RESUMO
INTRODUCTION: Mycetoma is a chronic granulomatous inflammatory disease of the subcutaneous tissue, which affects deep structures and bone. Most cases of actinomycetoma are caused by members of the genus Nocardia. CASE PRESENTATION: Here we report the case of a 43-year-old male who presented a disseminated mycetoma on the forearm, chest and neck, characterized by enlarged and erythematous lesions through which seropurulent material drains, and numerous atrophic scars. Molecular identification was performed by 16S gene amplification and sequencing. Nocardia mexicana was identified with 100% identity. Trimethoprim-sulfamethoxazole, diaminodiphenyl sulfone and amikacin was a successful treatment after 6 months. CONCLUSIONS: Nocardia mexicana is a rare organism that causes mycetoma. We report a case of extensive mycetoma on the forearm with spread to the neck and thorax associated with manipulation of the mouth of a calf.
Assuntos
Antibacterianos , Antebraço , Micetoma , Pescoço , Nocardiose , Nocardia , RNA Ribossômico 16S , Tórax , Humanos , Masculino , Adulto , Nocardia/isolamento & purificação , Nocardia/genética , Micetoma/microbiologia , Micetoma/tratamento farmacológico , Micetoma/diagnóstico , Nocardiose/microbiologia , Nocardiose/tratamento farmacológico , Nocardiose/diagnóstico , Antebraço/microbiologia , Antebraço/patologia , Tórax/diagnóstico por imagem , Tórax/microbiologia , Pescoço/patologia , Antibacterianos/uso terapêutico , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , DNA Bacteriano/genética , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Amicacina/uso terapêutico , DNA Ribossômico/genética , DNA Ribossômico/químicaRESUMO
Hyalohyphomycosis and phaeohyphomycosis are groups of mycoses caused by several agents and show different clinical manifestations. We report a case of an immunocompromised patient who presented rare manifestations of opportunistic mycoses: mycetoma-like hyalohyphomycosis on his right foot caused by Colletotrichum gloeosporioides, followed by cutaneous phaeohyphomycosis on his right forearm caused by Exophiala oligosperma. Further to the rarity of this case, the patient's lesion on the foot shows that the clinical aspects of mycetomas could falsely appear in other fungal infections similar to hyalohyphomycosis. We also show that the muriform cells that were seen in the direct and anatomopathological examination of the skin are not pathognomonic of chromoblastomycosis, as observed in the lesion of the patient's forearm.
Assuntos
Cromoblastomicose , Micetoma , Humanos , Masculino , Cromoblastomicose/patologia , Cromoblastomicose/diagnóstico , Cromoblastomicose/microbiologia , Cromoblastomicose/tratamento farmacológico , Micetoma/patologia , Micetoma/microbiologia , Micetoma/diagnóstico , Micetoma/tratamento farmacológico , Diagnóstico Diferencial , Hospedeiro Imunocomprometido , Hialoifomicose/patologia , Hialoifomicose/microbiologia , Hialoifomicose/diagnóstico , Exophiala/isolamento & purificação , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Previous studies on the distribution of mycetoma globally have failed to identify Ecuador as an endemic country. METHODS: We present data on 35 cases of mycetoma in Ecuador between 1955 and 2021: 5 cases from our experience and 30 cases from the literature. RESULTS: Eight cases of eumycetoma (23%) and 27 cases of actinomycetoma (77%) were diagnosed. Most cases originated from the coastal region of Ecuador. CONCLUSIONS: For the first time in an English-language publication, this communication confirms the presence of mycetoma in Ecuador, securing Ecuador's position on the global mycetoma map.
Assuntos
Micetoma , Equador/epidemiologia , Humanos , Micetoma/epidemiologia , Micetoma/diagnóstico , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , CriançaRESUMO
Mycetoma is a neglected tropical disease caused by fungi (eumycetoma) or bacteria (actinomycetoma), with high morbidity. Gordonia spp. are gram-positive bacteria that have previously been reported to cause mycetoma. Here, we report a case of Gordonia soli (initially misidentified as Nocardia spp.) as the etiological agent of actinomycetoma in a 64-year-old patient. After a literature search in the Cochrane Library, LILACS, SciELO, MEDLINE, PubMed, and PubMed Central databases, we concluded that this is the first case report of mycetoma caused by Gordonia soli. The current case highlights the importance of microbiological diagnosis of mycetoma and the challenges in its management.
Assuntos
Actinobacteria , Micetoma , Nocardia , Humanos , Pessoa de Meia-Idade , Micetoma/diagnóstico , Micetoma/tratamento farmacológico , Micetoma/microbiologia , Fungos , Doenças NegligenciadasRESUMO
Mycetoma is a neglected tropical disease (NTD) declared by the World Health Organization (WHO) in 2016. It is characterized by the progressive growth of nodules and granulomatous lesions on the legs, arms, and trunk. It is potentially disfiguring and causes disability or amputations in working-age people from marginalized areas. The causative agents can be fungi (eumycetoma) or actinobacteria (actinomycetoma), the latter being the most common in America and Asia. Nocardia brasiliensis is the most important causal agent of actinomycetoma in the Americas. Taxonomic problems have been reported when identifying this species, so this study aimed to detect the 16S rRNA gene variations in N. brasiliensis strains using an in silico enzymatic restriction technique. The study included strains from clinical cases of actinomycetoma in Mexico, isolated from humans and previously identified as N. brasiliensis by traditional methods. The strains were characterized microscopically and macroscopically, then subjected to DNA extraction and amplification of the 16S rRNA gene by PCR. The amplification products were sequenced, and consensus sequences were constructed and used for genetic identification and in silico restriction enzyme analysis with the New England BioLabs® NEBcutter program. All study strains were molecularly identified as N. brasiliensis; however, in silico restriction analysis detected a diversity in the restriction patterns that were finally grouped and subclassified into 7 ribotypes. This finding confirms the existence of subgroups within N. brasiliensis. The results support the need to consider N. brasiliensis as a complex species.
Assuntos
Micetoma , Nocardiose , Nocardia , Humanos , Micetoma/diagnóstico , Micetoma/genética , Micetoma/microbiologia , RNA Ribossômico 16S/genética , América Latina , Genes de RNAr , Nocardia/genética , Região do Caribe , Nocardiose/genética , Nocardiose/microbiologiaRESUMO
An illustrative case of mini-mycetoma in a 54-year-old female agricultural worker from Mexico.
Assuntos
Micetoma , Nocardiose , Nocardia , Fazendeiros , Feminino , Humanos , México , Pessoa de Meia-Idade , Micetoma/diagnóstico , Nocardiose/diagnóstico , Nocardia asteroidesRESUMO
BACKGROUND: Actinomycetoma due to Actinomadura madurae is susceptible to numerous chemotherapeutic agents, however, the response to those treatments is variable and closely related to several factors. OBJECTIVE: We aimed to evaluate the clinical-therapeutic characteristics of patients with actinomycetoma due to Actinomadura madurae with two treatment modalities. METHODS: 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. RESULTS: 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). CONCLUSION: 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 A. madurae with minimal bone involvement.