Mycetoma: experience of 482 cases in a single center in Mexico.

Alexandro Bonifaz,Gloria M González,Javier Araiza,Andrés Tirado-Sánchez,Amado Saúl,Rosa María Ponce,Luz Calderón,Marco Hernández,Todd Reynolds

doi:10.1371/journal.pntd.0003102

Alexandro Bonifaz, Gloria M González + Show 7 more

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https://doi.org/10.1371/journal.pntd.0003102

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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.

Highlights

Mycetoma is a chronic granulomatous disease, associated with a progressive, inflammatory reaction that clinically presents as tumor-like soft tissue swelling with sinus tract formation that drains purulent material containing grains
Mycetoma usually results of traumatic implantation of soil organisms on subcutaneous tissue; can be classified as eumycetoma or actinomycetoma depending on whether the infection is caused by filamentous fungi or aerobic filamentous actinomycetes, respectively [1,2,3]
Actinomycetomas caused by Nocardia spp. occur mostly in regions with higher humidity, while actinomycetoma caused by Actinomadura spp. and Streptomyces spp. or eumycetoma occur in drier areas with low relative humidity [1,3,4,5]

Summary

Introduction

Mycetoma is a chronic granulomatous disease, associated with a progressive, inflammatory reaction that clinically presents as tumor-like soft tissue swelling with sinus tract formation that drains purulent material containing grains. Mycetoma represents a classical neglected disease that primarily affects the poorer populations and rural regions of Africa, Latin America, and Asia at latitudes defined as the ‘‘mycetoma belt’’ where higher mycetoma frequencies are observed. This region is located around the Tropic of Cancer, between latitudes 15u South and 30u North, encompassing the countries with the highest rates of infection including Sudan, Somalia, Senegal, India, Yemen, Mexico, and Venezuela [1,4,5]. Actinomycetomas caused by Nocardia spp. occur mostly in regions with higher humidity, while actinomycetoma caused by Actinomadura spp. and Streptomyces spp. or eumycetoma occur in drier areas with low relative humidity [1,3,4,5]

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