Cruz COF, Vega SDC, Ramírez HL, Arenas GR

Language: Spanish
References: 29
Page: 263-267
PDF size: 176.45 Kb.

ABSTRACT

Background: mycetoma is a chronic inflammatory syndrome which depends on the inoculation of exogenous fungi or actinomycetes. In Mexico it is considered the most frequent deep mycosis. The 98% of all cases are caused by actinomycetes and only 2% by eumycetes. It is related to occupational exposure (farmers and rural workers). The most specific diagnostic method is the analysis of the grains. Treatment depends on the etiological agent. Eumycetoma is treated with antifungals and a combination with surgical procedures may be useful. Actinomycetoma respond to treatment with a broad range of antibiotics.
Objective: determine the epidemiological data of mycetoma patients in the last 30 years.
Methodology: observational, retrospective, cross-sectional, descriptive study of mycetoma patients studied at the Mycology Section of Dr Manuel Gea González General Hospital in the period between January 1987 to December 2017.
Results: data from 174 patients with mycetoma confirmed by mycologic study was obtained. Age ranged from seven to 80 years with an average age of 40 years, 71% of the cases were male, 41.38% were farmers and the most frequently affected region were lower limbs. In 4.83% was associated to type 2 diabetes mellitus. The most frequent etiological agents were Nocardia (54.48%), Actinomadura madurae (17.93%). Also eumycetes (9.66%): Madurella spp. was isolated in 2.76%, Acremonium spp. 1.38% and Pseudallescheria spp. 1.38%. Nocardia brasiliensis was identified by casein hydrolysis and molecular techniques in 15 cases.
Conclusions: a mycetoma diagnosis should be considered for patients presenting chronic granulomatose disease, fistulae and pseudonodules. Mycetoma is an important neglected disease and healthcare professionals should be trained to diagnose and treat this pathology in a timely manner.

REFERENCES

1. Arenas R, Micología médica ilustrada, 5ª ed., México, McGraw-Hill, 2014, pp.137-58.

2. Arenas R, Dermatología: atlas, diagnóstico y tratamiento, 6ª ed., México, McGraw-Hill, 2015, pp. 522-33.

3. Nenoff P, Van de Sande WW, Fahal AH, Reinel D y Schöfer H, Eumycetoma and actinomycetoma. An update on causative agents, epidemiology, pathogenesis, diagnostics and therapy, J Eur Acad Dermatol 2015; 29:1873-83.

4. Nazarro G y Veraldi S, Mycetomas: the experience of the Dermatology Unit of the University of Milan, Dermatopathology 2018; 5(1):6-9.

5. López-Martínez R, Méndez-Tovar LJ, Bonifaz A, Arenas R, Mayorga J, Welsh O et al., Update on the epidemiology of mycetoma in Mexico. A review of 3 933 cases, Gac Med Mex 2013; 149(5):586-92.

6. López-Martínez R, Mendez Tovar LJ, Lavalle P, Welsh O, Saul A y Macotela Ruiz E, Epidemiology of mycetoma in Mexico: study of 2 105 cases, Gac Med Mex 1992; 128(4):477-81.

7. Lavalle P, New data on the etiology of mycetoma in Mexico and on its pathogenesis, Gac Med Mex 1966; 96(6):545-74.

8. Zijlstra EE, Van de Sande WW, Welsh O, Mahgoub ES, Goodfellow M y Fahal AH, Mycetoma: a unique neglected tropical disease, Lancet Infect Dis 2016; 16(1):100-12.

9. Zaias N, Taplin D y Rebell G, Mycetoma, Arch Dermatol 1969; 99(2): 215-25.

10. Welsh O, Vera-Cabrera L y Salinas-Carmona MC, Mycetoma, Clin Dermatol 2007; 25(2):195-202.

11. Fahal AH, Rahman IA, El-Hassan AM, El-Rahman ME y Zijlstra EE, The safety and efficacy of itraconazole for the treatment of patients with eumycetoma due to Madurella mycetomatis, Trans R Soc Trop Med Hyg 2011; 105(3):127-32.

12. Kloezen W, Meis JF, Curfs-Breuker I, Fahal AH y Van de Sande WW, In vitro antifungal activity of isavuconazole against Madurella mycetomatis, Antimicrob Agents Chemother 2012; 56(11):6054-6.

13. Ramam M, Bhat R, Garg T, Sharma VK, Ray R, Singh MK et al., A modified two-step treatment for actinomycetoma, Indian J Dermatol Venereol Leprol 2007; 73(4):235-9.

14. Bonifaz A, Vázquez-González D y Perusquía-Ortiz AM, Subcutaneous mycoses: chromoblastomycosis, sporotrichosis and mycetoma, J Dtsch Dermatol Ges 2010; 8(8):619-27; quiz 628.

15. Mencarini J, Antonelli A, Scoccianti G, Bartolini L, Roselli G, Capanna R et al., Madura foot in Europe: diagnosis of an autochthonous case by molecular approach and review of the literature, New Microbiol 2016; 39(2):156-9.

16. Vera-Cabrera L, Salinas-Carmona MC, Waksman N, Messeguer-Pérez J, Ocampo-Candiani J y Welsh O, Host defenses in subcutaneous mycoses, Clin Dermatol 2012; 30(4):382-8.

17. Mahgoub ES, Gumaa SA y El Hassan AM, Immunological status of mycetoma patients, Bull Soc Pathol Exot Filiales 1977; 70(1):48-54.

18. Malone M, Gannass A y Bowling F, A chronic, destructive mycetoma infection in a diabetic foot in Saudi Arabia, Int J Low Extrem Wounds 2011; 28(10):12-5.

19. Kotwal N, Yanamandra U, Badwal S y Nair V, Mycetoma foot caused by Aspergillus in a diabetic patient, Intern Med 2012; 51(5):517-8.

20. Adam S, Geyer MD y Lindy P, Acremonium mycetoma in a heart transplant recipient, J Am Acad Dermatol 2006; 55(6):1095-100.

21. Padhi S, Uppin SG, Uppin MS, Umabala P, Challa S, Laxmi V et al., Mycetoma in South India: retrospective analysis of 13 cases and description of two cases caused by unusual pathogens: Neoscytalidium dimidiatum and Aspergillus flavus, Int J Dermatol 2010; 49(11):1289-96.

22. Bonifaz A, Tirado-Sánchez A, Calderón L, Saúl A et al., Mycetoma: experience of 482 cases in a Single Center in Mexico, plos Negl Trop Dis 2014; 8(8):e3102.

23. Arenas R, Vega E y Rangel G, Eumycetoma: present status and perspective, Gac Med Mex 2017; 153:761-70.

24. Amhed S, González G, Tirado Sánchez A, Moreno L, De Hoog S y Bonifaz A, Nigrograna mackinnonii, not Trematosphaeria grisea (syn., Madurella grisea), is the main agent of black grain eumycetoma en Latin America, J Clin Microbiol, 2018; 56(3):e01723-27.

25. Estrada R, Chávez-López G, Estrada-Chávez G, López-Martínez R y Welsh O, Eumycetoma, Clin Dermatol 2012; 30(4):389-96.

26. Fahal A, Mahgoub ES, El Hasan AM et al., A new model for managementof mycetoma in the Sudan, plos Negl Trop Dis 2014; 8:e3271.

27. Tovar A, Barrientos J y Mayorga J, Micetoma en pacientes pediátricos. Reporte de 19 casos, Dermatol Rev Mex 2015; 59:189-194.

28. Ahmed AO, Van Leeuwen W, Fahal A, Van de Sande WW, Verbrugh H et al., Mycetoma caused by Madurella mycetomatis: a neglected infectious burden, Lancet Infect Dis 2004; 4:566-74.

29. Van Belkum A, Fahal A y Van de Sande W, Mycetoma caused by Madurella mycetomatis: a completely neglected medico-social dilemma, Adv Exp Med Biol 2013; 764:179-89.