Dermatologic Manifestations of Mycetoma Follow-up

  • Author: Oliverio Welsh, MD DrSc; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 30, 2011
 

Prognosis

Actinomycetomas generally respond well to trimethoprim-sulfamethoxazole/amikacin (see Medication) in 90% of cases. In those cases in which bacteria have become resistant to this treatment, antibiotic susceptibility testing should be performed to select the best antimicrobial agent or agents to be used.

Eumycetoma tends to be a more chronic disease, and success with medical therapy is observed in only about 40% of cases. If the response is partial or negative to medical treatment, surgery of the affected area should be performed, and antifungal drugs continued until complete remission of the disease.

 
Contributor Information and Disclosures
Author

Oliverio Welsh, MD DrSc  Former Chair, Active Emeritus Professor, Department of Dermatology, Universidad Autónoma De Nuevo León, Mexico

Oliverio Welsh, MD DrSc is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Society of Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Lucio Vera-Cabrera, PhD  Professor, Department of Internal Medicine, Dr. Jose Eleuterio Gonzalez University Hospital, Universidad Autónoma De Nuevo León, Mexico

Lucio Vera-Cabrera, PhD is a member of the following medical societies: American Society for Microbiology

Disclosure: Nothing to disclose.

Mario C Salinas-Carmona, MD, PhD  Chair, Department of Immunology, Universidad Autónoma De Nuevo León, Mexico

Disclosure: Nothing to disclose.

Specialty Editor Board

Susan M Swetter, MD  Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, Pacific Dermatologic Association, Society for Investigative Dermatology, Society for Melanoma Research, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Pinoy E. Actinomycoses et mycetomas. Bull Inst Pasteur. 1913;11:929-38.

  3. Solis-Soto JM, Quintanilla-Rodriguez LE, Meester I, et al. In situ detection and distribution of inflammatory cytokines during the course of infection with Nocardia brasiliensis. Histol Histopathol. May 2008;23(5):573-81. [Medline].

  4. Salinas-Carmona MC, Welsh O, Casillas SM. Enzyme-linked immunosorbent assay for serological diagnosis of Nocardia brasiliensis and clinical correlation with mycetoma infections. J Clin Microbiol. Nov 1993;31(11):2901-6. [Medline].

  5. Salinas-Carmona MC, Perez-Rivera I. Humoral immunity through immunoglobulin M protects mice from an experimental actinomycetoma infection by Nocardia brasiliensis. Infect Immun. Oct 2004;72(10):5597-604. [Medline].

  6. Lopez Martinez R, Mendez Tovar LJ, Lavalle P, Welsh O, Saul A, Macotela Ruiz E. [Epidemiology of mycetoma in Mexico: study of 2105 cases]. Gac Med Mex. Jul-Aug 1992;128(4):477-81. [Medline].

  7. van de Sande WW, Fahal A, Verbrugh H, van Belkum A. Polymorphisms in genes involved in innate immunity predispose toward mycetoma susceptibility. J Immunol. Sep 1 2007;179(5):3065-74. [Medline].

  8. Kashima M, Kano R, Mikami Y, et al. A successfully treated case of mycetoma due to Nocardia veterana. Br J Dermatol. Jun 2005;152(6):1349-52. [Medline].

  9. Rodriguez-Nava V, Couble A, Molinard C, Sandoval H, Boiron P, Laurent F. Nocardia mexicana sp. nov., a new pathogen isolated from human mycetomas. J Clin Microbiol. Oct 2004;42(10):4530-5. [Medline].

  10. Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ Jr. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev. Apr 2006;19(2):259-82. [Medline].

  11. Desnos-Ollivier M, Bretagne S, Dromer F, Lortholary O, Dannaoui E. Molecular identification of black-grain mycetoma agents. J Clin Microbiol. Oct 2006;44(10):3517-23. [Medline].

  12. Vera-Cabrera L, Salinas-Carmona MC, Welsh O, Rodriguez MA. Isolation and purification of two immunodominant antigens from Nocardia brasiliensis. J Clin Microbiol. May 1992;30(5):1183-8. [Medline].

  13. Lacroix C, de Kerviler E, Morel P, Derouin F, Feuilhade de Chavin M. Madurella mycetomatis mycetoma treated successfully with oral voriconazole. Br J Dermatol. May 2005;152(5):1067-8. [Medline].

  14. Negroni R, Tobon A, Bustamante B, Shikanai-Yasuda MA, Patino H, Restrepo A. Posaconazole treatment of refractory eumycetoma and chromoblastomycosis. Rev Inst Med Trop Sao Paulo. Nov-Dec 2005;47(6):339-46. [Medline].

  15. N'diaye B, Dieng MT, Perez A, Stockmeyer M, Bakshi R. Clinical efficacy and safety of oral terbinafine in fungal mycetoma. Int J Dermatol. Feb 2006;45(2):154-7. [Medline].

  16. Welsh O, Sauceda E, Gonzalez J, Ocampo J. Amikacin alone and in combination with trimethoprim-sulfamethoxazole in the treatment of actinomycotic mycetoma. J Am Acad Dermatol. Sep 1987;17(3):443-8. [Medline].

  17. Fuentes A, Arenas R, Reyes M, Fernandez RF, Zacarias R. [Actinomycetoma and Nocardia sp. Report of five cases treated with imipenem or imipenem plus amikacin]. Gac Med Mex. May-Jun 2006;142(3):247-52. [Medline].

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  19. Vera-Cabrera L, Daw-Garza A, Said-Fernandez S, et al. Therapeutic Effect of a Novel Oxazolidinone, DA-7867, in BALB/c Mice Infected with Nocardia brasiliensis. PLoS Negl Trop Dis. Sep 10 2008;2(9):e289. [Medline].

  20. Chacon-Moreno BE, Welsh O, Cavazos-Rocha N, et al. Efficacy of ciprofloxacin and moxifloxacin against Nocardia brasiliensis in vitro and in an experimental model of actinomycetoma in BALB/c mice. Antimicrob Agents Chemother. Jan 2009;53(1):295-7. [Medline].

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  22. Fahal AH. Management of mycetoma. Exp Rev Dermatol. 2010;5:87-93.

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  27. Vera-Cabrera L, Gonzalez E, Rendon A, et al. In vitro activities of DA-7157 and DA-7218 against Mycobacterium tuberculosis and Nocardia brasiliensis. Antimicrob Agents Chemother. Sep 2006;50(9):3170-2. [Medline].

 
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Actinomycetoma of the foot (left) and arm (center) caused by Nocardia brasiliensis. Multiple nodules and fistulae are present. Microscopic examination of the pus (right). Granules are observed, which are multilobulated and surrounded by abundant clubs.
Eumycetoma. Mycetoma of the hand (left). Microscopic features of a Madurella mycetomatis grain are observed (center). Notice the presence of brownish hyphae and intercellular cement (hematoxylin and eosin stain). Macrocolony of another eumycotic agent, Pseudallescheria boydii (right).
Table 1. Fungi Causing Mycetoma
White grainBlack grain
Acremonium falciformeExophiala jeanselmei
Acremonium kilienseMadurella grisea
Acremonium recifeiM mycetomatis
Cylindrocarpon destructansM pseudomycetomatis
Fusarium moniliformeLeptosphaeria tomkinsii
Fusarium solaniLeptosphaeria senegalensis
Neotestudina rosatiiPyrenochaeta mackinnonii
Pseudallescheria boydiiPyrenochaeta romeroi
----------------Phlenodomus avramii
Table 2. Microorganisms Causing Actinomycetomas in Humans
Etiologic agentGrain
A maduraeWhite, large, 1-5 mm in diameter
A pelletieriRed, hard, 1 mm in diameter
N brasiliensisWhite to yellow, multilobed, soft, < 0.5 mm in diameter
N asteroidesUncommon, white, soft, < 0.5 mm in diameter
Nocardia otitidiscaviarumWhite to yellow, lobed, < 0.5 mm in diameter
Nocardia transvalensisWhite to yellow, < 0.5 mm in diameter
Nocardia veterana[8] --
Nocardia mexicana[9] --
Nocardiopsis dassonvilleiWhite to yellow, < 0.5 mm in diameter
S somaliensisYellow, hard, 2 mm in diameter
Streptomyces sudanensisYellow, hard, 2 mm in diameter
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