Mycetoma Medical Therapy

Welsh, Oliverio; Al-Abdely, Hail M.; Salinas-Carmona, Mario C.; Fahal, Ahmed H.

doi:10.1371/journal.pntd.0003218

Cited by 135 publications

(154 citation statements)

References 74 publications

Supporting

Mentioning

150

Contrasting

Unclassified

Order By: Relevance

“…Itraconazole is the most common antifungal agent used for eumycetoma treatment [2]. Voriconazole and posaconazole have been indicated for refractory cases of mycetoma [58] primarily caused by S .…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

See 1 more Smart Citation

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

et al. 2017

View full text Add to dashboard Cite

Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria that form grains in the tissue. The purpose of this study is to describe the epidemiologic, clinic, laboratory, and therapeutic characteristics of patients with mycetoma at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil, between 1991 and 2014. Twenty-one cases of mycetoma were included in the study. There was a predominance of male patients (1.3:1) and the average patient age was 46 years. The majority of the cases were from the Southeast region of Brazil and the feet were the most affected anatomical region (80.95%). Eumycetoma prevailed over actinomycetoma (61.9% and 38.1% respectively). Eumycetoma patients had positive cultures in 8 of 13 cases, with isolation of Scedosporium apiospermum species complex (n = 3), Madurella mycetomatis (n = 2) and Acremonium spp. (n = 1). Two cases presented sterile mycelium and five were negative. Six of 8 actinomycetoma cases had cultures that were identified as Nocardia spp. (n = 3), Nocardia brasiliensis (n = 2), and Nocardia asteroides (n = 1). Imaging tests were performed on all but one patients, and bone destruction was identified in 9 cases (42.68%). All eumycetoma cases were treated with itraconazole monotherapy or combined with fluconazole, terbinafine, or amphotericin B. Actinomycetoma cases were treated with sulfamethoxazole plus trimethoprim or combined with cycles of amikacin sulphate. Surgical procedures were performed in 9 (69.2%) eumycetoma and in 3 (37.5%) actinomycetoma cases, with one amputation case in each group. Clinical cure occurred in 11 cases (7 for eumycetoma and 4 for actinomycetoma), and recurrence was documented in 4 of 21 cases. No deaths were recorded during the study. Despite of the scarcity of mycetoma in our institution the cases presented reflect the wide clinical spectrum and difficulties to take care of this neglected disease.

show abstract

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

“…It´s considered a neglected disease by the World Health Organization (WHO) since 2016 and remains without any control program for prevention or surveillance [1, 2]. …”

Section: Introductionmentioning

confidence: 99%

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Isolation of the fungal grains may be performed either via a deep-seated biopsy or aspiration cytology [2], necessitating the use of special stains for thorough identification of the causative organism [2]. Microbiological culture provides definitive diagnosis, but may take several weeks to months [2,6,9], with the potential for inadvertent contamination, and additional, more extensive biopsies [8,10]. Moreover, the causative organisms may be fastidious and difficult to demonstrate [2], leading to further delays in diagnosis and intervention.…”

mentioning

confidence: 99%

“…Treatment can be challenging, and initially consists of a combination of antimicrobial agents [4,5] with extensive surgical debridement and limb amputation being potentially employed in unresponsive or poorly controlled cases [4,5,7,9]. The particular regimen is dictated by the causative organism, with eumycetoma reportedly requiring a longer period of treatment [1], exhibiting more resistance, a higher recurrence rate and overall poorer prognosis compared with actinomycetoma [1,7].…”

mentioning

confidence: 99%

Chronic swelling of the foot

Flores

2017

Skeletal Radiol

View full text Add to dashboard Cite

“…To identify the causative agent, a deepseated surgical biopsy is performed and histology, cytology, and culture assays are performed. As mycetoma can be caused by both bacteria and fungi, a rapid distinction between the two is necessary for initiation of proper treatment (2)(3)(4). Ideally, a rapid method would dispense with the requirement for a deep-seated surgical biopsy.…”

mentioning

confidence: 99%

Detection of (1→3)-β- d -Glucan in Eumycetoma Patients

et al. 2016

View full text Add to dashboard Cite

c Mycetoma can be caused by bacteria (actinomycetoma) or fungi (eumycetoma). Here, we demonstrated in 45 eumycetoma patients, 30 actinomycetoma patients, and 30 healthy controls that (1¡3)-␤-D-glucan detection in serum cannot reliably be used to discriminate between the two types of mycetoma. Mycetoma is a neglected chronic implantation mycosis, characterized by large tumor-like swellings and located mainly in the extremities. Mycetoma can be caused by more than 56 different pathogens (1), either of bacterial (actinomycetoma) or of fungal (eumycetoma) origin. To identify the causative agent, a deepseated surgical biopsy is performed and histology, cytology, and culture assays are performed. As mycetoma can be caused by both bacteria and fungi, a rapid distinction between the two is necessary for initiation of proper treatment (2-4). Ideally, a rapid method would dispense with the requirement for a deep-seated surgical biopsy. A rapid diagnostic test, which can be performed in serum, is therefore to be preferred.(1¡3)-␤-D-Glucan is a cell wall polysaccharide present in many fungal species. It is secreted during growth and disseminates from the site of infection. It can be detected in sera of patients with different fungal infections (5-9). There are currently no reports published on (1¡3)-␤-D-glucan detection in eumycetoma patients. In this study, we therefore set out to determine if (1¡3)-␤-D-glucan levels could be measured in eumycetoma patients and if measuring these levels would enable us to discriminate eumycetoma patients from healthy controls living in regions of endemicity or actinomycetoma patients.Seventy-five human sera were obtained from Sudanese mycetoma patients (45 patients with eumycetoma and 30 patients with actinomycetoma) seen in the Mycetoma Research Centre in Khartoum, Sudan, and 30 control sera were obtained from healthy volunteers at the blood bank in Khartoum, Sudan. For each patient, age, gender, disease duration, relative size of lesion, and site of infection were recorded. For each control, age and gender were recorded. Lesion size was measured, and lesions with a diameter of Ͻ5 cm were defined as small, lesions with a diameter of 5 to 10 cm were defined as moderate, and lesions with a diameter of Ͼ10 cm were defined as large. The demographic data for the controls were matched to those for the mycetoma patients, and the data for each group are represented in Table 1. Written informed consent was obtained from patients and controls, according to guidelines from the medical ethical committee at Soba University Hospital, Khartoum, Sudan. The study protocol was approved by this medical ethical committee. Sera were sent to the research laboratories of Associates of Cape Cod, Inc., and (1¡3)-␤-D-glucan concentrations were determined according to the protocol of the instructions for use of the Fungitell kit. Based on the (1¡3)-␤-D-glucan values measured, a receiver operating characteristic (ROC) analysis was performed using GraphPad Prism 5.03. The area under the ROC curve was 0.90 (Fig. 1A). ...

show abstract

Mycetoma Medical Therapy

Cited by 135 publications

References 74 publications

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

Chronic swelling of the foot

Detection of (1→3)-β- d -Glucan in Eumycetoma Patients

Contact Info

Product

Resources

About