trimethoprim--sulfamethoxazole-drug-combination and Mycetoma

Mycetoma are chronic subcutaneous infections, endemic in dry tropical regions. It can be caused either by actinomycetes or by fungi, presenting as filamentous grains in vivo. The foot is the most common localization. The main complication is osseous involvement. Patients are rural workers living in areas situated far from medical centers. Too often, they reach well-equipped hospitals with advanced mutilating lesions. Early case detection is the first condition for good therapeutic results. Clinical presentations of actinomycetoma and eumycetoma are similar, only biological diagnosis can distinguish the two etiological forms. This distinction is essential as medical therapy for each is radically different. Precise identification of the causal agent is required for targeted treatment but it can only be realized in rare specialized laboratories. For actinomycetoma, standard therapy is trimethoprim-sulphamethoxazole (STX). Duration of treatment period is one-year minimum. In case of poor response to STX or high risk of dissemination, a combination with amikacin gave high cure rate. Other options as amoxicillin-clavulanate are available. Medical cure of actinomycetoma is generally obtained with antibiotic treatments and surgical indications are exceptional. Disappointing results were observed using antifungal in the treatment of eumycetoma and medical therapy must be completed with surgical excision. Itraconazole is now the most used drug, new triazoles are on evaluation.

Topics: Actinobacteria; Antifungal Agents; Chronic Disease; Humans; Itraconazole; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination

"Mycetoma" means a fungal tumor. Mycetoma is a chronic, granulomatous, subcutaneous tissue infection caused by both bacteria (actinomycetoma) and fungi (eumycetoma). This chronic infection was termed Madura foot and eventually mycetoma, owing to its etiology. Inoculation commonly follows minor trauma, predominantly to the foot and hence is seen more among the barefoot-walking populations, common among adult males aged 20 to 50 years. The hallmark triad of the disease includes tumefaction, fistulization of the abscess, and extrusion of colored grains. The color of these extruded grains in the active phase of the disease offers a clue to diagnosis. Radiology, ultrasonology, cytology, histology, immunodiagnosis, and culture are tools used in diagnosis. Recently, DNA sequencing has also been used successfully. Though both infections manifest with similar clinical findings, Actinomycetoma has a rapid course and can lead to amputation or death secondary to systemic spread. However, actinomycetomas are more responsive to antibiotics, whereas eumycetomas require surgical excision in addition to antifungals. Complications include secondary bacterial infections that can progress to full-blown bacteremia or septicemia, resulting in death. With extremely disfiguring sequelae, following the breakdown of the nodules and formation of discharging sinuses, it poses a therapeutic challenge.

Topics: Actinomycetales Infections; Actinomycosis; Amikacin; Anti-Bacterial Agents; Humans; Mycetoma; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic, localized, slowly progressing infection of the cutaneous and subcutaneous tissues caused either by fungi (eumycetoma or implantation mycosis) or by aerobic actinomycetes (actinomycetoma). It is acquired by traumatic implantation, most commonly in the tropics and subtropics, especially in rural agricultural communities. Although well recognized elsewhere in Asia, it has not been reported from the Lao People's Democratic Republic (Laos).. A 30 year-old female elementary school teacher and rice farmer from northeast Laos was admitted to Mahosot Hospital, Vientiane, with a massive growth on her left foot, without a history of trauma. The swelling had progressed slowly but painlessly over 5 years and multiple draining sinuses had developed. Ten days before admission the foot had increased considerably in size and became very painful, with multiple sinuses and discharge, preventing her from walking. Gram stain and bacterial culture of tissue biopsies revealed a branching filamentous Gram-positive bacterium that was subsequently identified as Actinomadura madurae by 16S rRNA gene amplification and sequencing. She was treated with long-term co-trimoxazole and multiple 3-week cycles of amikacin with a good therapeutic response.. We report the first patient with actinomycetoma from Laos. The disease should be considered in the differential diagnosis of chronic skin and bone infections in patients from rural SE Asia.

Topics: Actinomycetales; Adult; Amikacin; Anti-Bacterial Agents; Biopsy; Cluster Analysis; DNA, Bacterial; DNA, Ribosomal; Female; Foot; Humans; Laos; Mycetoma; Phylogeny; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic granulomatous disease caused by bacteria or true fungi. It affects the skin the underlying tissue and sometimes subjacent bones and organs. The diagnosis of the disease is confirmed by the microscopic identification and by isolating the infecting agent. Actinomycetoma are treated with trimethoprim-sulfamethoxazole and/or diamino-diphenyl-sulfona (DDS). In patients resistant to these treatments adding amikacin cures about 95% of the resistant cases. In true fungi mycetoma, amphotericin B, ketoconazole, itraconazole, and in some cases these combined with surgery is the treatment of choice.

Topics: Amikacin; Antifungal Agents; Combined Modality Therapy; Dapsone; Drug Therapy, Combination; Female; Humans; Incidence; Male; Mycetoma; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma has a worldwide geographical distribution which is extremely uneven; however, it is a common disease in India and responsible for causing significant morbidity. Treatment of this condition is often a challenge for the treating dermatologist. The authors report a promising therapy for patients of actinomycotic mycetoma.. This assessment series included 18 patients with a confirmed diagnosis of actinomycetoma, and who had shown a poor response to previous treatments. Patient received a combination therapy of the Welsh regimen (amikacin along with cotrimoxazole) to which rifampicin was added as a third drug. Clinical evaluation included radiology and laboratory investigations.. Sixteen patients out of 18 completed the combination therapy, which lead to remission. Two patients were lost to follow-up. Of the 16 patients in remission, no recurrence was observed during a follow-up period of up to 18 months.

Topics: Adult; Amikacin; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mycetoma; Prospective Studies; Remission Induction; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report the excellent therapeutic response obtained with amikacin alone and in combination with trimethoprim-sulfamethoxazole in the treatment of 15 patients with actinomycotic mycetoma who had a poor response to the traditional pharmacologic agents and/or in whom important organs such as lungs, spinal cord, and bone were involved. We evaluated the results by clinical, radiologic, and laboratory tests. No important side effects were detected during or after the therapy.

Topics: Adult; Amikacin; Anti-Bacterial Agents; Clinical Trials as Topic; Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Mycetoma; Nocardia; Prospective Studies; Remission Induction; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic granulomatous inflammatory disease that affects the cutaneous and subcutaneous tissues, leading to gruesome complications if not treated early. As a neglected disease, it has received scant attention in developing curable drugs. Mycetoma treatment is still based on expert opinions in the absence of guidelines.. This descriptive, cross-sectional, hospital-based study aimed to determine and assess the disease treatment outcomes observed at Mycetoma Research Center, Sudan.. In this study, 75% of patients had eumycetoma, all of whom were treated with itraconazole and 37.4% underwent surgical excision, while 25% of the patients had actinomycetoma, 99.2% of whom were treated with a combination of cotrimoxazole and amoxicillin-clavulanate. The cure rate was 12.7% and 14.3% for patients with eumycetoma and actinomycetoma, respectively. Only 6.1% of eumycetoma patients underwent amputation. Remarkably, no patient with actinomycetoma underwent an amputation. Small lesions (OR=10.09, p<0.001) and good follow-up (OR=6.81, p=0.002) were positive predictors of complete cure. In terms of amputation, history of surgical recurrence at presentation (OR=3.67, p=0.020) and presence of grains (OR=7.13, p=0.012) were positive predictors, whereas small lesions were negative predictors (OR=0.06, p=0.009).. Treatment of mycetoma was suboptimal, with a low cure rate despite a long treatment duration. Complete cure has a significant association with small lesions and good follow-up.

Topics: Chronic Disease; Cross-Sectional Studies; Humans; Mycetoma; Sudan; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a neglected tropical chronic granulomatous inflammatory disease of the skin and subcutaneous tissues. More than 70 species with a broad taxonomic diversity have been implicated as agents of mycetoma. Understanding the full range of causative organisms and their antibiotic sensitivity profiles are essential for the appropriate treatment of infections. The present study focuses on the analysis of full genome sequences and antibiotic inhibitory concentration profiles of actinomycetoma strains from patients seen at the Mycetoma Research Centre in Sudan with a view to developing rapid diagnostic tests. Seventeen pathogenic isolates obtained by surgical biopsies were sequenced using MinION and Illumina methods, and their antibiotic inhibitory concentration profiles determined. The results highlight an unexpected diversity of actinomycetoma causing pathogens, including three Streptomyces isolates assigned to species not previously associated with human actinomycetoma and one new Streptomyces species. Thus, current approaches for clinical and histopathological classification of mycetoma may need to be updated. The standard treatment for actinomycetoma is a combination of sulfamethoxazole/trimethoprim and amoxicillin/clavulanic acid. Most tested isolates had a high IC (inhibitory concentration) to sulfamethoxazole/trimethoprim or to amoxicillin alone. However, the addition of the β-lactamase inhibitor clavulanic acid to amoxicillin increased susceptibility, particularly for Streptomyces somaliensis and Streptomyces sudanensis. Actinomadura madurae isolates appear to have a particularly high IC under laboratory conditions, suggesting that alternative agents, such as amikacin, could be considered for more effective treatment. The results obtained will inform future diagnostic methods for the identification of actinomycetoma and treatment.

Topics: Amoxicillin; Anti-Bacterial Agents; Clavulanic Acid; Humans; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination

Botryomycosis is a rare chronic granulomatous inflammatory disease of bacterial origin. Two forms of the disease exist; the cutaneous and the visceral form. The subcutaneous form mimics actinomycetoma clinically and histologically; however, the treatment is different. In this communication, we report on a Sudanese male patient who presented with foot botryomycosis.. Case report.. The patient was initially diagnosed with actinomycetoma by the presence of Streptomyces somaliensis like-grains in the histological slides. The patient was treated with a combination of co-trimoxazole and amikacin sulfate and shifted after 1 year to co-trimoxazole, amoxicillin, and clavulanic acid. Despite treatment, the infection progressed, and the bone was invaded. The infected limb was amputated. The histopathological report of the surgical biopsy showed gram-positive cocci inside the grain. The 16S sequence identified these cocci as Staphylococcus aureus.. This is the first reported botryomycosis case from Sudan, and it highlights why molecular identification is vital in diagnosis.

Topics: Humans; Male; Mycetoma; Staphylococcal Infections; Staphylococcus aureus; Sudan; Trimethoprim, Sulfamethoxazole Drug Combination

Actinomycetoma is a chronic granulomatous disease affecting skin, subcutaneous tissue, fascia, muscle and bones. With increasing resistance against commonly used treatment regimens, susceptibility testing is urgently needed.. We developed an in vitro susceptibility assay for Actinomadura madurae, one of the common causative agents of actinomycetoma, employing resazurin for endpoint reading. Using this assay, reproducible MICs were determined for the most commonly used antibacterial agents for actinomycetoma treatment. The tested antibacterial agents included trimethoprim/sulfamethoxazole, amikacin, streptomycin, amoxicillin, ceftriaxone, gentamicin, ciprofloxacin, doxycycline, imipenem, linezolid, penicillin G and rifampicin.. Following the clinical breakpoints as stated by CLSI, 100% of the tested strains were susceptible to trimethoprim/sulfamethoxazole (MIC 0.03/0.59-1/19 mg/L), amikacin (MIC 0.0078-0.25 mg/L), doxycycline (MIC <0.25-1 mg/L) and linezolid (MIC <0.25-2 mg/L), 90% to ciprofloxacin (MIC <0.25-2 mg/L), 80% to ceftriaxone (MIC <0.5 to >64 mg/L) and imipenem (MIC <0.25-32 mg/L) and only 20% to amoxicillin (MIC <0.5 to >64 mg/L) and rifampicin (MIC 0.5 to >32 mg/L).. Determinations of MICs by visual readings of colour changes versus spectrophotometric readings were comparable. This convenient visual reading has the advantage of feasible implementation in endemic settings.

Topics: Amikacin; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Doxycycline; Humans; Ifosfamide; Imipenem; Linezolid; Microbial Sensitivity Tests; Mycetoma; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Actinomycetoma due to. We aimed to evaluate the clinical-therapeutic characteristics of patients with actinomycetoma due to. This was a retrospective study of eighteen patients with a diagnosis of actinomycetoma. The most widely used therapeutic scheme was streptomycin 1 g every third day plus TMP/SMX 800 mg/160 mg/12h, followed by TMP/SMX with DDS 100 mg/day. In six patients (33%), ciprofloxacin 500 mg every 12 h was used instead of DDS.. Conventional scheme achieved clinical and mycological cure in 58% of the cases, improvement in 16%, and 25% of the patients failed to treatment; in the cases treated with ciprofloxacin, clinical and microbiological cure was achieved in 83% of patients and clinical improvement in 16%. The treatment time to achieve clinical and mycological did not have a statistically significant difference (median 10 ± 1.38 vs. 12 ± 4.6).. Treatment based on streptomycin + TMP/SMX with ciprofloxacin was found to be effective in treating patients with actinomycetoma, and comparable to the conventional treatment with DDS in actinomycetoma due to

Topics: Actinomadura; Humans; Mycetoma; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic granulomatous subcutaneous infection caused by anaerobic pseudofilamentous bacteria or fungi. It is commonly prevalent in tropical and subtropical countries. Men are more susceptible to the disease due to greater participation in agricultural works. Mycetoma commonly involves lower extremities, wherein untreated cases lead to aggressive therapeutic choices, such as amputation of the affected body organs and consequently lifelong disability.. In this report, we present the rare case of a 58-year-old man, originally from Algeria with a left foot chronic tumefaction of 5 years. In the initial clinical examination, mycetoma was diagnosed based on tumefaction and the presence of multiple sinuses with the emission of white grains. The latter was observed via direct examination. The histopathological analysis demonstrated an actinomycetoma caused by bacteria, as the etiological agent. Imaging showed a bone involvement with osteolysis at the levels of 2nd to 4th metatarsal diaphysis. The mycological and bacterial cultures were both negative. For an accurate diagnosis, the obtained grains were subjected to molecular analysis, targeting the 16S-rDNA gene. Molecular identification yielded Actinomadura madurae as the causal agent, and 800/160 mg of trimethoprim/sulfamethoxazole was prescribed twice a day for 1 year, as a treatment.. Considering low information about this disease, especially in non-endemic areas, it is of high importance to enhance the knowledge and awareness of clinicians and healthcare providers, in particular in the countries with immigration issues.

Topics: Actinobacteria; Actinomadura; Algeria; Anti-Bacterial Agents; DNA, Ribosomal; Emigrants and Immigrants; Foot; Humans; Male; Middle Aged; Mycetoma; Paris; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Antineoplastic Agents; Humans; Immunocompromised Host; Lymphoma; Male; Mycetoma; Nocardia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Accidents, Traffic; Anti-Infective Agents; Child; Dapsone; Drug Therapy, Combination; Humans; Male; Motorcycles; Mycetoma; Nocardia; Nocardia Infections; Ribotyping; Thoracic Injuries; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

Topics: Anti-Bacterial Agents; beta-Lactams; Drug Therapy, Combination; Humans; Linezolid; Male; Microbial Sensitivity Tests; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination

We present the case of an actinomycotic mycetoma of the foot due to Actinomycetes viscosus. It evolved for nine years on the foot of a 26-year-old patient from a rural environment: Douar Inezgane (city in southern Morocco). Bacteriological study of the skin and grains confirmed the diagnosis. It showed positive bacilli on direct examination and on Gram staining and in positive culture. Histological study showed a polymorphous granulomatous inflammation without signs of malignancy with actinomycotic grains. Then we retained the diagnosis of primary cutaneous actinomycosis without visceral locations. The treatment was based on antibiotics: penicillin G by intravenous infusion for five weeks, relayed orally by amoxicillin associated with trimethoprim-sulfamethoxazole for long periods. After six months of treatment, we observed a favorable outcome with reduction of the swelling, nodules, lymphadenopathy, fistula's number and extension of time of issue of grains. The current follow up is 15 months. The primary cutaneous actinomycosis is still relevant in Morocco.

Topics: Actinomyces viscosus; Actinomycosis; Adult; Anti-Bacterial Agents; Foot Dermatoses; Humans; Male; Morocco; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amikacin; Diagnosis, Differential; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mobility Limitation; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination; Wheelchairs

Mycetoma is a neglected, chronic, localized, progressively destructive, granulomatous infection caused either by fungi (eumycetoma) or by aerobic actinomycetes (actinomycetoma). It is characterized by a triad of painless subcutaneous mass, multiple sinuses and discharge containing grains. Mycetoma commonly affects young men aged between 20 and 40 years with low socioeconomic status, particularly farmers and herdsmen.. A 30 year-old male farmer from an ethnic minority in Phin District, Savannakhet Province, Lao PDR (Laos) developed a painless swelling with multiple draining sinuses of his right foot over a period of approximately 3 years. X-ray of the right foot showed osteolysis of tarsals and metatarsals. Aerobic culture of sinus discharge yielded large numbers of Staphylococcus aureus and a slow growing Gram-positive rod. The organism was subsequently identified as Nocardia aobensis by 16S ribosomal RNA gene sequencing. The patient received antimicrobial treatment with amikacin and trimethoprim-sulfamethoxazole according to consensus treatment guidelines. Although slight improvement was noted the patient left the hospital after 14 days and did not take any more antibiotics. Over the following 22 weeks the swelling of his foot subsequently diminished together with healing of discharging sinuses.. This is the first published case of Actinomycetoma caused by Nocardia aobensis and the second case of Actinomycetoma from Laos. A treatment course of only 14 days with amikacin and trimethoprim-sulfamethoxazole was apparently sufficient to cure the infection, although long-term treatment up to one year is currently recommended. Treatment trials or prospective descriptions of outcome for actinomycetoma should investigate treatment efficacy for the different members of Actinomycetales, particularly Nocardia spp., with short-term and long-term treatment courses.

Topics: Adult; Amikacin; Anti-Bacterial Agents; Foot Diseases; Humans; Laos; Male; Mycetoma; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

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: Actinomyces; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Male; Mycetoma; Penicillin G Benzathine; Rifampin; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic skin and soft tissue infection encountered in the dry tropical regions and are caused by fungi (eumycetoma) or bacteria (actinomycetoma).. A 25-year-old man consulted at the hospital on Mayotte Island for a left knee injury sustained 10 years earlier in a motorcycle accident with broken skin occurring in Anjouan in the Comoro Islands. Clinical and histological diagnosis of mycetoma was made, and in the absence of microbiological diagnosis, empirical antifungal therapy was initiated. Given the poor outcome, new biopsies were performed and resulted in the identification of Nocardia otitidiscaviarum. More than 1 year later, the patient had fully recovered and after administration of several and extended antibiotic courses including cotrimoxazole and linezolid.. Bacterial mycetomas are usually described in semi-arid regions and the occurrence of this disease is unexpected in humid tropical areas such as the Comoro Islands. N. otitidiscaviarum is rarely involved in this infection, particularly in Africa.

Topics: Accidents, Traffic; Acetamides; Adult; Anti-Infective Agents; Comoros; Humans; Knee; Knee Injuries; Linezolid; Male; Mycetoma; Nocardia; Oxazolidinones; Skin; Trimethoprim, Sulfamethoxazole Drug Combination; Tropical Climate

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

We report the first documented case of a mycetoma caused by Nocardia yamanashiensis after the initial description of this species. The 16S-rRNA gene sequence analysis was used to identify the novel species, which showed a similarity of 99.9% to the gene sequence of the type strain. The case showed both clinical non-response and reduced susceptibility in vitro to amoxicillin plus clavulanate, and it was treated successfully with trimethoprim-sulfamethoxazole and doxycycline. Given antibiotic resistance concerns, we suggest that antimicrobial susceptibility testing should be done for the majority of Nocardia species without well-established resistance patterns.

Topics: Administration, Oral; Adult; Amoxicillin; Anti-Bacterial Agents; Clavulanic Acid; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Male; Mycetoma; Nocardia; Papua New Guinea; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic, granulomatous, subcutaneous, inflammatory lesion caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Mycetoma commonly affects young people between 20 and 40 years old. The most common affected site is the foot. The characteristic clinical triad is tumefaction, draining sinuses and discharging grains. We report a healthy 31-year-old male, with a 6-year history of a progressive inflammatory tumor associated with sinus tracts and granules on his left sole. Actinomycetoma was suspected. The clinical diagnosis was confirmed by microbiological and histopathological study. Polymerase chain reaction and DNA sequencing identified Actinomadura madurae. To our knowledge, this is the second case of mycetoma reported in Chile. Our report emphasizes the need to consider this diagnosis in patients with chronic granulomatous disease associated with sinus tracts, fistulas and grains.

Topics: Actinomycetales Infections; Adult; Anti-Bacterial Agents; Biopsy; Foot Dermatoses; Humans; Male; Mycetoma; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic granulomatous infection of the subcutaneous tissue caused by fungi or fungus-like bacteria. The infection eventually spreads to bone resulting in significant morbidity. Rarely, viscera may be involved through contiguous spread. It is common in tropical countries like India, though disease is worldwide in distribution. A 22-year-old male patient, a farmer by occupation, presented with multiple discharging sinuses over the left chest wall, shoulder, upper arm, and adjacent neck of eight months duration. A diagnosis of actinomycetoma was made based on clinical and histopathological features as culture was negative for both fungus and bacteria. The patient was treated with a modified two-step regimen. It consisted of an intensive phase with intravenous gentamicin 80 mg 12th hourly and cotrimoxazole 320/1600 mg twice daily orally for four weeks. This was followed by a maintenance phase with oral cotrimoxazole and doxycycline 100 mg twice daily. Patient showed excellent response with healing of all sinuses after two months of therapy. Involvement of covered parts of the body such as chest wall and shoulders is common in actinomycetoma compared to eumycetoma. Early institution of long-term combination therapy with antimicrobials results in excellent outcome.

Topics: Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents; Chronic Disease; Doxycycline; Drug Therapy, Combination; Gentamicins; Humans; Infusions, Intravenous; Male; Mycetoma; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Adult; Anti-Infective Agents; Diagnosis, Differential; Female; Fingers; Hand Dermatoses; Humans; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is chronic inflammatory process characterized by areas of tumefaction with draining sinus tracts. It affects the foot in 80% of cases. The purpose of this report is to describe a case that posed a diagnostic challenge due to unusual scalp location and clinical presentation.. A 23-year-old woman residing in a rural zone of Senegal consulted for indolent lesions ongoing on the scalp for 2 years. Physical examination showed two soft tumid lesions measuring about 3 cm in diameter on the vertex. The surface of the lesions was crusty but showed no sign of granules. Skull x-ray was normal. Skin biopsy demonstrated a polymorphous granulomatous infiltrate with foci of suppuration circumscribing small, irregular grains with radiating filaments. Mycological culture on Lowenstein medium demonstrated Actinomadurella pelletiere. Treatment with cotrimoxazole for 8 months led to significant regression of the lesions.. The mycetoma described in this report posed a diagnostic challenge because of its unusual scalp location and especially its tumoral or pseudo-cystic presentation. This clinical form of mycetoma must be taken into account for diagnosis in any patient from endemic areas.

Topics: Actinomycetales; Actinomycetales Infections; Adult; Anti-Infective Agents; Female; Humans; Mycetoma; Scalp Dermatoses; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Actinomycetoma is the most frequent type of mycetoma in Mexico. Localization on the scalp is very rare. Because of this topography and potential spread to the brain, the present case became a diagnostic and therapeutic challenge.. We report the case of a 44-year-old woman with a 6 × 5 cm red, friable, granulomatous, vascular neoformation on the scalp and eye diagnosed as Nocardia brasiliensis actinomycetoma.. A combination of amikacin and oral trimethoprim-sulfamethoxazole (SXT) was successfully administered with an excellent outcome and no side effects.. This is a rare presentation of mycetoma of the scalp that was cured in 12 weeks with a combination of amikacin and SXT.

Topics: Accidents, Traffic; Adult; Anti-Infective Agents; Eye Infections, Bacterial; Female; Humans; Mexico; Mycetoma; Nocardia Infections; Scalp Dermatoses; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomycetales; Actinomycetales Infections; Anti-Bacterial Agents; Anti-Infective Agents; Drug Therapy, Combination; Female; Foot Dermatoses; Humans; Middle Aged; Mycetoma; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Agricultural Workers' Diseases; Amikacin; Anti-Bacterial Agents; Debridement; Female; Humans; Mycetoma; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Actinomycetomas are chronic, granulomatous, subcutaneous infections caused by actinomycetes bacteria. Despite prolonged high-dose and combination antibiotic therapies, some cases remain resistant with risks of bone and visceral involvement.. We sought to evaluate the efficacy and safety of imipenem monotherapy, and in combination with amikacin for the treatment of severe and refractory disease, and to identify the disease characteristics that might predict therapy failure with first-line sulfonamides.. A retrospective study was performed of all microbiologically confirmed cases of actinomycetomas treated since 1995 at a tertiary center for mycology. Eleven patients (Nocardia, n = 10) were treated with sulfonamide combinations (trimethoprim/sulfamethoxazole and dapsone). Eight patients (Nocardia, n = 7) refractory to previous therapies including sulfonamides received a 3-week course of either parenteral imipenem monotherapy (1.5 g daily, n = 3) or combination therapy with amikacin (1 g daily, n = 5), which was repeated at 6-month intervals.. Eleven patients with limited disease and mean disease duration of 1.7 years responded successfully to sulfonamides after a mean treatment period of 15 months (range 6-48 months). Patients receiving imipenem had mean disease duration of 10 years, with visceral and bone involvement in 4 patients. Imipenem treatment was well tolerated, and 4 patients achieved clinical and microbiological cure after one to two courses of treatment, the others demonstrating greater than 75% clinical improvement and negative culture results.. Patient cohorts in this study were small because strict criteria for inclusion included species identification and adequate follow-up periods. The efficacy data for imipenem +/- amikacin therapy cannot be extrapolated to all Nocardia mycetomas, as the cohort treated in this study had particularly refractory infection.. Sulfonamides are effective for limited disease of relatively short duration. Imipenem monotherapy or in combination with amikacin is well tolerated and demonstrates efficacy in severe disease refractory to sulfonamides.

Topics: Adolescent; Adult; Aged; Amikacin; Dapsone; Drug Combinations; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Humans; Imipenem; Male; Middle Aged; Mycetoma; Nocardia; Sulfonamides; Trimethoprim, Sulfamethoxazole Drug Combination

A 29-year-old woman presented with multiple painful swelling with discharging sinuses over the scalp. Histopathological examination of the biopsy tissue was suggestive of actinomycotic mycetoma. Streptomyces spp. was isolated from blood culture. The patient was successfully treated with trimethoprim-sulfamethoxazole and crystalline penicillin. This case is reported because of the rare occurrence of bacteremia by Streptomyces spp. secondary to subcutaneous actinomycotic mycetoma. Moreover, an interesting association between successive two pregnancies and occurrence of mycetoma of the scalp was observed in this case.

Topics: Actinomycetales Infections; Adult; Animals; Anti-Bacterial Agents; Bacteremia; Blood; Female; Humans; Mycetoma; Penicillins; Sinusitis; Skin Diseases, Bacterial; Streptomyces; Trimethoprim, Sulfamethoxazole Drug Combination

A 45-year-old male presented with history of multiple swellings over the foot with sinuses discharging seropurulent pus. Actinomadura madurae was demonstrated and identified by microbiological culture from the pus obtained directly of the lesion. This case is reported to emphasize the importance of laboratory diagnosis in the management and assessment of the prognosis of such cases.

Topics: Actinomycetales; Anti-Infective Agents; Dapsone; Drug Therapy, Combination; Foot Dermatoses; Gentian Violet; Humans; India; Male; Middle Aged; Mycetoma; Phenazines; Rifampin; Suppuration; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia, Actinomyces, and Streptomyces species comprise the three broad classes of organisms that are causative for bacterial mycetoma. Although culture and molecular laboratory studies can usually identify the precise etiologic agent in bacterial mycetoma, occasionally these methods fail to clarify this situation. We report a classic clinical case of this infectious disease where usual diagnostic methods failed to identify the responsible organism, and discuss the empiric approach to such cases.

Topics: Anti-Bacterial Agents; Emigrants and Immigrants; False Negative Reactions; Forearm; Humans; Male; Microbiological Techniques; Middle Aged; Mycetoma; Nocardia; Skin; Trimethoprim, Sulfamethoxazole Drug Combination

We describe the case of a 14-year-old girl with Down syndrome and a large cutaneous plaque localized to the right neck and shoulder that had enlarged over five years after a minor traumatic injury. The plaque was characterized by numerous inflammatory nodules and fistulae that secreted purulent discharge. Nocardia grains were identified and Nocardia brasiliensis was identified by culture. Histopathology examination showed a chronic inflammatory infiltrate with granuloma development. The treatment scheme was with Diaminodiphenylsulfone 50/mg/d and Trimethoprim-Sulfamethoxazole 800/160 mg BID. Therapy was continued over 1(1/2) years, with a tapering dose. After 2(1/2) years of continuous treatment, clinical and microbiological healing was achieved.

Topics: Adolescent; Dapsone; Diagnostic Errors; Down Syndrome; Edible Grain; Female; Granuloma; Humans; Mycetoma; Neck; Nocardia; Nocardia Infections; Plant Shoots; Shoulder Injuries; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Cutaneous; Wound Infection

Mycetoma is a chronic infection that affects skin, subcutaneous tissue and bone. Its etiology can be mycotic or bacterial. It affects mainly the lower extremities of middle age men living in tropical climates. We report a 44-year-old male living in a template zone, consulting for swelling and pain in the left foot, lasting for 10 years. Physical examination showed a swollen left foot with hyperpigmented skin and a few crusted papules. Radiology showed an extensive bone involvement of the midfoot with several oval and radiolucid images. Magnetic resonance showed soft and bone tissue involvement, with multiple oval and low intensity images in T1 and T2. The biopsy was compatible with an unspecific chronic osteomyelitis. A bacterial identiFcation by polymerase chain reaction and sequencing in the biopsy determined the presence of an Actinomadumra madurae. Treatment with cotrimaxazol was started.

Topics: Actinomycetales; Adult; Anti-Infective Agents; Foot Dermatoses; Humans; Male; Mycetoma; Polymerase Chain Reaction; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acremonium; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Brazil; Female; Humans; Itraconazole; Madurella; Male; Middle Aged; Mycetoma; Nocardia; Rural Population; Streptomyces; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Back; Humans; Iatrogenic Disease; Mycetoma; Neck; Nocardia Infections; Skin Diseases, Bacterial; Sulfonamides; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Injuries; Agricultural Workers' Diseases; Anti-Bacterial Agents; Argentina; Ciprofloxacin; Drug Therapy, Combination; Endemic Diseases; Humans; Male; Middle Aged; Mycetoma; Nocardia; Nocardia Infections; Penicillin G; Syphilis; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

We present a case of mycetoma by Actinomadura spp. on the foot of an Albanian young man arrived to our observation approximately 5 years after the first clinical manifestations (hard tumefaction, slightly painful upon weight-bearing and palpation and cutaneous fistulas that discharged an abundant granulomatous secretion). Direct microscopic analysis and culture of the white-yellowish grains included Gram staining, which showed extensively branched Gram-positive hyphae less than 1 mm in diameter, allowing to make a diagnosis of Actinomycetoma. Since Actinomycetoma is sensitive to drug treatment, the patient was given trimethoprim-sulfamethoxazole and amikacin twice daily for 45 days. After six months of chemotherapy, the patient's general condition improved, the swelling is slightly diminished and grain extrusion has ceased. The patient has been able to resume ambulation with normal footwear. Given the absence of liver and kidney functional alterations, the patient is scheduled to continue pharmacological treatment with trimethoprim-sulfamethoxazole.

Topics: Actinomycetales; Actinomycetales Infections; Albania; Amikacin; Anti-Infective Agents; Foot; Humans; Male; Middle Aged; Mycetoma; Radiography; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A 29-year-old woman with swelling, multiple nodules and discharging sinuses of her right foot is presented. A single nodule on the sole was excised 15 years ago and since then she has had recurrent attacks of swelling and discharging sinuses that improved partially with antibiotics. Magnetic resonance images (MRI) revealed an ill-defined mass predominantly with low signal intensity on T2W images. Within the granulomata, multiple unenhancing foci, with low T1W and T2W signal most likely representing the fungal balls or grains were detected. Histopathological examination revealed large clusters of microorganisms resembling fungal hyphae and bacteria, which were surrounded by mixed inflammatory infiltrate cells and stained positively by PAS and Gomori's methenamine silver stain. As minimal regression was seen on MRI with 4 months' itraconazole (200 mg day(-1)) treatment, co-trimoxazole (160 TMP/800 SMX b.i.d.) was added to treatment. Complete remission was established by MRI examination after 10 months with this combination therapy.

Topics: Adult; Anti-Infective Agents; Antifungal Agents; Female; Foot Dermatoses; Fungi; Humans; Hyphae; Itraconazole; Magnetic Resonance Imaging; Microscopy; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Antifungal Agents; Arthritis, Infectious; Foot Dermatoses; Humans; Itraconazole; Madurella; Magnetic Resonance Imaging; Male; Mycetoma; Osteitis; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Foot Diseases; Humans; Male; Middle Aged; Mycetoma; Nocardia asteroides; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Comparatively few cases of mycetoma ("Madura foot") have been reported in Australia, and only one caused by Nocardia brasiliensis. We report two Aboriginal women from remote communities in central Australia who presented with longstanding mycetomas caused by this organism. Difficulties in diagnosis substantially delayed commencement of effective treatment, illustrating the need to consider this condition in chronic suppurative skin infection.

Topics: Adult; Anti-Bacterial Agents; Biopsy; Chronic Disease; Debridement; Female; Humans; Mycetoma; Native Hawaiian or Other Pacific Islander; Nocardia; Nocardia Infections; Northern Territory; Rural Health; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Buttocks; Chemotherapy, Adjuvant; Dapsone; Humans; Male; Mycetoma; 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

Topics: Anti-Infective Agents; Dapsone; Drug Combinations; Foot Dermatoses; Humans; Japan; Mexico; Mycetoma; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Actinomycotic mycetoma is frequent in Senegal and the treatment has changed greatly over the last decades. We observed 27 cases due to Actinomadura pelletieri (n = 21), Actinomadura madurae (n = 5) and Streptomyces somaliensis (n = 1). The diagnosis was based on clinical and histological arguments. All the patients were treated with cotrimoxazole for several months. The mycetoma was situated on the foot in 15/27 patients. Extrapodal localizations were frequent for red grains due to A. pelletieri (11/21). These mycetomas, the most frequent in Senegal, are extremely severe lesions with rapid local and distance extension. We were able to obtain 8 clinical cures. One death occurred in patient with an abdominal localization and multiorgan invasion. Mid-term outcome could not be determined in the other cases since they were lost to follow-up after initial improvement with cotrimoxazole. As sole treatment, cotrimoxazole should lead to cure in most cases.

Topics: Actinomycetales; Buttocks; Female; Foot Dermatoses; Humans; Male; Mycetoma; Retrospective Studies; Senegal; Trimethoprim, Sulfamethoxazole Drug Combination

Botryomycosis is a rare and chronic but readily treatable form of mycetoma. It is caused by a persistent bacterial infection and is distinguished by the formation of grains and multiple sinuses in the skin. The most usual cause is caused by Staphylococcus aureus. The authors' experience with four Transvaal cases is reported. In one case there was destruction of the skull and penetration of the cranial cavity by the botryomycotic process. Treatment with a range of common antistaphylococcal antibiotics led to astonishingly rapid recovery. Among the drugs used, cotrimoxazole was, perhaps, the most practical.

Topics: Adult; Africa; Aged; Chronic Disease; Humans; Male; Mycetoma; Scalp Dermatoses; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amikacin; Coxsackievirus Infections; Drug Combinations; Hand; Humans; Male; Middle Aged; Mycetoma; Nocardia asteroides; Nocardia Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is the most frequent deep mycosis in Mexico and is caused by Nocardia brasiliensis in 86% of the cases. Two cases of mycetoma due to Nocardia caviae, the first in Mexico, are reported. The strains were identified by their biochemical properties according to the criteria of Gordon and Mihm (1962). Few cases of mycetoma caused by this actinomycete have been reported in the world. One of our cases was unusual: occurring on the trunk as a tumor and diagnosed by finding the "grains" on histologic examination.

Topics: Dapsone; Drug Combinations; Humans; Male; Middle Aged; Mycetoma; Nocardia Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Cranial mycetoma is not as rare as was believed. In the Sudan, the majority of cases are caused by S. somaliensis; no cases were found to be caused by Nocardia species. Cranial actinomycetoma proved to be potentially fatal and was the most difficult to treat. The best treatment results were achieved in cases of A. madurae infection.

Topics: Actinomycetales Infections; Adolescent; Adult; Child; Dapsone; Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mitosporic Fungi; Mycetoma; Radiography; Skull; Streptomycin; Sudan; Sulfamethoxazole; Temporomandibular Joint; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two cases of cutaneous nocardial infection are reported. The Nocardia species are gram-positive, partially acid-fast bacteria. Cutaneous involvement may develop as one of four types: (1) mycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection, or (4) systemic disease with cutaneous involvement. A review of each of these types of infection is included, as well as potential clues that may suggest the diagnosis of nocardiosis.

Topics: Abscess; Aged; Amikacin; Drug Combinations; Facial Dermatoses; Humans; Lymphangitis; Male; Minocycline; Mycetoma; Nocardia; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Skin Ulcer; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Three mycetoma cases with pulmonary dissemination are presented. Two of them caused by N. brasiliensis and one by N. asteroides. The dissemination in one of them was by contiguity and the two other by hematogenous way. We point out the sequence of treatments used, emphasizing the excellent therapeutic result achieved with the association of sulfamethoxazole-trimethoprim and amikacin endovenously. We propose a therapeutic trial in a greater number of severe cases of mycetoma with the last antibiotic association in order to evaluate its therapeutic efficacy.

Topics: Administration, Oral; Adult; Amikacin; Drug Combinations; Drug Therapy, Combination; Humans; Injections, Intravenous; Kanamycin; Lung Diseases, Fungal; Male; Middle Aged; Mycetoma; Nocardia Infections; Radiography; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

From 1972 to October 1982 we have observed 39 cases of mycetoma in the Skin Department of the Hospital del Milagro, Salta (Argentina). The diagnosis was based on the clinical aspect, mycological studies and in most cases histopathology was done as well. The mayoritary of the patients were farmers. From the clinical point of view there si a true prevalence of Nocardia Brasiliensis. Most of the mycetomas can be found in the lower limbs. Some of the patients presented quite severe lesions and eight of them had bone involvement. The combination of long action sulphas with sulphonas has been efficient enough in the treatment of mycetomas caused by Nocardia Brasiliensis.

Topics: Actinomycetaceae; Adult; Aged; Argentina; Dapsone; Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mitosporic Fungi; Mycetoma; Nocardia; Nocardia Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination