Mycetoma: Experience of 482 Cases in a Single Center in Mexico

Abstract

Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3∶1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.

Eumicetoma: actualidades y perspectivas

“…En el continente asiático se reporta con mayor frecuencia en la India y Yemen 8 , mientras que en Latinoamérica su frecuencia es menor comparada con la del actinomicetoma y se presenta principalmente en México, Guatemala y Venezuela [9][10][11] . En México, los eumicetomas representan el 3.48 al 7.88% y los actinomicetomas entre el 96.52 y el 92.12% 12,13 .En una revisión de 3933 casos de micetoma en la República Mexicana, que correspondieron a una incidencia de 73 casos nuevos por año, se encontraron 137 eumicetomas, señalándose que Madurella grisea (n = 39) tiene una frecuencia ligeramente superior a Madurella mycetomatis (n = 36), que es el agente causal más frecuente en el mundo 13 . En Europa e Israel, los procesos de migración de población originaria de áreas endémicas han incrementado el número de casos reportados en los últimos años 14,15 .…”

Histopathological Approach in Diagnosis of Mycetoma Causative Agents: A Mini Review

“…The disease is characterized by numerous deformations and disabilities. Mycetoma is endemic in the so called the Mycetoma belt that includes various countries across the world, but it is reported extensively from Sudan, Mexico and India [3,4]. The disease is characterized by a triad of subcutaneous swelling, multiple sinuses and discharge and painless mass [1].…”

A possible Madura foot from medieval Estremoz, southern Portugal

“…The common name for pedal maduromycosisis Madura foot, deriving from the city of Madurai, in India, where it was first medically reported inthe middle of the 1800's (Bonifaz et al, 2014), although it seems to have been first described in the Indian Sanskrit text Atharva Veda (Hospenthal, 2009). Madura foot is native to the tropical, subtropical and equatorial areas between latitudes 30 • N and 15 • S in the commonly called "mycetoma belt" (Bakshi and Mathur, 2008), especially among barefoot populations (Tomczyk et al, 2014) and agricultural workers (Bonifaz et al, 2014).…”

“…Madura foot is native to the tropical, subtropical and equatorial areas between latitudes 30 • N and 15 • S in the commonly called "mycetoma belt" (Bakshi and Mathur, 2008), especially among barefoot populations (Tomczyk et al, 2014) and agricultural workers (Bonifaz et al, 2014). Environmental factors such as rainfall play an important role in the distribution of this disease, as well as the nature of the soil and presence of abundant, sharp, thorny vegetation (Mathur et al, 1979).…”

“…For these reasons, it is most common in the foot, although it can also occur in the thigh, knee and lower leg, the hand, forearm, arm, shoulder, back, abdominal wall and chest, as well as occasionally in the head or face (Arenas and Lavalle, 2001). This pathology is more common in males (Bakshi and Mathur, 2008;Bonifaz et al, 2014) due to activity but also to possible inhibition of the growth of some of these pathogens caused by progesterone (Hernández-Hernández et al, 1995;Hospenthal, 2009). The first three clinical cases reported for Europe came from Greece, southern Italy and Sardinia (Plehn, 1928).…”