Mycetoma: A common yet unrecognized health burden in central India

Abstract

Context: Mycetoma is a chronic suppurative infective disorder of skin, subcutaneous tissue, fascia, and bones caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. Triad of tumefaction, discharging sinuses, and grains characterizes the disease. Aims: This study was undertaken to study the clinical spectrum and treatment response of mycetoma in central India. Settings and Design: It was a retrospective study of clinical and/or biopsy-proven and treated cases of mycetoma from November 2015 to October 2016. Subjects and Methods: Medical records of diagnosed and treated mycetoma patients were enrolled retrospectively during November 2015 and October 2016. Case records of patients were evaluated with respect to demographic, clinical, microbiological details, bone involvement, and treatment. Type of therapies and outcome, wherever available, were also assessed. Statistical Analysis: Statistical analysis was done using proportion, mean, and percentages. Results: Eleven cases (male = 8) were seen during the study period (seven actinomycetoma and four eumycetoma). Foot and lower extremity was the most common site (9/11), whereas upper extremity and forehead were involved in one case each. On culture, the organisms isolated were Phialophora and Fusarium . Modified Welsch regimen was started in six of seven patients with actinomycetoma, whereas one was started on sulfamethoxazole–trimethoprim and a combination of amoxicillin and clavulanic acid therapy. All four cases of eumycetoma were treated with itraconazole. On follow-up, six cases of actinomycetoma cases showed significant improvement. Two cases of eumycetoma showed mild to moderate improvement and one case required surgical intervention. One case each of actinomycetoma and eumycetoma were lost to follow-up. Conclusion: Mycetoma has been recognized as a neglected tropical disease by the World Health Organization, recently. There are very few case reports from the central part of India. Prominent case detection in our study emphasizes the need of larger studies to know the extent of disease in this part of India.

Skin Mycetoma in an 11-Year-Old African Boy: Case Presentation with Emphasis on Histopathological Features and Differential Diagnosis

“…Instead, in cases of actinomycetoma, red grains are present in the case of infection with Actinomadura pelletieri ; yellow grains in the case of Streptomyces somaliensis infection (as in our case described), and pale grains in the case of Nocardia brasiliensis , N. otitidiscaviarum , N. asteroids , and Actinomadura madurae [ 6 , 15 , 16 , 17 , 18 ].…”

Detection of slow growing Actinomadura species proved a key formanagement of mycetoma: A case report from Chhattisgarh

“…A study by Sawatrkar et al from central India had all actinomycetoma cases were culture negative. [ 10 ] It may be due to shortage in the incubation period which might be possible in our case if incubation was not prolonged. Culture positive Actinomadura cases are less reported in literature and diagnosis was made on microscopy.…”

“…Two cases of Mycetoma from State of Chhattisgarh were reported by Sawatrkar et al but etiological agents were not mentioned. [ 10 ] Scarcity of reports or underreporting of cases from the Chhattisgarh causes ambiguity in predominance of eumycetoma or actinomycetoma.…”

A Rare Case of Oral Cavity Eumycetoma

“…The grains found in eumycetoma are densely packed fungal mycelia embedded in a hard and brown–black cement material. [ 10 ]…”

“…Most common agents are azoles such as itraconazole and ketoconazole, but they have a disadvantage of short-term efficacy, recurrence and side-effects. [ 10 ] Eumycetoma is refractory to treatment and thus the patient counselling is very much important as a prolonged follow-up period is necessary to monitor for disease recurrence. [ 10 ] New therapies such as voriconazole and posaconazole are effective in refractory types of eumycetoma.…”