A case of eumycetoma due to Madurella grisea in northern Brazil

A case of mycetoma caused by the black fungus Madurella grisea in northern Brazil is reported. The lesion was located on the patient’s right foot without bone involvement. Clinical samples were collected by opening the fistules with a scalp and the grains removed for microbiological and histopathological analyses. Although mycetoma caused by M. grisea has been previously reported in Brazil, this is the first time that of this fungus has been identify in this particular region of the country.     

Iscephalosporium acremonium capable of producing maduromycosis?

Summary A case of mycetoma apparently due toCephalosporium acremonium is described. The position ofCephalosporium spp. as agents of maduromycosis is briefly considered.     

Red grain mycetoma of the scalp (Actinomadura pelletieri). A case report from India

A case of red grain mycetoma on the scalp is described. The disease, caused by Actinomadura pelletieri, is extremely rare in this part of the world, and from India this is perhaps the first case with scalp involvement. The lesion showed satisfactory response to partial excision followed by chemotherapy with streptomycin.Mycetoma is a clinical syndrome of localized indolent deforming tumid lesions and sinuses involving the cutaneous and subcutaneous tissues (8). The disease is caused by two groups of agents; one bacterial and the orher fungal and is accordingly classified as actinomycotic and eumycotic mycetoma respectively. The lesions discharging fungal microcolonies referred to as grains usually occur on the foot or the hand. Occasionally, the lesions have been seen on the axillary (3) and the thoracocervical region (6). The involvement of the scalp is extremely rare. Reddy et al (7) in their study of 50 cases from Southern India, found only one instance of a scalp infection, the causative agent being A. madurae. We report herein on a patient with classical lesions of mycetoma on the scalp as a result of Actinomadura pelletieri infection.     

Infecc Ón Humana PorNocardia Asteroides,En México

Summary Although the existence ofNocardia asteroides as a human pathogen in Mexico has been known for several years, up to now there are only few reports in our country concerning the isolation of this microorganism both as a saprophyte as well as human or animal pathogen. This fact is more interesting when compared with the high incidence ofN. brasiliensis, causal agent of actinomycotic mycetoma, the most frequently observed deep mycosis in Mexico.In this paper, the isolation of eigth strains ofN. asteroides from clinical specimens is reported. Five strains were isolated from sputa, one from a fistulous lesion of the scrotum, one from a brain abscess and one more from a foot mycetoma.One of the strains isolated from sputum was in a case of pulmonary nocardiasis; another of these strains was isolated from a patient with coexistent pulmonary tuberculosis and nocardiasis. With the last three strains isolated from sputa, it was not possible to establish any correlation between the isolations and the clinical and radiological findings of the patients; two of the patients had pulmonary tuberculosis and the isolation ofN. asteroides was achieved only in one occasion in each case, with scant growth, and observed in routine cultures made for tubercle bacilli. The last strain was isolated from the sputum of a patient with chronic bronchitis. Some comments are made to the possibility that these three last isolations merely represent a saprophytic phase of the fungus.Some clinical and other features are discussed concerning the other three cases of scrotal fistula, brain abscess and mycetoma produced byN. asteroides.     

Mapping the Potential Risk of Mycetoma Infection in Sudan and South Sudan Using Ecological Niche Modeling

In 2013, the World Health Organization (WHO) recognized mycetoma as one of the neglected tropical conditions due to the efforts of the mycetoma consortium. This same consortium formulated knowledge gaps that require further research. One of these gaps was that very few data are available on the epidemiology and transmission cycle of the causative agents. Previous work suggested a soil-borne or Acacia thorn-prick-mediated origin of mycetoma infections, but no studies have investigated effects of soil type and Acacia geographic distribution on mycetoma case distributions. Here, we map risk of mycetoma infection across Sudan and South Sudan using ecological niche modeling (ENM). For this study, records of mycetoma cases were obtained from the scientific literature and GIDEON; Acacia records were obtained from the Global Biodiversity Information Facility. We developed ENMs based on digital GIS data layers summarizing soil characteristics, land-surface temperature, and greenness indices to provide a rich picture of environmental variation across Sudan and South Sudan. ENMs were calibrated in known endemic districts and transferred countrywide; model results suggested that risk is greatest in an east-west belt across central Sudan. Visualizing ENMs in environmental dimensions, mycetoma occurs under diverse environmental conditions. We compared niches of mycetoma and Acacia trees, and could not reject the null hypothesis of niche similarity. This study revealed contributions of different environmental factors to mycetoma infection risk, identified suitable environments and regions for transmission, signaled a potential mycetoma-Acacia association, and provided steps towards a robust risk map for the disease.     

Mycetoma of the forearm due to Actinomadura madurae

A case of mycetoma, with abscess-like lesions which appeared on the right forearm of a 43-year-old male, is briefly reported. A few whitish granules were detected in the oily-like discharge, the same as in the histologic examination. No bone involvement was discovered in X-ray examination. Actinomadura was identified in the culture. A daily dose of 4 g bactrin brought significant improvement to the patients continuing the treatment.     

Eumycetoma of the Hand Caused by <Emphasis Type="Italic">Leptosphaeria tompkinsii</Emphasis> and Refractory to Medical Therapy with Voriconazole

We report on the first case of eumycetoma caused by the organism Leptosphaeria tompkinsii to be diagnosed and possibly acquired within the United Kingdom. Conventional culture of fungal grains and surgical tissue specimens was negative and the diagnosis was achieved using panfungal polymerase chain reaction and sequencing technology. Despite limited surgical resection and prolonged antifungal therapy with voriconazole, the patient developed progressive disease with mycetoma bone involvement. This case highlights the usefulness of molecular diagnostic techniques in eumycetoma where organisms may fail to grow with conventional culture or be difficult to identify morphologically. It also reminds us that eumycetoma is a difficult infection to treat and despite optimism regarding the efficacy of the newer triazole antifungals in this condition, treatment failures may still occur.     

Antifungal Activity of Natural Naphthoquinones and Anthraquinones against Madurella mycetomatis

Eumycetoma, the fungal form of the neglected tropical disease mycetoma, is a crippling infectious disease with low response rates to currently available antifungal drugs. In this study, a series of natural naphthoquinones and anthraquinones was evaluated for their activity against Madurella mycetomatis, which is the most common causative agent of eumycetoma. The metabolic activity of Madurella mycetomatis as well as the viability of Galleria mellonella larvae upon treatment with quinones was investigated. Several hydroxy-substituted naphthoquinones exhibited activity against Madurella mycetomatis. In particular, naphthazarin (5,8-dihydroxy-1,4-naphthoquinone) was identified as a considerably active antifungal compound against Madurella mycetomatis (IC₅₀=1.4 μM), while it showed reduced toxicity to Galleria mellonella larvae, which is a well-established in vivo invertebrate model for mycetoma drug studies.     

Actinomycetoma caused by Rhodococcus spp.

We report a case of mycetoma caused by Rhodococcus in a 62-year-old man who presented with multiple draining sinuses of the left foot. Biopsy specimen showed granulomatous reaction and microabcesses contained granules. These granules were composed by rod and coccoid Gram-positive and partially acid-fast elements. Culture grew a Nocardia-like organism, confirmed at the Center for Disease Control as Rhodococcus spp.     

Invasion of a soft contact lens by Exophiala jeanselmei

The invasion of a soft contact lens by Exophiala jeanselmei is documented. All species in this genus are pathogenic. In humans E. jeanselmei is a recognized cause of mycetoma, phaeohyphomycosis and keratomycosis. This fungus has not been previously listed among lens invaders.     

Temperature resistant Nocardia biovarieties in Tucumán,Argentina?

Eighty-six regional strains of the pathogenic Nocardia species isolated from soil and human mycetoma were tested for their response to different incubation temperatures and for their tolerance to different temperatures. The aim was to assess whether growth temperature and tolerance to elevated temperatures are valuable criteria for the differentiation of pathogenic species of local strains based on the results obtained from a large number of strains. The results showed that 75.34% of all N. brasiliensis isolates from both sources grew at a temperature higher than 37 °C. 20% of the mycetoma strains and 11.32% of those from soil grew at 45 °C. 98.1% of N. brasiliensis from soil and 55.0% of the mycetoma strains tolerated 50 °C for 8 h and many isolates from both sources endured this temperature for an even longer time and tolerated yet higher temperatures. Both properties (growth temperature and temperature tolerance) are used to identify N. asteroides complex (N. farcinica) and N. otitidiscaviarum, and according to our results they are not suitable to differentiate regional strains of this species. The N. asteroides strains assayed showed an ability to grow at and tolerate elevated temperatures superior to those belonging to the other species. Although adaptation of local N. asteroides and N. otitidiscaviarum strains to temperature is important, it is more significant for N. brasiliensis, because this species is predominant in the Tucumán soil and responsible for the major number of diseases in the area.This revised version was published online in October 2005 with corrections to the Cover Date.     

Successful Terbinafine Treatment for Cutaneous Phaeohyphomycosis Caused by Trematosphaeria grisea in a Heart Transplanted Man: Case Report and Literature Review

Phaeohyphomycosis is a chronic infectious disease caused by dematiaceous fungi. It is characterized by the presence of pigmented septate mycelia within tissues. In the case of superficial infection, the lesion(s) chronically evolve(s) toward painless pseudo-tumor(s) of the soft parts. We report herein the original case of a heart transplanted man who exhibited phaeohyphomycosis of the left hand, with no mention of travels in endemic areas. Trematosphaeria grisea was identified as the causative agent, which is quite innovative since this species has been rather described in mycetoma. The antifungal treatment initially based on isavuconazole alone was not sufficient to cure the patient. In contrast, its association with local terbinafine ointment allowed total clinical improvement. This finding is unusual as diagnosis of phaeohyphomycosis caused by T. grisea is uncommon in nontropical countries, and as the outcome appeared successful by the means of add-on therapeutic strategy with terbinafine.

     

A review of mycetomas in Turkey

In this survey, cases of mycetoma in Turkey were described together with presentation of a unique case.     

A Call to Action for Mycetoma

Purpose of Review

Here, we discuss the current needs and priorities for mycetoma control and prevention, highlight lessons learned from leprosy and podoconiosis, and motivate an urgent need to accelerate progress toward reducing the burden of mycetoma in endemic areas.

Recent Findings

In 2015, the World Health Assembly (WHA) added mycetoma, a progressively debilitating disease caused by fungi and bacteria, to the World Health Organization (WHO) list of priority neglected tropical diseases (NTDs). Designation of other diseases as NTDs has raised awareness, enabled global partnerships, and advanced the capacity to combat disease through integrated programming. Although key mycetoma etiologic agents have been identified, many questions remain and mycetoma may similarly benefit from NTD designation.

Summary

In collaboration with experts at WHO and elsewhere, we formed a global mycetoma working group to connect partners from a variety of sectors and specialties. We envision that this group will evolve into a formalized partnership that can prioritize strategic planning, advocacy, and research needs, identify funding sources, and coordinate activities related to mycetoma and other NTDs affecting the skin. The experiences gained from other NTDs can help to guide the global mycetoma working group’s activities to better address the goals set forth in the WHA resolution.

     

Reevaluation of the teleomorph of the genus Histoplasma by ubiquinone systems

A study was performed to investigate the ability of Streptomyces griseus to cause experimental mycetoma in the skin and in the foot pads of mice. The lesions appeared as palpable subcutaneous nodules discharging pale yellow cheesy pus and granules of S. griseus. The inoculated foot pads of the mice also developed nodular lesions which later became oedematous with bone destruction and fibrosis.     

Black grain mycetoma: Studies on the pigment of Madurella mycetomi

The brown pigment produced byMadurella mycetomi has the capacity for condensation with itself or with organic material to form a complex which eventually becomes chemically intractable, and comprises the cement of the black grain in mycetoma cases. Such parts of it as allowed analysis suggested a glycoprotein, whose behaviour differed both from tannins and melanins.     

The Importance of a Proper Aetiological Diagnosis in the Management of Patients with Invasive Mycoses: A Case Report of a Brain Abscess by <Emphasis Type="Italic">Scedosporium apiospermum</Emphasis>

Scedosporium apiospermum is a saprobic fungus responsible for many different clinical manifestations. Although it affects mostly immunocompromised patients, pulmonary and disseminated scedosporiosis have also been reported in immunocompetent subjects. It often causes subcutaneous mycetoma, despite its preferential tropism to CNS. The authors describe a fatal case of a S. apiospermum brain abscess in a 58-year-old female. She was affected by chronic liver disease and idiopathic pulmonary fibrosis and had been treated with corticosteroid therapy for a long time. She recovered in a neurosurgery unit, wherein TC scan and cerebral MRI revealed an expansive left temporo-parietal process with vasogenic oedema. A stereotactic puncture of the lesion was carried out, and pus of brain abscess was evacuated. Empirical antifungal therapy was initiated with liposomal amphotericine B based on the clinical suspicion of Zygomycetes infection; after 3 days, posaconazole was added. The correct aetiological diagnosis arrived too late and the patient was treated with no specific therapy. This fatal case confirms the necessity of having a fast and correct aetiological diagnosis to improve the patient’s outcome.     

Conceptions et Mises À Jour Au Sujet Des Mycétomes

Résumé L'auteur expose quelques points de vue et considérations sur les mycétomes. On considère le terme de mycétome comme inadéquat et propose son remplacement par celui degranose, c'est-à-dire affection à formation de grains. On estime que les agents des mycétomes se divisent en deux groupes:spécifiques (qui provoquent uniquement des mycétomes) etnon-spécifiques (qui produisent également d'autres tableaux cliniques). On procède à une mise au point de la conception actuelle sur l'origine saprophytique des mycétomes. On débat de problèmes actuels de pathogénie, de diagnostic, de pronostic et de traitement.

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Summary Instead of mycetoma the term ofgranosis (affection with grain formation) is suggested.In the author's opinion, the causative organisms of mycetoma may be divided in 2 groups:specific agents (causing exclusively mycetoma) andnot specific agents (producing also other clinical pictures). An up to date view on the actual opinions concerning the saprophytic origine of mycetoma is presented. Present state of the pathogenicity, diagnosis, prognosis and treatment of this disease are discussed.

     

Efficient staining of actinomycetoma and eumycetoma grains using henna extract

The use of natural, nontoxic, convenient and eco-friendly dyes for histopathological diagnosis avoids some of the synthetic dyes’ hazards. I used an aqueous extract of henna at a concentration of 20 g/ml and acidified with acetic acid to stain mycetoma grains. Henna stained mycetoma grains orange-red to brown. The engulfed mycetoma grains within inflammatory cells stained well with henna extract compared to hematoxylin and eosin (H & E) and hexamine silver.