Diagnosis and Management of Fungal Neglected Tropical Diseases In Community Settings-Mycetoma and Sporotrichosis.

Roberto Estrada-Castañón,Guadalupe Estrada-Chávez,María De Guadalupe Chávez-López

doi:10.3390/tropicalmed4020081

Abstract

Background: This is a retrospective, analytic observational study where we describe cases of sporotrichosis and mycetoma from Acapulco General Hospital and Community Dermatology Mexico C.A. over 25 years. Analysis of environmental features that favour the development of such diseases has been made, as well as the limitations in the study and treatment of such diseases in resource poor settings. Methods: We reviewed the information on 76 sporotrichosis and 113 mycetoma patients out of a total of 14,000 consultations at Acapulco General Hospital and from Community Dermatology clinics. We analysed the epidemiological and mycological characteristics and the investigations used for diagnosis such as direct examination, culture, intradermal test reactions, and biopsy. Results: In total 91 confirmed cases of actinomycetoma, 22 of eumycetoma and 76 of sporotrichosis have been identified including diagnostic studies for both diseases and their treatment. Discussion: The results obtained have been analysed and interpreted in patients with mycetoma and sporotrichosis in the state of Guerrero, México, along with limitations in their management in areas with limited economic and logistical resources. The prevalence of mycetoma in our setting is compared with other centres where patients from all over the country are seen. The possible causes for variations in prevalence in specific areas has been looked for, in one of the poorest states of the Mexican Republic.

Highlights

Mycetoma and sporotrichosis are two of the most widely distributed implantation mycoses worldwide
In order to facilitate and assist the management of affected patients, we provided financial support for transportation and food during their trip to Acapulco city, where after having any ancillary studies such as imaging including Computer Assisted Tomography (CAT) scans in specific cases, culture, or further mycological studies, free treatment for their specific health conditions was provided after evaluation; this included: Trimethoprim sulfamethoxazole and dapsone (DDS) for patients with actinomycetoma, itraconazole (100–200mg daily), and terbinafine (250 mg daily) for eumycetoma patients and potassium iodide for sporotrichosis; the use of the latter medication is due to cost constraints
Encounters with criminal groups have been few and without severe consequences during work in the communities, the potential risk for personnel, has forced us to adapt our working methods to include the use of teledermatology and telemedicine in order to continue the work of teaching, research, and advice for the health personnel based in remote areas [15]