Abstract

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.

Highlights

  • This study describes some aspects of mycetoma

  • Mycetoma is a chronic subcutaneous infections caused by the inoculation of filamentous fungi or aerobic filamentous bacteria that form grains in the affected tissues [1]

  • We describe the epidemiological, clinical, laboratory, and therapeutic aspects of patients treated at a reference hospital in Rio de Janeiro, Brazil, between 1991 and 2014

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Summary

Introduction

Mycetoma is a chronic subcutaneous infections caused by the inoculation of filamentous fungi (eumycetoma) or aerobic filamentous bacteria (actinomycetoma) that form grains in the affected tissues [1]. Its considered a neglected disease by the World Health Organization (WHO) since 2016 and remains without any control program for prevention or surveillance [1, 2]. Mycetoma occurs worldwide and prevails in tropical and subtropical regions, especially in sub-Saharan areas of Africa, India, and Mexico [3,4]. The incidence and prevalence of mycetoma in Brazil are unknown, since it is not considered a public health problem, as its frequency is smaller than other diseases such as sporotrichosis, tuberculosis, leprosy, and dengue (the latter two are classified as neglected diseases by the WHO) [6]. Mycetoma evolves slowly in its clinical manifestation. Laboratory diagnosis and treatment are difficult, presenting significant medical, occupational and socioeconomic impacts [2,7]

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