Pale Grains Research Articles

Mycetoma in north-western Yemen: Clinico-epidemiological and histopathological study.

Background Mycetoma is widespread in Yemen; however, there are only a few documented reports on the entity from this geographical area. Methods A prospective study of 184 cases of mycetoma (male 145 and female 39) from different regions of north-western Yemen was conducted between July 2000 and May 2014. Clinical profile was recorded in a standardized protocol. The diagnosis was based on clinical features, X-ray studies, examination of grains, and histopathology. Results Eumycetoma was diagnosed in 129, caused by Madurella mycetomatis in 124, Leptosphaeria senegalensis in one and pale grain fungus in four, whereas actinomycetoma occurred in 55, caused by Streptomyces somaliensis in 29, Actinomadura madurai in nine, Actinomadura pelletieri in one, and Nocardia in sixteen. Eumycetoma cases were treated with prolonged course of antifungal drugs, mostly ketoconazole, with itraconazole being used in four patients, along with excision or debulking. Results were better when antifungal drugs were given two to three months before surgery and in those who received itraconazole. Actinomycetoma cases were initially treated with co-trimoxazole monotherapy; later streptomycin was added in 30 cases. Six patients who did not show adequate improvement and two others from the start were treated with modified Welsh regimen and with good results. Limitations Identification of different causative agents was done by histopathology and could not be reconfirmed by culture. Conclusion Mycetoma is widespread in north-western Yemen with a higher incidence of eumycetoma and a majority of the cases were caused by Madurella mycetomatis. Modified Welsh regimen in actinomycetoma and itraconazole with excision in eumycetoma showed the best results.

Eumycetoma Osteomyelitis Calcaneus in Adolescent; report of case and literature review

BackgroundMycetoma is the most common neglected disease in humans. It is a chronic, progressive, and destructive disease primarily caused by fungi or bacteria characterized by formation of dark pale grains commonly involve skin, soft tissue and rarely bone.Case presentationA 19 year old male patient with chronic right ankle pain, swelling and abscess formation for more than 1 year, patient was treated repeatedly with incision and drainage without any success. No X-ray, biopsy or swab for culture and sensitivity had been considered through the course of presentation. Patient was referred to Omdurman hospital where osteomyelitis secondary euomycetoma infection has been confirmed based on radiological and pathological assessment. Patient was treated surgically with aggressive debridement and bone curettage plus postoperative Itraconazole for 1 year.ConclusionClinicians must consider osteomyelitis as important differential diagnosis during initial assessment Eumycetoma infection in adults. Aggressive bone curettage followed by regular X-ray follow up can be limb saving procedure in such cases.

Clinical study on task specific dystonia among beedi workers

Clinical study on task specific dystonia among beedi workers - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/.2018.0010, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Mycetoma: Nonvenereal perineal lesions

Mycetoma is a chronic, granulomatous disease of the skin, and subcutaneous tissue, which sometimes involves muscle, bones, and neighboring organs. It is characterized by tumefaction, abscess formation, and fistulae with discharge of grains from sinuses. Mycetoma can be caused by various species of fungi (eumycetoma) and aerobic actinomycetes (actinomycetoma), which occur as saprophytes in soil or plants. A tentative diagnosis sufficient to initiate treatment may be made on the basis of grain color. For instance, melanoid grains are always caused by fungi and ochroid or pale grains by actinomycetes. Although this is not the thumbrule, there are exceptional reports too. As trauma favors infection, most lesions are on the foot and lower leg but they may occur anywhere on the body mimicking actinomycosis. However, lab investigations and culture are important tool to differentiate apart from the clinical picture. We are reporting atypical case with unusual site of presentation (perineum and thigh) of mycetoma.

Aspergillus Nidulans: A Rare Etiological Agent of Eumycetoma

Mycetomas caused by true fungi are known as eumycetomas. Common causative species are Madurella, Leptosphaeria, Aspergillus, Exophiala, Fusarium, Acremonium, and Scedosporium. Aspergillus nidulans is a rare etiological agent, causing pale grain mycetoma. Only 7 cases of Aspergillus nidulans mycetoma have been reported in literature 1 from India (Rajasthan, 1985), 6 from Africa. We report this case of mycetoma because of the rarity of Aspergillus nidulans as an etiological agent. A 41 year old male shopkeeper presented with multiple painful nodules and discharging sinuses on the right upper extremity since 12 years. The affected limb was swollen and woody hard. There was a single enlarged (3 cm) firm, non-tender right axillary lymph node. There was no fever or other constitutional symptoms. The initial nodule had appeared on the distal right forearm 12 years earlier without preceding trauma. Gradually similar lesions had appeared extending up to the upper arm, breaking down discharging seropurulent material without grains. He had been treated empirically with oral antibiotics and had undergone surgical drainage of the nodules, with temporary relief. Right sided axillary lymph node dissection had been performed 10 years ago; however no organism had been detected. Routine blood investigations were normal. X-ray of the involved extremity showed soft tissue swelling without evidence of bony involvement. Histopathology from a recent discharging nodule showed a mixed inflammatory infiltrate of mononuclear cells, neutrophils, plasma cells and eosinophils along with marked thickening and fibrotic changes in the dermis. Culture from the nodules repeatedly grew Aspergillus nidulans. The patient is currently under treatment with itraconazole and potassium iodide since 1 month and, is responding well.

An ultrastructural study of pale eumycetoma grains.

The electron microscopic appearances of grains from seven patients with pale grain eumycetoma infections have been studied. The infecting fungi were Pseudallescheria boydii (2), Fusarium sp. (1), Acremonium kiliense (1), a non-sporing mould (2) and Trichophyton violaceum (1). P. boydii grown in vitro and grains from a Madurella mycetomatis infection were used for comparison. The most important ultrastructural features of the pale eumycetoma grains were the gross thickening of the fungal cell walls maximal at the periphery of the grain, the predominance of grossly disorganised hyphae and the appearance of cytoplasmic membrane systems. In some areas adjacent cell walls appeared to fuse. These changes may account for some of the well recognised difficulties in isolating organisms from eumycetoma grains and treating the infections with antifungal drugs.

The histopathological features of pale grain eumycetoma

Histological findings in 24 cases of pale grain eumycetoma have been compared. The inflammatory response and morphology of grains caused by different organisms are very similar. However the histological appearances of Neotestudina rosatii infections, although reminiscent of dermatophyte mycetomas, are distinctive. The characteristic features include the presence of cement and the short swollen hyphal segments. Petriellidium boydii grains are more likely to contain numerous vesicles or swollen hyphae and be surrounded by a prominent eosinophilic fringe. In contrast, Fusarium and Acremonium grains usually have a minimal fringe and contain a dense mass of intermeshing hyphae. However the features separating P. boydii and Fusarium/Acremonium grains are not invariable and can only be used as an approximate guide to the correct identity of the organism.