The orthopaedic aspects of mycetoma

Fahal, Ahmed Hassan; Shaheen, Samir; Jones, David H.

doi:10.1302/0301-620x.96b3.31421

Cited by 41 publications

(60 citation statements)

References 27 publications

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“…Some cases reported to have a bony involvement (15%), which complicates clinical management, leaving surgical amputation as the most likely treatment option. A similar finding was reported by Fahal, et al who found bone destruction in 794 cases (17%), but higher rate of bony involvement was reported in case report which was found in 5 patients out of 6 (Fahal et al 2014b). …”

Section: Discussionsupporting

confidence: 88%

Clinical presentation and management of mycetoma in gezira mycetoma center in Sudan

Ahmed

Alshiekh²,

Awadalla³

et al. 2017

IJM

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Background: Mycetoma is a neglected tropical disease characterised by deformity and disabilities with various medical, health, and socioeconomic impacts on the affected communities. It is a common health problem in Gezira state in Sudan. Objective: This study was conducted to review the clinical presentation and management of mycetoma in Gezira Mycetoma Center in Medani, Sudan. Methodology: This was a prospective descriptive health facility-based study conducted among 100 patients diagnosed with mycetoma attended to Gezira Mycetoma Center during the period from October 2014 to Sept. 2015. Variable checked was demographic characteristic, clinical presentation, types of mycetoma, and types of surgery done. Results: The commonest age was 20-40 years, which represents 49(49%). Males were 76(76%). Participants were mostly farmers or animal breeders with percentage of 31% and 12% respectively. All patients presented with a swelling (100%) and mostly with discharge in a sinuses (75%).The vast majority of patients reside in Gezira State (82%). Eumycetoma was reported in 98% of cases versus 2% actinomycetoma. Diagnosis depended on clinical examination mainly and X-ray for bone involvement which was reported in 15%. All cases underwent surgical intervention in the form of wide local excision (81%), amputation (17%) and debulking (2%). Conclusion:The study concluded that most of the patients presented late, with history of inadequate management.

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Section: Discussionsupporting

confidence: 88%

Clinical presentation and management of mycetoma in gezira mycetoma center in Sudan

Ahmed

Alshiekh²,

Awadalla³

et al. 2017

IJM

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“…It is a chronic, specific, granulomatous, progressive subcutaneous inflammatory disease that spreads to involve the skin, deep structures and bones [4,5]. The disease is caused by true fungi or by certain bacteria and hence it is usually classified into eumycetoma and actinomycetoma, respectively [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…The infection usually progresses slowly over many years and it is commonly painless and that may contribute to the late presentation of many patients [2,18]. The painless subcutaneous mass, multiple sinuses and discharge with grains is distinctive of this infection [1] Young adult males in the age range 20–40 years are more frequently affected [2,4]. Farmers, workers and students are affected most but no occupation is exempted [2,5].…”

Section: Introductionmentioning

confidence: 99%

Head and Neck Mycetoma: The Mycetoma Research Centre Experience

et al. 2015

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Mycetoma is a unique neglected tropical disease which is endemic in what is known as the “mycetoma belt”. The disease has many devastating impacts on patients and communities in endemic area and is characterised by massive deformity, destruction and disability. Mycetoma is commonly seen in the foot and hand and less frequent in other parts of the body. Mycetoma of the head and neck is a rarity and is associated with high morbidity and even mortality if not treated early. In this communication we report on 49 patients with head and neck mycetoma followed up at the Mycetoma Research Centre in Khartoum. Most of the reported patients had actinomycetoma and the majority were young adult males from mycetoma endemic areas in the Sudan. Most of them were students, farmers and workers. Prior to presentation the majority had long disease duration and the cause was multifactorial. Advanced disease with massive lesion, deformity and disability was the common presentation. There was no obvious history of local trauma, familial tendency or other predisposing factor identified in this group of patients. MRI and CT scan were the most accurate diagnostic tools to determine the disease extent. The treatment outcome was rather poor and characterised by low cure rate, poor outcome and high follows-up dropout. Such a gloomy outcome calls for structured and objective health education programs.

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“…7 Management for maduramycosis entails extensive debridement of the infected tissue combined with prolonged antifungal therapy with ketoconazole (400-800 mg/day) or itraconazole (400 mg daily). [8][9][10] Long treatment periods, financial burden from the treatment complicated by drug resistance results in frequent failure of medical management and increases the probability of a surgical intervention such as amputation. The use of potent, extended-spectrum triazoles such as Posaconazole (800 mg/day) has produced high cure rates (80%) with remission up to 2 years after treatment.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Management of Madura Foot with Oral Posaconazole and Ciprofloxacin

Sharma

Nat

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. Madura foot is a chronic infection caused by fungus and/or bacteria. Traditionally, treatment has been surgical debridement or amputation. Non-invasive management with long-term antimicrobials alone has been reported as successful. We report a case of Madura foot in a Somali refugee successfully managed with oral posaconazole and ciprofloxacin. CASE PRESENTATIONA 22-year-old Somali male presented with right foot pain and swelling for 7 years and "tiny watermelon seeds" extruding out of the "puncture wounds" on the sole of the right foot (Figures 1-3). The patient gave a history of prolonged barefoot outdoor exposure in his native country and at his refugee camp in Kenya. Physical examination revealed swelling of the sole of his right foot and multiple sinus tracts along with evidence of recent drainage (Figures 1 and 2). Magnetic resonance imaging (MRI) of the right foot showed contiguous involvement of the skin and subcutaneous tissue over the medial and plantar aspects of the foot and reactive changes in the bone consistent with an underlying osteomyelitis. Subsequent biopsy showed ulceration and extensive fibrosis (Figure 3), focal granulomas (Figure 4), and clusters of darkly pigmented fungal hyphae ( Figure 5). The patient was hospitalized and initially treated with intravenous trimethoprimsulfamethoxazole (TMP-SMX) and liposomal amphotericin B. The patient was discharged home on an oral regimen of

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The orthopaedic aspects of mycetoma

Abstract: This article presents an overview of mycetoma and offers guidelines for orthopaedic surgeons who may be involved in the care of patients with this condition.

Cited by 41 publications

References 27 publications

Clinical presentation and management of mycetoma in gezira mycetoma center in Sudan

Clinical presentation and management of mycetoma in gezira mycetoma center in Sudan

Head and Neck Mycetoma: The Mycetoma Research Centre Experience

Non-Invasive Management of Madura Foot with Oral Posaconazole and Ciprofloxacin

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