Cases Of Actinomycetoma Research Articles

Phylogenetic identification of Nocardia brasiliensis strains isolated from actinomycetoma in Mexico State using species-specific primers

Summary Objective The aim of our research was to update the situation concerning actinomycetoma in Mexico, to localize areas where it is frequently found and to identify the main strains from the isolates. Material and methods To localize cases of actinomycetoma, patients’ medical records from the dermatology departments of general and private hospitals were reviewed. Pathologic strains were looked for in general hospital patients and in reference institutes in Mexico City. The clinical strains were kept in Bennett agar and were subsequently identified using polyphasic approaches, including a partial sequence of 16S rDNA using species-specific primers designed to recognise Nocardia species. Results Eleven cases of actinomycetoma and five species of pathological strains were identified. Most cases were found in south-eastern Mexico and Nocardia brasiliensis was the most frequently isolated species. Conclusions This research confirmed the presence of actinomycetoma in Mexico as well as the zones of high incidence and the most frequent pathological strain.

Variable antibiotic susceptibility patterns among Streptomyces species causing actinomycetoma in man and animals

BackgroundDrug therapy is recommended in conjunction with surgery in treatment of actinomycetoma. The specific prescription depends on the type of bacteria (actinomycetoma) or fungi (eumycetoma) causing the disease and their in vitro antimicrobial susceptibility.ObjectivesTo investigate the antimicrobial susceptibility among isolates of Streptomyces spp. isolated from cases of actinomycetoma in man and animals in Sudan.MethodsStreptomyces strains (n = 18) isolated from cases of actinomycetoma were tested in vitro against 15 commonly prescribed antibacterial agents using MIC agar dilution method as per standard guidelines.ResultsStreptomyces strains isolated from actinomycetoma fall into various phenotypic groups. All of the strains were inhibited by novobiocin (8 μg/mL), gentamycin (8, 32 μg/mL) and doxycycline (32 μg/mL). Fusidic acid (64 μg/mL) inhibited 94.4% of the strains; bacitracin, streptomycin, cephaloridine, clindamycin, ampicillin, rifampicin and tetracycline (64 μg/mL) inhibited between 61.1 and 77.8% of the strains. All strains were found resistant to amphotericin B (64 μg/mL), penicillin (20 μg/mL) and sulphamethoxazole (64 μg/mL).ConclusionsSaprophytic Streptomyces spp. cause actinomycetoma in man and animal belong to separate phenotypes and have a wide range of susceptibility patterns to antimicrobial agents, which pose a lot of difficulties in selecting effective in vivo treatment for actinomycetoma.

Actinomycetoma in Arm Disseminated to Lung with Grains of Nocardia brasiliensis with Peripheral Filaments

Actinomycetomas represent 97.8% of mycetomas in Mexico, where 86.6% are produced by Nocardia brasiliensis. We report a case of actinomycetoma in the arm by Nocardia brasiliensis disseminated to lung. Uncommon grains were observed which present outside peripheral filaments and also numerous filaments loosing the grains. These characteristics of the grains are due probably because for the long treatment with antibiotics of the patient. In situ antibiotic action against the microcolonies is discussed.

Les mycétomes en Algérie. À propos de deux nouveaux cas. Revue des cas rapportés de 1995 à 2005

Mycetoma are inflammatory process in which exogenous causatives agents fungal or actinomycotic produce grains. This work reports two new cases of actinomycetoma due to Actinomadura madurae and to Streptomyces somaliensis in patients from Tamanrasset and Ain defla (Algeria). Diagnosis was based on mycology of grains and identification of the etiologic agent through culture. This document relate epidemiological situation of mycetoma in Algeria during the last 10 years (1995–2005).

Treatment of actinomycetoma due to Nocardia spp. with amoxicillin?clavulanate

Actinomycetoma is a chronic occupational condition that occurs frequently in tropical regions. In Mexico 85% of cases are caused by Nocardia brasiliensis. There are two treatments of choice for these cases: a regimen of dapsone plus trimethoprim-sulfamethoxazole (co-trimoxazole) and, recently, amikacin, either alone or combined. However, not all cases respond properly to these therapies. To report a retrospective, 11-year study of cases of actinomycetomas caused by Nocardia spp., treated with amoxicillin-clavulanate (co-amoxiclav). All cases were identified clinically and microbiologically and had previously failed standard therapies. Oral co-amoxiclav 875/125 mg was administered every 12 h. Clinical, microbiological and laboratory follow up was performed every 2 months during the treatment period. Twenty-one cases of actinomycetoma were included, 19 caused by N. brasiliensis and one each by N. asteroides and N. otitidiscaviarum. Clinical and microbiological cure occurred in 15 of 21 cases (71%); two cases improved (10%) and four failed (19%). Mean treatment period was 9.6 months, during which neither side-effects nor laboratory test alterations were reported. Treatment with co-amoxiclav represents an alternative or rescue treatment for cases that have previously failed standard therapies.

Madura foot due to Actinomadura madurae: Imaging appearance

We report a rare case of actinomycetoma of the foot (madura foot) due to Actinomadura madurae in a patient living in a Temperate Zone country. Plain radiographs and MRI imaging were useful in establishing the diagnosis.

Mycetoma in Yemen: clinicoepidemiologic and histopathologic study.

Mycetoma is widespread in Yemen, but has not been fully documented. A prospective study of 70 patients (53 male, 17 female; from different regions of Yemen) was performed. The clinical profile of the cases was recorded in a special protocol. The diagnosis was based on clinical features, examination of grains, roentgenographic studies, and histopathology (44 cases). Fifty cases were diagnosed as eumycetoma and 20 as actinomycetoma. The identification of the causative species was performed in 44 cases by histopathologic studies. Among the cases of eumycetoma, Madurella mycetomatis was recognized in 27 patients, Leptosphaeria senegalensis in two, and pale-grain fungi in two. Among the cases of actinomycetoma, Streptomyces somaliensis was seen in eight patients, Streptomyces madurae in one, and Nocardia species in four. The treatment of eumycetoma patients with ketoconazole and excision in selected cases controlled the disease activity in the majority. Most of the cases of actinomycetoma were better controlled with drug therapy alone, with a combination of penicillin and cotrimoxazole, or cotrimoxazole alone. Mycetoma is widespread in Yemen, with a higher incidence of eumycetoma and a maximum number of cases from the Hudaida region. A multicenter study is needed to evaluate the exact extent of disease.

Presentation and treatment of actinomycetoma in Tawam Hospital, Al Ain, UAE

Of ten cases of actinomycetoma seen over a period of 12 years at Tawam Hospital, United Arab Emirates, all occurred in adults, of whom eight were males. There were equal numbers of foreign residents and UAE nationals. The main aetiological agent was Streptomyces somaliensis, and the only complication, occurring in six of the ten patients, was bone involvement beneath the skin lesions. Response to surgical and ketoconazole treatment proved to be unsatisfactory while a combination of rifampicin, co-trimoxazole and amikacin produced good results.

Mycetoma: a retrospective study of 41 cases seen in São Paulo, Brazil, from 1978 to 1989.

Clinical and epidemiological aspects of 41 cases of mycetoma seen in São Paulo city from January 1978 to December 1989 are presented. Twenty-eight cases (68%) were caused by actinomycetes, while 13 (32%) were caused by true fungi. In only 22 (78%) actinomycetoma cases was it possible to identify the agent. Nocardia brasiliensis, by far the commonest actinomycete isolated, was responsible for 13 cases. Among eumycetomata, Madurella grisea was isolated from 3 cases, Scedosporium apiospermum from 2 cases, and Madurella mycetomatis from 1 case, and in 7 cases the agent was not identified. Distribution by sex and age was similar to that reported in the literature. Feet and legs were the commonest sites affected. The mean age of actinomycetoma patients was 33.2 years, while patients with eumycetomata were an average of 32.8 years. Mean duration of the disease was 6.8 and 9.8 years respectively. Most patients came from rural areas in the north-eastern region of the country and worked as field labourers. Bone involvement was frequent for both actinomycetomata and eumycetomata and was characterized by osteoporosis, periostal reaction and cavitation. The authors' elected treatment consists of combining sulfamethoxazole (800 mg) and trimethoprim (100 mg) with prednisone (10 mg) orally, daily.

Histological and microbiological aspects of actinomycetoma cases in Venezuela.

A ten year (1976-1986) review study of cases of Actinomycetoma in Venezuela was made through personal interview and clinical examinations, analysis of medical records of patients with actinomycetoma, histological studies of biopsy samples, as well as microbiological studies of isolates strain, also through out personal interviews with researchers and dermatologists who were sources of information on mycetoma cases. A total of 47 cases were recorded. As etiologic agent Actinomadura madurae was found in 20 cases - (42.5%), Nocardia brasiliensis in 13 cases (27.6%), Nocardia spp 7 cases (14.8%), Streptomyces somaliensis in 4 cases (8.5%), N. asteroides in 2 cases (4.2%) and N. otitidis caviarum, (N. caviae) in 1 case (2.1%). Most of the reported cases involved individuals living and working in rural areas, mostly males who outnumber females 4:1. The patients were 18 to 80 years old. A. madurae was reported as the most frequent etiologic agent. Most of the clinical cases were seen when the disease was well established. Twenty four of the forty seven cases reported were observed in Lara State, which represents a 51.0% of all the cases studied.

The second case of mycetoma due to Nocardia caviae in Israel.

A second case of actinomycetoma due to Nocardia caviae contracted in Israel is reported. A 39-year-old female of Yemenite origin, resident in Israel for more than 15 years, presented with a sclerotic tumor mass on the dorsum of the right foot which discharged an oily purulent fluid containing minute yellowish granules. Seen in the microscopic examination of smears were thin Gram-positive filaments and bacillary elements. Culture of the crushed granules yielded small pale colonies identified as Nocardia caviae. In vitro testing of the isolate to various antibiotics, isoniaside and sulphonamides showed the organism to be more sensitive to isoniaside and tetracycline. Isoniaside was administered for one year with marked improvement and was then replaced by tetracycline due to side effects, this treatment still being continued.