surgery is the treatment of choice, but successful reconstruction may be challenging and recurrence is common. Topical negative pressure (TNP) promotes the formation of granulation tissue, which facilitates closure of deep wounds and chronic ulcers. This case illustrates that eumycotic mycetoma is difficult to treat. Whether TNP contributed to the successful outcome cannot be proven but, given the generally poor response of eumycetoma to therapy, we suggest that the role of TNP in the management of this disease merits attention.

Reconstructive Surgery for Mycetoma: Is There a Need to Establish an Algorithm?

“…53 The lesion involved plantar arch of the right foot and was recurrent and complicated by multiple sinuses formation. 53 This modality coupled with medical treatment had resulted in complete disappearance of the lesion at an 18-month follow-up. 53 Although graft had developed necrosis, the presence of an adequate granulation tissue in the surgically treated area had facilitated reepithelialization of the wound.…”

“…It is interesting to note that STSG after application of topical negative pressure wound therapy (NPWT) to cover skin defects has been successfully described in the literature. 53,54 An STSG was used for covering a skin defect after application of topical NPWT to induce the granulation tissue formation following local excision of a Madura foot. 53 The lesion involved plantar arch of the right foot and was recurrent and complicated by multiple sinuses formation.…”

“…53,54 An STSG was used for covering a skin defect after application of topical NPWT to induce the granulation tissue formation following local excision of a Madura foot. 53 The lesion involved plantar arch of the right foot and was recurrent and complicated by multiple sinuses formation. 53 This modality coupled with medical treatment had resulted in complete disappearance of the lesion at an 18-month follow-up.…”

Draft Genome Sequences of Three Clinical Isolates of Madurella mycetomatis, the Major Cause of Black-Grain Mycetoma

“…Many other fungi belonging to different taxonomic orders are also known to produce black-grain mycetoma. However, M. mycetomatis is the main agent of eumycetoma, which is associated with increased morbidity, disability, and poor response to medical treatment, with profound socioeconomic consequences (4,5). To date, only one draft genome of M. mycetomatis has been reported.…”

Actinomycetoma-The Welsh Regimen in a Rural Indian Scenario

“…The prevalence of actinomycetes is higher than that of eumycetes in South India, whereas the reverse is seen in North India [12,13,[21][22][23].…”