trimethoprim--sulfamethoxazole-drug-combination and Cutaneous-Fistula

Mycetoma is a bacteriological or fungal infectious disease affecting the skin and/or soft tissues, which can be complicated by bone involvement. The most common feature is a tumor of the foot, but extrapodal localizations have been described. We report one case of a 47-year-old man who presented with tumefaction of a leg with multiple skin fistulae. Histopathological examination permitted to confirm the diagnosis of actinomycetoma and TDM showed the degree of bone and soft tissues involvement. Our case was characterized by the very inflammatory aspect of the tumor, its localization to the leg without foot involvement, the modest functional signs compared to the importance of radiological bone involvements, the deep destruction of the fibula while the tibia was apparently intact and the good response to treatment. In spite of its characteristic features, diagnosis of mycetoma is still late in our country, often with bone and/or articular spread. Priority may be given to measures for reduction of mycetoma diagnosis lateness.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Bone Diseases, Infectious; Cutaneous Fistula; Delayed Diagnosis; Diclofenac; Humans; Leg; Male; Middle Aged; Mycetoma; Osteolysis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomycetales; Actinomycetales Infections; Actinomycosis; Anti-Bacterial Agents; Ciprofloxacin; Cutaneous Fistula; Diagnosis, Differential; Foot Dermatoses; Foot Ulcer; Guatemala; HIV Seronegativity; Humans; Immunocompetence; Male; Middle Aged; Mycetoma; Nocardia Infections; Osteitis; RNA, Ribosomal, 16S; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

With the increased movement of the world population, acquaintance with the clinical picture of the Madura foot is of growing importance beyond its original endemic areas. The characteristic triad of symptoms consists of indurated swelling, multiple sinus tracts with purulent discharge filled with grains and localization at the foot. An increasing number of new etiologic agents are recognized today. For a better choice of therapy an adequate diagnostic procedure is essential ; a deep biopsy for histology appears to give a more substantial contribution to identification of the causal organism than culture. The treatment which should be started early, is at first essentially a drug treatment. However, in spite of high expectations with regard to new antimycotic drugs, amputation or disarticulation is often inevitable even today, particularly when the lesion is caused by Eumycetes. The first two documented patients with this disease in the Netherlands are described. They developed serious deformities of the lower extremity despite long-term use of antimycotic and antibiotic medication.

Topics: Adult; Aged; Amputation, Surgical; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Biopsy; Cutaneous Fistula; Endemic Diseases; Foot Deformities, Acquired; Foot Diseases; Global Health; Humans; Itraconazole; Ketoconazole; Male; Mycetoma; Netherlands; Suppuration; Trimethoprim, Sulfamethoxazole Drug Combination